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Rong P, Heidrick L, Pattee GL. A multimodal approach to automated hierarchical assessment of bulbar involvement in amyotrophic lateral sclerosis. Front Neurol 2024; 15:1396002. [PMID: 38836001 PMCID: PMC11148322 DOI: 10.3389/fneur.2024.1396002] [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: 03/05/2024] [Accepted: 05/01/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction As a hallmark feature of amyotrophic lateral sclerosis (ALS), bulbar involvement leads to progressive declines of speech and swallowing functions, significantly impacting social, emotional, and physical health, and quality of life. Standard clinical tools for bulbar assessment focus primarily on clinical symptoms and functional outcomes. However, ALS is known to have a long, clinically silent prodromal stage characterized by complex subclinical changes at various levels of the bulbar motor system. These changes accumulate over time and eventually culminate in clinical symptoms and functional declines. Detection of these subclinical changes is critical, both for mechanistic understanding of bulbar neuromuscular pathology and for optimal clinical management of bulbar dysfunction in ALS. To this end, we developed a novel multimodal measurement tool based on two clinically readily available, noninvasive instruments-facial surface electromyography (sEMG) and acoustic techniques-to hierarchically assess seven constructs of bulbar/speech motor control at the neuromuscular and acoustic levels. These constructs, including prosody, pause, functional connectivity, amplitude, rhythm, complexity, and regularity, are both mechanically and clinically relevant to bulbar involvement. Methods Using a custom-developed, fully automated data analytic algorithm, a variety of features were extracted from the sEMG and acoustic recordings of a speech task performed by 13 individuals with ALS and 10 neurologically healthy controls. These features were then factorized into 10 composite outcome measures using confirmatory factor analysis. Statistical and machine learning techniques were applied to these composite outcome measures to evaluate their reliability (internal consistency), validity (concurrent and construct), and efficacy for early detection and progress monitoring of bulbar involvement in ALS. Results The composite outcome measures were demonstrated to (1) be internally consistent and structurally valid in measuring the targeted constructs; (2) hold concurrent validity with the existing clinical and functional criteria for bulbar assessment; and (3) outperform the outcome measures obtained from each constituent modality in differentiating individuals with ALS from healthy controls. Moreover, the composite outcome measures combined demonstrated high efficacy for detecting subclinical changes in the targeted constructs, both during the prodromal stage and during the transition from prodromal to symptomatic stages. Discussion The findings provided compelling initial evidence for the utility of the multimodal measurement tool for improving early detection and progress monitoring of bulbar involvement in ALS, which have important implications in facilitating timely access to and delivery of optimal clinical care of bulbar dysfunction.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, United States
| | - Lindsey Heidrick
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City, KS, United States
| | - Gary L Pattee
- Neurology Associate P.C., Lincoln, NE, United States
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Bouvier L, McKinlay S, Truong J, Genge A, Dupré N, Dionne A, Kalra S, Yunusova Y. Speech timing and monosyllabic diadochokinesis measures in the assessment of amyotrophic lateral sclerosis in Canadian French. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:267-277. [PMID: 37272348 PMCID: PMC10696137 DOI: 10.1080/17549507.2023.2214706] [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] [Indexed: 06/06/2023]
Abstract
PURPOSE The primary objective of this study was to determine if speech and pause measures obtained using a passage reading task and timing measures from a monosyllabic diadochokinesis (DDK) task differ across speakers of Canadian French diagnosed with amyotrophic lateral sclerosis (ALS) presenting with and without bulbar symptoms, and healthy controls. The secondary objective was to determine if these measures can reflect the severity of bulbar symptoms. METHOD A total of 29 Canadian French speakers with ALS (classified as bulbar symptomatic [n = 14] or pre-symptomatic [n = 15]) and 17 age-matched healthy controls completed a passage reading task and a monosyllabic DDK task (/pa/ and /ta/), for up to three follow-up visits. Measures of speaking rate, total duration, speech duration, and pause events were extracted from the passage reading recordings using a semi-automated speech and pause analysis procedure. Manual analysis of DDK recordings provided measures of DDK rate and variability. RESULT Group comparisons revealed significant differences (p = < .05) between the symptomatic group and the pre-symptomatic and control groups for all passage measures and DDK rates. Only the DDK rate in /ta/ differentiated the pre-symptomatic and control groups. Repeated measures correlations revealed moderate correlations (rrm = > 0.40; p = < 0.05) between passage measures of total duration, speaking rate, speech duration, and number of pauses, and ALSFRS-R total and bulbar scores, as well as between DDK rate and ALSFRS-R total score. CONCLUSION Speech and pause measures in passage and timing measures in monosyllabic DDK tasks might be suitable for monitoring bulbar functional symptoms in French speakers with ALS, but more work is required to identify which measures are sensitive to the earliest stages of the disease.
