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Zhang Y, Ding H, Gao H, Liu J, Wang F, Wu Y. Factors influencing speech improvement following maxillary complete-arch implant-supported restorations: A retrospective study. Clin Oral Implants Res 2024; 35:1240-1250. [PMID: 38867397 DOI: 10.1111/clr.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/14/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE This study explored factors affecting speech improvement in patients with an edentulous maxilla after the delivery of a complete-arch implant-supported fixed dental prosthesis (IFDP). MATERIALS AND METHODS Patients who had received IFDP for edentulous maxilla were enrolled, and various potential speech improvement-related factors were considered, including patient demographics, anterior residual bone volume, preoperative facial features, preoperative acoustic parameters, and adaptation time. Acoustic analysis and perceptual ratings were used to assess three fricatives [s], [f], and [ɕ]. Correlation and regression analyses were conducted to assess the association between changes in fricatives and potential factors (α = .05). RESULTS The study included 50 patients (18 females and 32 males, aged 50.62 ± 15.71 years, range 19-76). Significant correlations were found among the change in the center of gravity (ΔCoG) of [s] and anterior residual bone volume, zygomatic implants number and proportion (p < .05). These correlations were largely mirrored in the perceptual score (ΔPS) changes. After controlling for age, sex, preoperative acoustic parameters, and adaptation time, the ΔCoG and ΔPS of fricatives were mainly correlated with the anterior residual bone volume, preoperative acoustic parameters, and adaptation time. CONCLUSION Speech improvements post-IFDP delivery are mainly related to preoperative speech characteristics, anterior residual bone volume, and adaptation time. The residual bone volume's impact on consonants varies with specific articulatory gestures. This study provides insights into forecasting speech outcomes following IFDP restoration and provides recommendations and methods for data collection in developing future prediction models.
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Affiliation(s)
- Yun Zhang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Hongwei Ding
- Speech-Language-Hearing Centre, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Hanqi Gao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jie Liu
- Speech-Language-Hearing Centre, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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Rowe HP, Stipancic KL, Campbell TF, Yunusova Y, Green JR. The association between longitudinal declines in speech sound accuracy and speech intelligibility in speakers with amyotrophic lateral sclerosis. CLINICAL LINGUISTICS & PHONETICS 2024; 38:227-248. [PMID: 37122073 PMCID: PMC10613582 DOI: 10.1080/02699206.2023.2202297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to examine how neurodegeneration secondary to amyotrophic lateral sclerosis (ALS) impacts speech sound accuracy over time and how speech sound accuracy, in turn, is related to speech intelligibility. Twenty-one participants with ALS read the Bamboo Passage over multiple data collection sessions across several months. Phonemic and orthographic transcriptions were completed for all speech samples. The percentage of phonemes accurately produced was calculated across each phoneme, sound class (i.e. consonants versus vowels), and distinctive feature (i.e. features involved in Manner of Articulation, Place of Articulation, Laryngeal Voicing, Tongue Height, and Tongue Advancement). Intelligibility was determined by calculating the percentage of words correctly transcribed orthographically by naive listeners. Linear mixed effects models were conducted to assess the decline of each distinctive feature over time and its impact on intelligibility. The results demonstrated that overall phonemic production accuracy had a nonlinear relationship with speech intelligibility and that a subset of features (i.e. those dependent on precise lingual and labial constriction and/or extensive lingual and labial movement) were more important for intelligibility and were more impacted over time than other features. Furthermore, findings revealed that consonants were more strongly associated with intelligibility than vowels, but consonants did not significantly differ from vowels in their decline over time. These findings have the potential to (1) strengthen mechanistic understanding of the physiological constraints imposed by neuronal degeneration on speech production and (2) inform the timing and selection of treatment and assessment targets for individuals with ALS.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Kaila L Stipancic
