Dysarthria Profiles in Adults With Hereditary Ataxia

Oral diadochokinetic production in children with typical speech development and speech-sound disorders

BACKGROUND

AIMS: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC).

METHODS & PROCEDURES

Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono-, bi- and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate.

OUTCOMES & RESULTS

The DDK rates increased throughout childhood, but the oldest children, 9-year-olds in the current study, did not achieve adult-like rates for all mono- and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate.

CONCLUSIONS & IMPLICATIONS

This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills.

WHAT THIS PAPER ADDS

What is already known on the subject Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean-speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work? This study provided normative data of young Korean-speaking children aged 3-9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone.

Investigating Perceptual Subgroups in Speakers With Ataxic Dysarthria: An Auditory Free Classification Approach

PURPOSE

Ataxic dysarthria has presented with considerable heterogeneity in the presentation of speech characteristics. Converging evidence supports the existence of subgroups, specifically related to the instability and inflexibility of motor patterns as a possible explanation of this variability.

METHOD

To further examine the alignment of the speech characteristics of ataxic dysarthria with the instability/inflexibility framework, 23 graduate student listeners participated in an auditory free classification task and a guided classification task. Listeners grouped 15 speakers with ataxic dysarthria based on their judgment of the most salient perceptual characteristics during two speaking tasks: alternating motion rates (AMRs) and connected speech (one to two sentences). Listener ratings were then compared with a priori determinations of speakers who fit the instability subgroup profile and the inflexibility subgroup profile.

RESULTS

Results of both the free classification and guided classification listening paradigms provided supportive evidence of subgroups, particularly for the AMR task, in the context of strong inter- and intrarater reliability.

CONCLUSION

This study adds to the growing evidence of the existence of instability and inflexibility subgroups in ataxic dysarthria and serves as a proof of concept for use of the auditory free classification paradigm in dysarthria subgroup research.

Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications

PURPOSE

The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis.

METHOD

Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate.

RESULTS

Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions.

DISCUSSION

A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.

Genotypic Differences in Networks Supporting Regional Predictors of Speech Rate in Spinocerebellar Ataxia: Preliminary Observations

Background: Disordered speech production, dysarthria, is a common characteristic of the spinocerebellar ataxias (SCAs). Although dysarthric features differ across SCAs, a previous analysis revealed that a combination of regional cerebral blood flow (rCBF) in the left inferior frontal region and the right caudate predicted syllable rate, a pattern reported in normal speakers. This study examined the relationships between primary predictor brain regions and other areas of the brain in three SCA groups. The regions associated with the primary predictors are considered as elements of secondary networks since they are associated with regional speech predictors rather than directly with speech performance.

Methods: Speech and rCBF data from 9 SCA1, 8 SCA5, and 5 SCA6 individuals were analyzed. Partial correlations were used to identify brain regions associated with the primary predictors.

Results: Secondary networks differed across SCA genotypes. SCA1 and SCA6 demonstrated both positive and negative associations between primary and secondary areas, whereas the associations in the SCA5 genotype were only positive. The SCA5 associations were also largely bilaterally symmetrical. Both SCA1 and SCA5 demonstrated secondary associations with the right caudate, whereas the SCA6 group had no such associations.

Conclusions: These results demonstrate that although primary aspects of a brain network may remain functional, pathophysiological processes associated with different SCA genotypes may express themselves in alterations of broader, secondary brain networks. These secondary networks may reflect generic functional associations with the primary predictor regions, compensatory activity in the presence of an SCA, SCA pathology, or some combination of these factors.

Intact Correction for Self-Produced Vowel Formant Variability in Individuals With Cerebellar Ataxia Regardless of Auditory Feedback Availability

Purpose Individuals with cerebellar ataxia (CA) caused by cerebellar degeneration exhibit larger reactive compensatory responses to unexpected auditory feedback perturbations than neurobiologically typical speakers, suggesting they may rely more on feedback control during speech. We test this hypothesis by examining variability in unaltered speech. Previous studies of typical speakers have demonstrated a reduction in formant variability (centering) observed during the initial phase of vowel production from vowel onset to vowel midpoint. Centering is hypothesized to reflect feedback-based corrections for self-produced variability and thus may provide a behavioral assay of feedback control in unperturbed speech in the same manner as the compensatory response does for feedback perturbations. Method To comprehensively compare centering in individuals with CA and controls, we examine centering in two vowels (/i/ and /ɛ/) under two contexts (isolated words and connected speech). As a control, we examine speech produced both with and without noise to mask auditory feedback. Results Individuals with CA do not show increased centering compared to age-matched controls, regardless of vowel, context, or masking. Contrary to previous results in neurobiologically typical speakers, centering was not affected by the presence of masking noise in either group. Conclusions The similar magnitude of centering seen with and without masking noise questions whether centering is driven by auditory feedback. However, if centering is at least partially driven by auditory/somatosensory feedback, these results indicate that the larger compensatory response to altered auditory feedback observed in individuals with CA may not reflect typical motor control processes during normal, unaltered speech production.

Articulation lost in space. The effects of local orobuccal anesthesia on articulation and intelligibility of phonemes

Motor speech requires numerous neural computations including feedforward and feedback control mechanisms. A reduction of auditory or somatosensory feedback may be implicated in disorders of speech, as predicted by various models of speech control. In this paper the effects of reduced somatosensory feedback on articulation and intelligibility of individual phonemes was evaluated by using topical anesthesia of orobuccal structures in 24 healthy subjects. The evaluation was done using a combination of perceptual intelligibility estimation of consonants and vowels and acoustic analysis of motor speech. A significantly reduced intelligibility was found, with a major impact on consonant formation. Acoustic analysis demonstrated disturbed diadochokinesis. These results underscore the clinical importance of somatosensory feedback in speech control. The interpretation of these findings in the context of speech control models, neuro-anatomy and clinical neurology may have implications for subtyping of dysarthria.

When Additional Training Isn't Enough: Further Evidence That Unpredictable Speech Inhibits Adaptation

Purpose Robust improvements in intelligibility following familiarization, a listener-targeted perceptual training paradigm, have been revealed for talkers diagnosed with spastic, ataxic, and hypokinetic dysarthria but not for talkers with hyperkinetic dysarthria. While the theoretical explanation for the lack of intelligibility improvement following training with hyperkinetic talkers is that there is insufficient distributional regularity in the speech signals to support perceptual adaptation, it could simply be that the standard training protocol was inadequate to facilitate learning of the unpredictable talker. In a pair of experiments, we addressed this possible alternate explanation by modifying the levels of exposure and feedback provided by the perceptual training protocol to offer listeners a more robust training experience. Method In Experiment 1, we examined the exposure modifications, testing whether perceptual adaptation to an unpredictable talker with hyperkinetic dysarthria could be achieved with greater or more diverse exposure to dysarthric speech during the training phase. In Experiment 2, we examined feedback modifications, testing whether perceptual adaptation to the unpredictable talker could be achieved with the addition of internally generated somatosensory feedback, via vocal imitation, during the training phase. Results Neither task modification led to improved intelligibility of the unpredictable talker with hyperkinetic dysarthria. Furthermore, listeners who completed the vocal imitation task demonstrated significantly reduced intelligibility at posttest. Conclusion Together, the results from Experiments 1 and 2 replicate and extend findings from our previous work, suggesting perceptual adaptation is inhibited for talkers whose speech is largely characterized by unpredictable degradations. Collectively, these results underscore the importance of integrating signal predictability into theoretical models of perceptual learning.