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Affiliation(s)
- Liziane Bouvier
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Scotia McKinlay
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Justin Truong
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Angela Genge
- Montreal Neurological Institute-Hospital – The Neuro, Montréal, Canada
| | - Nicolas Dupré
- Neurosciences axis, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Annie Dionne
- Neurosciences axis, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Division of Neurology, University of Alberta, Edmonton, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- University Health Network—Toronto Rehabilitation Institute, Toronto, Canada
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Rong P, Heidrick L. Hierarchical Temporal Structuring of Speech: A Multiscale, Multimodal Framework to Inform the Assessment and Management of Neuromotor Speech Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:92-115. [PMID: 38099851 DOI: 10.1044/2023_jslhr-23-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE Hierarchical temporal structuring of speech is the key to multiscale linguistic information transfer toward effective communication. This study investigated and linked the hierarchical temporal cues of the kinematic and acoustic modalities of natural, unscripted speech in neurologically healthy and impaired speakers. METHOD Thirteen individuals with amyotrophic lateral sclerosis (ALS) and 10 age-matched healthy controls performed a story-telling task. The hierarchical temporal structure of the speech stimulus was measured by (a) 26 articulatory-kinematic features characterizing the depth, phase synchronization, and coherence of temporal modulation of the tongue tip, tongue body, lower lip, and jaw, at three hierarchically nested timescales corresponding to prosodic stress, syllables, and onset-rime/phonemes, and (b) 25 acoustic features characterizing the parallel aspects of temporal modulation of five critical-spectral-band envelopes. All features were compared between groups. For each aspect of temporal modulation, the contributions of all articulatory features to the parallel acoustic features were evaluated by group. RESULTS Generally consistent disease impacts were identified on the articulatory and acoustic features, manifested by reduced modulation depths of most articulators and critical-spectral-band envelopes, primarily at the timescales of syllables and onset-rime/phonemes. For healthy speakers, the strongest articulatory-acoustic relationships were found for (a) jaw and lip, in modulating stress timing, and (b) tongue tip, in modulating the timing relation between onset-rime/phonemes and syllables. For speakers with ALS, the tongue body, tongue tip, and jaw all showed the greatest contributions to modulating syllable timing. CONCLUSIONS The observed disease impacts likely reflect reduced entrainment of speech motor activities to finer-grained linguistic events, presumably due to the dynamic constraints of the neuromuscular system. To accommodate these restrictions, speakers with ALS appear to use their residual articulatory motor capacities to accentuate and convey the perceptually most salient temporal cues underpinned by the syllable-centric parsing mechanism. This adaptive strategy has potential implications in managing neuromotor speech disorders.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Lindsey Heidrick
- Department of Hearing and Speech, The University of Kansas Medical Center, Kansas City
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Rong P, Rasmussen L. A Fine-Grained Temporal Analysis of Multimodal Oral Diadochokinetic Performance to Assess Speech Impairment in Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:307-332. [PMID: 38064644 DOI: 10.1044/2023_ajslp-23-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE This study used a semiautomated fine-grained temporal analysis to extract features of temporal oral diadochokinetic (DDK) performance across multiple modalities and tasks, from neurologically healthy and impaired individuals secondary to amyotrophic lateral sclerosis (ALS). The aims were to (a) delineate temporal oral DDK deficits relating to the neuromotor pathology of ALS and (b) identify the optimal task-feature combinations to detect speech impairment in ALS. METHOD Mandibular myoelectric, kinematic, and acoustic data were acquired from 13 individuals with ALS and 10 healthy controls producing three alternating motion rate tasks and one sequential motion rate task. Twenty-seven features were extracted from the multimodal data, characterizing three temporal constructs: duration/rate, variability, and coordination. The disease impacts on these features were assessed across tasks, and the task eliciting the greatest disease-related change was identified for