- Department of Communicative Disorders and Sciences, The State University of New York, Buffalo, New York, USA
| | - Thomas F Campbell
- Callier Center for Communication Disorders, University of Texas, Dallas, Texas, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Zhang Y, Liu J, Yu D, Ding H, Wu Y. Articulation distortion in Mandarin-speaking individuals with complete arch maxillary implant-supported fixed dental prostheses. J Prosthet Dent 2023:S0022-3913(23)00685-6. [PMID: 37978009 DOI: 10.1016/j.prosdent.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
STATEMENT OF PROBLEM Implant-supported fixed dental prostheses (IFPs) have been increasingly used to restore edentulous jaws, yet few studies have utilized acoustic analysis for objective evaluation of postrestoration speech outcomes. PURPOSE The purpose of this clinical study was to assess speech articulation in edentulous individuals before and after the provision of IFPs by combining the results of subjective evaluations and objective acoustic analysis parameters. MATERIAL AND METHODS The study included thirty-four individuals who had an edentulous maxilla and had been provided with an IFP for over 6 months, along with 6 dentate controls. Acoustic analysis was conducted, and mean opinion scores (MOS) were rated from recordings. The participants were interviewed about perceived speech changes. Changes in the parameters were evaluated using the paired t test or Wilcoxon signed-rank test (α=.05). A comparison between dentate controls and edentulous individuals (with or without prostheses) was made using an independent t test or Mann-Whitney U test (α=.025). RESULTS Following restoration, the center of gravity (CoG) changes occurred in 11 of 12 consonants in edentulous individuals (P<.05). Prosthesis use allowed the CoG of all affricates and fricatives to appear larger and closer to control values. Before restoration, the CoG of 9 of 12 consonants in edentulous individuals differed from controls (P<.01); after restoration, this reduced to 3 out of 12 (P<.01). MOS improved in 10 of 12 consonants (P<.01), nearing a score of 4. Despite restoration, the CoG of alveolo-palatals [tɕh], [tɕ], and [ɕ] remained different from controls (P<.01). Most participants were satisfied with the improvement, with few reporting discomfort with alveolars [s] and [tsh]. CONCLUSIONS IFPs can enhance speech in edentulous individuals, yet articulation distortions of alveolar and alveolo-palatal consonants persist. The improper palatal shape of IFPs or an abrupt joint between the IFP and atrophic natural bone may contribute to these distortions.
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Affiliation(s)
- Yun Zhang
- Doctoral student, Department of 2nd Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Jie Liu
- Postgraduate student, Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai, PR China
| | - Dedong Yu
- Associate Professor, Department of 2nd Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Hongwei Ding
- Professor, Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai, PR China
| | - Yiqun Wu
- Professor, Department of 2nd Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, PR China.
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Mohamadi O, Torabinezhad F, Sanjari MA, Razazian N, Ebadi A. Evaluation of orofacial force-related measures using a novel measuring device: explanation of associations with speech rate in dysarthria. Expert Rev Med Devices 2023; 20:1193-1210. [PMID: 37942748 DOI: 10.1080/17434440.2023.2282178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The aim of this study was to examine the potential associations between orofacial force-related measures and speech rate in matched groups of 23 adults with dysarthria, and 69 healthy adults. RESEARCH DESIGN AND METHODS A novel piezoresistive sensor-based device was utilized to obtain the orofacial maximum forces (OMFs) and rate of force development (RFD) measures. The study computed alternating motion rates (AMRs), sequential motion rates (SMRs), and articulation rate (AR) for all participants. The analysis included between-group comparisons and correlation analyses. The study also examined the reliability of the OMFs and RFD measures. RESULTS Individuals with dysarthria exhibited significantly slower speech rates (approximately 41.89% to 56.53% slower) compared to the control group. Except for a few exceptions in the jaw, the dysarthria group demonstrated significantly lower OMFs and RFD measures. The correlation analysis revealed that OMFs were weakly to moderately correlated (r = .488-.674) and RFD measures were very weak to moderately correlated (r = .047-.578) with speech rate measures. CONCLUSIONS The findings suggest that reduced OMFs and RFD measures may contribute to the slowed speech rate observed in adults with dysarthria. The study also highlights that OMFs are significantly more reliable (day-to-day) than RFD measures.