each feature. Such "optimal" task-feature combinations were fed into logistic regression to differentiate individuals with ALS from healthy controls. RESULTS Temporal deficits in ALS were characterized by (a) increased duration and variability and reduced coordination of jaw muscle activities, (b) increased duration and variability and altered temporal symmetry of jaw velocity profile, (c) increased muscle-burst-to-peak-velocity duration, and (d) increased motion-to-voice onset duration. These temporal features were differentially affected across tasks. The optimal task-feature combinations, which were further clustered into three composite factors reflecting temporal variability, coarser-grained duration, and finer-grained duration, differentiated ALS from controls with an F1 score of 0.86 (precision = 1.00, recall = 0.75). CONCLUSIONS Temporal oral DDK deficits are likely attributed to a hierarchy of interrelated neurophysiological and biomechanical factors associated with the neuromotor pathology of ALS. These deficits, as assessed crossmodally, provide previously unavailable insights into the multifaceted timing impairment of oromotor performance in ALS. The optimal task-feature combinations targeting these deficits show promise as quantitative markers for (early) detection of speech impairment in ALS.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Lily Rasmussen
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
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Rong P, Taylor A. A Vowel-Centric View Toward Characterizing Temporal Organization of Motor Speech Activities in Neurologically Impaired and Healthy Speakers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3697-3720. [PMID: 37607386 DOI: 10.1044/2023_jslhr-23-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE This study tested the hypotheses that (a) motor speech activities are temporally organized around the nuclei into vowel-centric units that hold both stability and flexibility and (b) such temporal organization is impacted by motor speech impairment. METHOD Thirteen individuals with amyotrophic lateral sclerosis and 10 healthy controls read a sentence 3 times at each of the following rates: habitual, fast, and slow. Articulatory gestures and phonatory event were assessed in two vowel-centric units, as operationally defined within and across the boundaries of two target words-cat and must-to accommodate common coda omission and coarticulation. Twelve absolute and relative timing measures centering on the nucleus were derived to characterize the temporal organization of each unit. These measures were evaluated in terms of (a) their relations with global duration across rate conditions and (b) between-groups differences for the habitual rate condition. RESULTS Both vowel-centric units remained stable in relative timing between the articulatory gestures approaching and moving away from the nucleus across rate conditions. Relative timing between the articulatory gestures and phonatory event at smaller temporal granularities varied with global duration, but in different ways for neurologically impaired and healthy speakers. Disease impacts on relative timing were only detected across word boundaries. All absolute timing measures revealed consistent temporal scaling effects and disease-related prolongations. CONCLUSIONS The findings provide preliminary support for vowel-centric temporal organization of motor speech activities. Such temporal organization holds some extent of both stability and flexibility, which may facilitate the parsing of syllabic events during auditory processing, while accommodating task-specific suprasegmental variations. The timing impairments in amyotrophic lateral sclerosis are likely attributed to the disease-imposed dynamic constraints, reducing the entrainment of the related motor speech activities to the underlying linguistic elements. These findings have potential implications in guiding the assessment and management of temporal speech deficits in ALS.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence
| | - Ava Taylor
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence
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Rong P, Benson J. Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:722-745. [PMID: 36106430 DOI: 10.1080/17549507.2022.2110281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KS, USA and