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Affiliation(s)
- Omid Mohamadi
- Department of Speech-Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Torabinezhad
- Department of Speech-Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab. Rehabilitation Research Center, and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Razazian
- Department of Neurology, Imam Reza hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Weismer G. Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence. Brain Sci 2023; 13:brainsci13050768. [PMID: 37239240 DOI: 10.3390/brainsci13050768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent rationale for their use is needed. The use of oromotor nonverbal performance to diagnose disease or dysarthria type, versus specific aspects of speech production deficits that contribute to loss of speech intelligibility, is argued to be an important part of the debate. Framing these issues are two models of speech motor control, the Integrative Model (IM) and Task-Dependent Model (TDM), which yield contrasting predictions of the relationship between oromotor nonverbal performance and speech motor control. Theoretical and empirical literature on task specificity in limb, hand, and eye motor control is reviewed to demonstrate its relevance to speech motor control. The IM rejects task specificity in speech motor control, whereas the TDM is defined by it. The theoretical claim of the IM proponents that the TDM requires a special, dedicated neural mechanism for speech production is rejected. Based on theoretical and empirical information, the utility of oromotor nonverbal tasks as a window into speech motor control is questionable.
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Affiliation(s)
- Gary Weismer
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
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Robison RD, DiBiase L, Anderson A, Wymer JP, Plowman EK. Maximum lingual pressure impacts both swallowing safety and efficiency in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 2023; 35:e14521. [PMID: 36573040 PMCID: PMC10033350 DOI: 10.1111/nmo.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although reduced lingual strength is a confirmed early manifestation of amyotrophic lateral sclerosis (ALS), its functional impact on swallowing remains unclear. We therefore sought to examine relationships between maximum anterior isometric lingual pressure (MAIP) with swallowing safety, swallowing efficiency, and swallowing timing metrics in a large cohort of individuals with ALS. METHODS Ninety-seven participants with ALS completed a standardized videofluoroscopic swallowing examination (VF) and lingual pressure testing (Iowa Oral Performance Instrument). Duplicate and blinded ratings of the Penetration-Aspiration Scale (PAS) and Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) percent efficiency (%C2-C42 ) and timing (laryngeal vestibule closure (LVC) duration: amount of time (milliseconds, msec) between LVC onset and laryngeal vestibule opening; time-to-LVC: hyoid burst to onset of LVC (msec); and swallow reaction time: interval between bolus passing ramus of mandible and onset of LVC (msec)) were performed across bolus trials. Swallowing safety (safe PAS: 1, 2, 4; unsafe PAS: 3, 5, 6, 7, and 8) and efficiency (inefficient: ≥3% worst total residue) were derived. Statistical analyses including descriptives, binary logistic regressions, and Spearman's rho correlations were performed (α = 0.05). KEY RESULTS Mean MAIP was 36.3 kPa (SD: 18.7). Mean MAIP was higher in those with safe swallowing as compared to those who penetrated (mean difference: 12 kPa) or aspirated (mean difference: 18 kPa). Individuals with efficient swallowing demonstrated higher MAIP than those with inefficient swallowing (mean difference: 11 kPa). Binary logistic regression analyses revealed increasing MAIP was significantly associated with a 1.06 (95% CI: 1.03-1.09) and 1.04 (95% CI: 1.01-1.06) greater odds of safe and efficient swallowing, respectively. No relationships were observed between MAIP and swallow reaction time across all bolus trials. Longer time-to-LVC (5 ml thin liquid: rs = -0.35, p = 0.002; cup sip thin liquid: rs = -0.26, p = 0.02; moderately thick liquid: rs = -0.28, p = 0.01) and prolonged LVC duration (cup sip thin liquid, rs = -0.34, p = 0.003) were associated with lower MAIP. CONCLUSIONS AND INFERENCES Reduced lingual strength was confirmed in this group of 97 individuals with ALS that was associated with a diminished ability to effectively transport boluses and aide in laryngeal vestibule closure to prevent entry of material into the airway.
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Affiliation(s)
- Raele Donetha Robison
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Emily K. Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Speech, Language and Hearing Science Department, University of Florida, Gainesville, Florida, USA
- Department of Surgery, University of Florida, Gainesville, Florida, USA
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Ghasemzadeh H, Doyle PC, Searl J. Image representation of the acoustic signal: An effective tool for modeling spectral and temporal dynamics of connected speech. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:580. [PMID: 35931551 PMCID: PMC9458292 DOI: 10.1121/10.0012734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Recent studies have advocated for the use of connected speech in clinical voice and speech assessment. This suggestion is based on the presence of clinically relevant information within the onset, offset, and variation in connected speech. Existing works on connected speech utilize methods originally designed for analysis of sustained vowels and, hence, cannot properly quantify the transient behavior of connected speech. This study presents a non-parametric approach to analysis based on a two-dimensional, temporal-spectral representation of speech. Variations along horizontal and vertical axes corresponding to the temporal and spectral dynamics of speech were quantified using two statistical models. The first, a spectral model, was defined as the probability of changes between the energy of two consecutive frequency sub-bands at a fixed time segment. The second, a temporal model, was defined as the probability of changes in the energy of a sub-band between consecutive time segments. As the first step of demonstrating the efficacy and utility of the proposed method, a diagnostic framework was adopted in this study. Data obtained revealed that the proposed method has (at minimum) significant discriminatory power over the existing alternative approaches.
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Affiliation(s)
- Hamzeh Ghasemzadeh
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, Massachusetts 02114, USA
| | - Philip C Doyle
- Department of Otolaryngology Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford University, 801 Welch Road, Stanford, California. 94305, USA
| | - Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, 1026 Red Cedar Road, Oyer Speech & Hearing Building, East Lansing, Michigan 48824, USA
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Clark HM, Duffy JR, Strand EA, Hanley H, Solomon NP. Orofacial Muscle Strength across the Dysarthrias. Brain Sci 2022; 12:brainsci12030365. [PMID: 35326321 PMCID: PMC8946724 DOI: 10.3390/brainsci12030365] [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] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure generation (Pmax) by the tongue, lips, and cheeks represented strength. Pmax was lower for speakers with mixed spastic–flaccid dysarthria for all tongue and lip measures, as well as for speakers with flaccid or spastic dysarthria for anterior tongue elevation and lip compression. Anterior tongue elevation and cheek compression tended to be lower than normal for the hypokinetic group. Pmax did not differ significantly between controls and speakers with ataxic dysarthria on any measure. Correlations were generally weak between dysarthria severity and orofacial weakness but were stronger in the dysarthria groups with more prominent orofacial weakness. The results generally support predictions that orofacial weakness accompanies flaccid and/or spastic dysarthria but not ataxic dysarthria. The findings support including type of dysarthria as a variable of interest when examining orofacial weakness in motor speech disorders.
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Affiliation(s)
- Heather M. Clark
- Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (E.A.S.)
- Correspondence: ; Tel.: +1-507-2983-1283
| | | | | | - Holly Hanley
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC 28608, USA;
| | - Nancy Pearl Solomon
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA;
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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9
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Tamura T, Tanaka Y, Watanabe Y, Sato K. Relationships between maximum tongue pressure and second formant transition in speakers with different types of dysarthria. PLoS One 2022; 17:e0264995. [PMID: 35259200 PMCID: PMC8903301 DOI: 10.1371/journal.pone.0264995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
The effects of muscle weakness on speech are currently not fully known. We investigated the relationships between maximum tongue pressure and second formant transition in adults with different types of dysarthria. It focused on the slope in the second formant transition because it reflects the tongue velocity during articulation. Sixty-three Japanese speakers with dysarthria (median age, 68 years; interquartile range, 58–77 years; 44 men and 19 women) admitted to acute and convalescent hospitals were included. Thirty neurologically normal speakers aged 19–85 years (median age, 22 years; interquartile range, 21.0–23.8 years; 14 men and 16 women) were also included. The relationship between the maximum tongue pressure and speech function was evaluated using correlation analysis in the dysarthria group. Speech intelligibility, the oral diadochokinesis rate, and the second formant slope were based on the impaired speech index. More than half of the speakers had mild to moderate dysarthria. Speakers with dysarthria showed significantly lower maximum tongue pressure, speech intelligibility, oral diadochokinesis rate, and second formant slope than neurologically normal speakers. Only the second formant slope was significantly correlated with the maximum tongue pressure (r = 0.368, p = 0.003). The relationship between the second formant slope and maximum tongue pressure showed a similar correlation in the analysis of subgroups divided by sex. The oral diadochokinesis rate, which is related to the speed of articulation, is affected by voice on/off, mandibular opening/closing, and range of motion. In contrast, the second formant slope was less affected by these factors. These results suggest that the maximum isometric tongue strength is associated with tongue movement speed during articulation.