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Rong P, Heidrick L. Functional Role of Temporal Patterning of Articulation in Speech Production: A Novel Perspective Toward Global Timing-Based Motor Speech Assessment and Rehabilitation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4577-4607. [PMID: 36399794 DOI: 10.1044/2022_jslhr-22-00089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to (a) relate temporal patterning of articulation to functional speech outcomes in neurologically healthy and impaired speakers, (b) identify changes in temporal patterning of articulation in neurologically impaired speakers, and (c) evaluate how these changes can be modulated by speaking rate manipulation. METHOD Thirteen individuals with amyotrophic lateral sclerosis (ALS) and 10 neurologically healthy controls read a sentence 3 times, first at their habitual rate and then at a voluntarily slowed rate. Temporal patterning of articulation was assessed by 24 features characterizing the modulation patterns within (intra) and between (inter) four articulators (tongue tip, tongue body, lower lip, and jaw) at three linguistically relevant, hierarchically nested timescales corresponding to stress, syllable, and onset-rime/phoneme. For Aim 1, the features for the habitual rate condition were factorized and correlated with two functional speech outcomes-speech intelligibility and intelligible speaking rate. For Aims 2 and 3, the features were compared between groups and rate conditions, respectiely. RESULTS For Aim 1, the modulation features combined were moderately to strongly correlated with intelligibility (R 2 = .51-.53) and intelligible speaking rate (R 2 = .63-.73). For Aim 2, intra-articulator modulation was impaired in ALS, manifested by moderate-to-large decreases in modulation depth at all timescales and cross-timescale phase synchronization. Interarticulator modulation was relatively unaffected. For Aim 3, voluntary rate reduction improved several intra-articulator modulation features identified as being susceptible to the disease effect in individuals with ALS. CONCLUSIONS Disrupted temporal patterning of articulation, presumably reflecting impaired articulatory entrainment to linguistic rhythms, may contribute to functional speech declines in ALS. These impairments tend to be improved through voluntary rate reduction, possibly by reshaping the temporal template of motor plans to better accommodate the disease-related neuromechanical constraints in the articulatory system. These findings shed light on a novel perspective toward global timing-based motor speech assessment and rehabilitation.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Lindsey Heidrick
- Department of Hearing and Speech, The University of Kansas Medical Center, Kansas City
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Moore S, Rong P. Articulatory Underpinnings of Reduced Acoustic-Phonetic Contrasts in Individuals With Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2022-2044. [PMID: 35973111 DOI: 10.1044/2022_ajslp-22-00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study is to identify the articulatory underpinnings of the acoustic-phonetic correlates of functional speech decline in individuals with amyotrophic lateral sclerosis (ALS). METHOD Thirteen individuals with varying severities of speech impairment secondary to ALS and 10 neurologically healthy controls speakers read 12 minimal word pairs, targeting the contrasts in the height, advancement, and length of vowels; the manner and place of articulation for consonants and consonant cluster; and liquid and glide approximants, 5 times. Sixteen acoustic features were extracted to characterize the phonetic contrasts of these minimal word pairs. These acoustic features were correlated with a functional speech index-intelligible speaking rate-using penalized regression, based on which the contributive features were identified as the acoustic-phonetic correlates of the functional speech outcome. Articulatory contrasts of the minimal word pairs were characterized by a set of dissimilarity indices derived by the dynamic time warping algorithm, which measured the differences in the displacement and velocity trajectories of tongue tip, tongue dorsum, lower lip, and jaw between the minimal word pairs. The contributive articulatory features to the acoustic-phonetic correlates were identified by penalized regression. RESULTS A variety of acoustic-phonetic features were identified as contributing to the functional speech outcome, of which the contrasts in vowel height and advancement, [r]-[l], [r]-[w], and initial cluster-singleton were the most affected in individuals with ALS. Differential articulatory underpinnings were identified for these acoustic-phonetic features. Impairments of these articulatory underpinnings, especially of tongue tip and tongue dorsum velocities and tongue tip displacement, were associated with reduced acoustic-phonetic contrasts of the minimal word pairs, in a context-specific manner. CONCLUSION The findings established explanatory relationships between articulatory impairment and the acoustic-phonetic profile of functional speech decline in ALS, providing useful information for developing targeted management strategies to improve and prolong functional speech in individuals with ALS.
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Affiliation(s)
- Sophie Moore
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
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Rong P, Hansen O, Heidrick L. Relationship between rate-elicited changes in muscular-kinematic control strategies and acoustic performance in individuals with ALS-A multimodal investigation. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106253. [PMID: 36007484 DOI: 10.1016/j.jcomdis.2022.106253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION As a key control variable, duration has been long suspected to mediate the organization of speech motor control strategies, which has management implications for neuromotor speech disorders. This study aimed to experimentally delineate the role of duration in organizing speech motor control in neurologically healthy and impaired speakers using a voluntary speaking rate manipulation paradigm. METHODS Thirteen individuals with amyotrophic lateral sclerosis (ALS) and 10 healthy controls performed a sentence reading task three times, first at their habitual rate, then at a slower rate. A multimodal approach combining surface electromyography, kinematic, and acoustic technologies was used to record jaw muscle activities, jaw kinematics, and speech acoustics. Six muscular-kinematic features were extracted and factor-analyzed to characterize the organization of the mandibular control hierarchy. Five acoustic features were extracted, measuring the spectrotemporal properties of the diphthong /ɑɪ/ and the plosives /t/ and /k/. RESULTS The muscular-kinematic features converged into two interpretable latent factors, reflecting the level and cohesiveness/flexibility of mandibular control, respectively. Voluntary rate reduction led to a trend toward (1) finer, less cohesive, and more flexible mandibular control, and (2) increased range and decreased transition slope of the diphthong formants, across neurologically healthy and impaired groups. Differential correlations were found between the rate-elicited changes in mandibular control and acoustic performance for neurologically healthy and impaired speakers. CONCLUSIONS The results provided empirical evidence for the long-suspected but previously unsubstantiated role of duration in (re)organizing speech motor control strategies. The rate-elicited reorganization of muscular-kinematic control contributed to the acoustic performance of healthy speakers, in ways consistent with theoretical predictions. Such contributions were less consistent in impaired speakers, implying the complex nature of speaking rate reduction in ALS, possibly reflecting an interplay of disease-related constraints and volitional duration control. This information may help to stratify and identify candidates for the rate manipulation therapy.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence KS, USA.
| | - Olivia Hansen
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence KS, USA; Department of Hearing & Speech, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lindsey Heidrick
- Department of Hearing & Speech, University of Kansas Medical Center, Kansas City, KS, USA
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Pernon M, Assal F, Kodrasi I, Laganaro M. Perceptual Classification of Motor Speech Disorders: The Role of Severity, Speech Task, and Listener's Expertise. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2727-2747. [PMID: 35878401 DOI: 10.1044/2022_jslhr-21-00519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The clinical diagnosis of motor speech disorders (MSDs) is mainly based on perceptual approaches. However, studies on perceptual classification of MSDs often indicate low classification accuracy. The aim of this study was to determine in a forced-choice dichotomous decision-making task (a) how accuracy of speech-language pathologists (SLPs) in perceptually classifying apraxia of speech (AoS) and dysarthria is impacted by speech task, severity of MSD, and listener's expertise and (b) which perceptual features they use to classify. METHOD Speech samples from 29 neurotypical speakers, 14 with hypokinetic dysarthria associated with Parkinson's disease (HD), 10 with poststroke AoS, and six with mixed dysarthria associated with amyotrophic lateral sclerosis (MD-FlSp [combining flaccid and spastic dysarthria]), were classified by 20 expert SLPs and 20 student SLPs. Speech samples were elicited in spontaneous speech, text reading, oral diadochokinetic (DDK) tasks, and a sample concatenating text reading and DDK. For each recorded speech sample, SLPs answered three dichotomic questions following a diagnostic approach, (a) neurotypical versus pathological speaker, (b) AoS versus dysarthria, and (c) MD-FlSp versus HD, and a multiple-choice question on the features their decision was based on. RESULTS Overall classification accuracy was 72% with good interrater reliability, varying with SLP expertise, speech task, and MSD severity. Correct classification of speech samples was higher for speakers with dysarthria than for AoS and higher for HD than for MD-FlSp. Samples elicited with continuous speech reached the best classification rates. An average number of three perceptual features were used for correct classifications, and their type and combination differed between the three MSDs. CONCLUSIONS The auditory-perceptual classification of MSDs in a diagnostic approach reaches substantial performance only in expert SLPs with continuous speech samples, albeit with lower accuracy for AoS. Specific training associated with objective classification tools seems necessary to improve recognition of neurotypical speech and distinction between AoS and dysarthria.