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Affiliation(s)
- Toshiaki Tamura
- Department of Speech, Language, and Hearing Sciences, Niigata University of Health and Welfare, Niigata city, Niigata, Japan
- Major in Health and Welfare, Niigata University of Health and Welfare Graduate School, Niigata city, Niigata, Japan
- * E-mail:
| | - Yasuhiro Tanaka
- Faculty of Psychological and Physical Science, Aichi Gakuin University, Nisshin city, Aichi, Japan
| | - Yoshihiro Watanabe
- Department of Rehabilitation, Uonuma Kikan Hospital, Uonuma city, Niigata, Japan
| | - Katsuro Sato
- Department of Speech, Language, and Hearing Sciences, Niigata University of Health and Welfare, Niigata city, Niigata, Japan
- Major in Health and Welfare, Niigata University of Health and Welfare Graduate School, Niigata city, Niigata, Japan
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10
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Lee J, Madhavan A, Krajewski E, Lingenfelter S. Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence. Muscle Nerve 2021; 64:520-531. [PMID: 34296769 DOI: 10.1002/mus.27361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022]
Abstract
Bulbar dysfunction is a common presentation of amyotrophic lateral sclerosis (ALS) and significantly impacts quality of life of people with ALS (PALS). The current paper reviews measurements of dysarthria and dysphagia specific to ALS to identify efficient and valid assessment measures. Using such assessment measures will lead to improved management of bulbar dysfunction in ALS. Measures reviewed for dysarthria in PALS are organized into three categories: acoustic, kinematic, and strength. A set of criteria are used to evaluate the effectiveness of the measures' identification of speech impairments, measurement of functional verbal communication, and clinical applicability. Assessments reviewed for dysphagia in PALS are organized into six categories: patient reported outcomes, dietary intake, pulmonary function and airway defense capacity, bulbar function, dysphagia/aspiration screens, and instrumental evaluations. Measurements that have good potential for clinical use are highlighted in both topic areas. Additionally, areas of improvement for clinical practice and research are identified and discussed. In general, no single speech measure fulfilled all the criteria, although a few measures were identified as potential diagnostic tools. Similarly, few objective measures that were validated and replicated with large sample sizes were found for diagnosis of dysphagia in PALS. Importantly, clinical applicability was found to be limited; thus, a collaborative team focused on implementation science would be helpful to improve the clinical uptake of assessments. Overall, the review highlights the need for further development of clinically viable and efficient measurements that use a multidisciplinary approach.
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Affiliation(s)
- Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sydney Lingenfelter
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
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11
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Chiaramonte R, Bonfiglio M. Acoustic analysis of voice in bulbar amyotrophic lateral sclerosis: a systematic review and meta-analysis of studies. LOGOP PHONIATR VOCO 2019; 45:151-163. [DOI: 10.1080/14015439.2019.1687748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rita Chiaramonte
- Department of Physical Medicine and Rehabilitation, University of Catania, Catania, Italy
| | - Marco Bonfiglio
- Department for Health Activities, ASP Siracusa, Siracusa, Italy
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12
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Searl J, Knollhoff S. Articulation contact pressures scaled to the physiologic range of the tongue in amyotrophic lateral sclerosis: A pilot study. JOURNAL OF COMMUNICATION DISORDERS 2019; 82:105937. [PMID: 31541930 DOI: 10.1016/j.jcomdis.2019.105937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to compare the percentage of the maximum isometric lingual strength range at which lingual-alveolar consonants are produced (%Pmax) by people with amyotrophic lateral sclerosis (PALS) compared to people without the disease measured at study entry, and then 3 and 6 months later. DESIGN Prospective cohort comparison study over time. METHODS Ten people with ALS and nine without produced the consonants /t, d, s, z, l, n/ in real words within sentences as the articulatory contact pressure (ACP) between the tongue tip and palate was sensed by a miniature transducer. Maximum isometric tongue pressing values also were obtained to allow calculation of %Pmax. Data were analyzed to compare PALS with bulbar symptoms, PALS with spinal-only symptoms, and people without ALS. RESULTS %Pmax did not differ between any of the three participant groups at any of the three measurement times. Maximum isometric pressure did decrease significantly in both ALS groups when comparing baseline to 3- and 6-months later. Maximum pressures remained stable for the non-ALS group at the three measurement times. CONCLUSION The results suggest that speech motor activity of the tongue in people with ALS may be scaled relative to their overall tongue strength, such that the %Pmax does not change as the tongue gets progressively weaker.
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Affiliation(s)
- Jeff Searl
- University of Kansas Medical Center, Kansas City, KS, United States.
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Searl J. Sense of Effort and Articulatory Contact Pressure Associated with Talking by Individuals Using Tracheoesophageal Speech. Folia Phoniatr Logop 2019; 72:218-227. [DOI: 10.1159/000496794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
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Searl J, Knollhoff S. Changes in lingual-alveolar contact pressure during speech over six months in amyotrophic lateral sclerosis. JOURNAL OF COMMUNICATION DISORDERS 2017; 70:49-60. [PMID: 29126546 DOI: 10.1016/j.jcomdis.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study compared lingual-alveolar contact pressures during consonant (LACP-Sp) production between adults with and without amyotrophic lateral sclerosis (ALS) over three visits within six months and assessed the relationship between LACP-Sp and speech intelligibility. METHODS Ten people with ALS and nine without read sentences with lingual-alveolar consonants embedded as LACP-Sp was recorded. Recordings were done at study entry, then three and six months after entry. Six of ten with ALS had bulbar symptoms detected in clinical encounter at the time of study enrollment (ALS-B); the remaining four had only spinal symptoms (ALS-S). RESULTS Main and interaction effects varied across experimental stimuli. However, the pattern of results from the ANOVAs indicated that the ALS-B had lower LACP-Sp values than the other groups. Time main effects were present indicating a reduction in LACP-Sp. However, there were interaction effects for fricatives and/l/, with the ALS-S group demonstrating greater reduction over time than the other groups. Word intelligibility had moderate to large correlations with LACP-Sp but confidence intervals were broad and only a few were statistically significant. CONCLUSION LACP-Sp does decrease over time in people with ALS and may reflect a general weakening of the tongue. Confirmation of these group changes will require assessment with a larger sample size.
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Affiliation(s)
- Jeff Searl
- Hearing and Speech Department, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Stephanie Knollhoff
- Hearing and Speech Department, University of Kansas Medical Center, Kansas City, KS, United States
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Solomon NP, Makashay MJ, Helou LB, Clark HM. Neurogenic Orofacial Weakness and Speech in Adults With Dysarthria. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:951-960. [PMID: 28763804 PMCID: PMC5829797 DOI: 10.1044/2017_ajslp-16-0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/07/2017] [Indexed: 05/16/2023]
Abstract
PURPOSE This study compared orofacial strength between adults with dysarthria and neurologically normal (NN) matched controls. In addition, orofacial muscle weakness was examined for potential relationships to speech impairments in adults with dysarthria. METHOD Matched groups of 55 adults with dysarthria and 55 NN adults generated maximum pressure (Pmax) against an air-filled bulb during lingual elevation, protrusion and lateralization, and buccodental and labial compressions. These orofacial strength measures were compared with speech intelligibility, perceptual ratings of speech, articulation rate, and fast syllable-repetition rate. RESULTS The dysarthria group demonstrated significantly lower orofacial strength than the NN group on all tasks. Lingual strength correlated moderately and buccal strength correlated weakly with most ratings of speech deficits. Speech intelligibility was not sensitive to dysarthria severity. Individuals with severely reduced anterior lingual elevation Pmax (< 18 kPa) had normal to profoundly impaired sentence intelligibility (99%-6%) and moderately to severely impaired speech (26%-94% articulatory imprecision; 33%-94% overall severity). CONCLUSIONS Results support the presence of orofacial muscle weakness in adults with dysarthrias of varying etiologies but reinforce tenuous links between orofacial strength and speech production disorders. By examining individual data, preliminary evidence emerges to suggest that speech, but not necessarily intelligibility, is likely to be impaired when lingual weakness is severe.
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Affiliation(s)
- Nancy Pearl Solomon
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Matthew J. Makashay
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Leah B. Helou
- National Military Audiology & Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
- Systems Neuroscience Institute, University of Pittsburgh, PA
| | - Heather M. Clark
- Department of Neurology, Speech Pathology, Mayo Clinic, Rochester, MN
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
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