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Affiliation(s)
- Michaela Pernon
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
- Laboratoire de Phonétique et Phonologie, UMR 7018, CNRS-Université Sorbonne Nouvelle, Paris, France
- CRMR Wilson & Parkinson Unit, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Ina Kodrasi
- Signal Processing for Communication Group, Idiap Research Institute, Martigny, Switzerland
| | - Marina Laganaro
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
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Kent RD, Kim Y, Chen LM. Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:574-623. [PMID: 34958599 DOI: 10.1044/2021_jslhr-21-00396] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Ray D Kent
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Yunjung Kim
- School of Communication Sciences & Disorders, Florida State University, Tallahassee
| | - Li-Mei Chen
- Department of Foreign Languages and Literature, National Cheng Kung University, Tainan, Taiwan
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Rong P. A Novel Hierarchical Framework for Measuring the Complexity and Irregularity of Multimodal Speech Signals and Its Application in the Assessment of Speech Impairment in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2996-3014. [PMID: 34293265 DOI: 10.1044/2021_jslhr-20-00743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purposes of this study are to develop a novel multimodal framework for measuring variability at the muscular, kinematic, and acoustic levels of the motor speech hierarchy and evaluate the utility of this framework in detecting speech impairment in amyotrophic lateral sclerosis (ALS). Method The myoelectric activities of three bilateral jaw muscle pairs (masseter, anterior temporalis, and anterior belly of digastric), jaw kinematics, and speech acoustics were recorded in 13 individuals with ALS and 10 neurologically healthy controls during sentence reading. Thirteen novel measures (six muscular, three kinematic, four acoustic), which characterized two different but interrelated aspects of variability-complexity and irregularity-were derived using linear and nonlinear methods. Exploratory factor analysis was applied to identify the latent factors underlying these measures. Based on the latent factors, three supervised classifiers-support vector machine (SVM), random forest (RF), and logistic regression (Logit)-were used to differentiate between the speech samples for patients and controls. Results Four interpretable latent factors were identified, representing the complexity of jaw kinematics, the irregularity of jaw antagonists functioning, the irregularity of jaw agonists functioning, and the irregularity of subband acoustic signals, respectively. Based on these latent factors, the speech samples for patients and controls were classified with high accuracy (> 96% for SVM and RF; 88.64% for Logit), outperforming the unimodal measures. Two factors showed significant between-groups differences, as characterized by decreased complexity of jaw kinematics and increased irregularity of jaw antagonists functioning in patients versus controls. Conclusions Decreased complexity of jaw kinematics presumably reflects impaired fine control of jaw movement, while increased irregularity of jaw antagonists functioning could be attributed to reduced synchronization of motor unit firing in ALS. The findings provide preliminary evidence for the utility of the multimodal framework as a novel quantitative assessment tool for detecting speech impairment in ALS and (potentially) in other neuromotor disorders.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence
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