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Stegmann G, Krantsevich C, Liss J, Charles S, Bartlett M, Shefner J, Rutkove S, Kawabata K, Talkar T, Berisha V. Automated speech analytics in ALS: higher sensitivity of digital articulatory precision over the ALSFRS-R. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-9. [PMID: 38932502 DOI: 10.1080/21678421.2024.2371986] [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: 03/24/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Objective: Although studies have shown that digital measures of speech detected ALS speech impairment and correlated with the ALSFRS-R speech item, no study has yet compared their performance in detecting speech changes. In this study, we compared the performances of the ALSFRS-R speech item and an algorithmic speech measure in detecting clinically important changes in speech. Importantly, the study was part of a FDA submission which received the breakthrough device designation for monitoring ALS; we provide this paper as a roadmap for validating other speech measures for monitoring disease progression. Methods: We obtained ALSFRS-R speech subscores and speech samples from participants with ALS. We computed the minimum detectable change (MDC) of both measures; using clinician-reported listener effort and a perceptual ratings of severity, we calculated the minimal clinically important difference (MCID) of each measure with respect to both sets of clinical ratings. Results: For articulatory precision, the MDC (.85) was lower than both MCID measures (2.74 and 2.28), and for the ALSFRS-R speech item, MDC (.86) was greater than both MCID measures (.82 and .72), indicating that while the articulatory precision measure detected minimal clinically important differences in speech, the ALSFRS-R speech item did not. Conclusion: The results demonstrate that the digital measure of articulatory precision effectively detects clinically important differences in speech ratings, outperforming the ALSFRS-R speech item. Taken together, the results herein suggest that this speech outcome is a clinically meaningful measure of speech change.
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Affiliation(s)
- Gabriela Stegmann
- Arizona State University, Phoenix, AZ, USA
- Aural Analytics, Scottsdale, AZ, USA
| | - Chelsea Krantsevich
- Arizona State University, Phoenix, AZ, USA
- Aural Analytics, Scottsdale, AZ, USA
| | - Julie Liss
- Arizona State University, Phoenix, AZ, USA
- Aural Analytics, Scottsdale, AZ, USA
| | - Sherman Charles
- Aural Analytics, Scottsdale, AZ, USA
- Linus Health, Boston, MA, USA
| | | | | | - Seward Rutkove
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kan Kawabata
- Aural Analytics, Scottsdale, AZ, USA
- Linus Health, Boston, MA, USA
| | - Tanya Talkar
- Aural Analytics, Scottsdale, AZ, USA
- Linus Health, Boston, MA, USA
| | - Visar Berisha
- Arizona State University, Phoenix, AZ, USA
- Aural Analytics, Scottsdale, AZ, USA
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Bingham IN, Norel R, Roitberg EG, Peller J, Trevisan MA, Agurto C, Shalom DE, Aguirre F, Embon I, Taitz A, Harris D, Wright A, Seaver K, Sullivan S, Green JR, Ostrow LW, Fraenkel E, Berry JD. Listener effort quantifies clinically meaningful progression of dysarthria in people living with amyotrophic lateral sclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308140. [PMID: 38853969 PMCID: PMC11160879 DOI: 10.1101/2024.05.31.24308140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative motor neuron disease that causes progressive muscle weakness. Progressive bulbar dysfunction causes dysarthria and thus social isolation, reducing quality of life. The Everything ALS Speech Study obtained longitudinal clinical information and speech recordings from 292 participants. In a subset of 120 participants, we measured speaking rate (SR) and listener effort (LE), a measure of dysarthria severity rated by speech pathologists from recordings. LE intra- and inter-rater reliability was very high (ICC 0.88 to 0.92). LE correlated with other measures of dysarthria at baseline. LE changed over time in participants with ALS (slope 0.77 pts/month; p<0.001) but not controls (slope 0.005 pts/month; p=0.807). The slope of LE progression was similar in all participants with ALS who had bulbar dysfunction at baseline, regardless of ALS site of onset. LE could be a remotely collected clinically meaningful clinical outcome assessment for ALS clinical trials.
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Affiliation(s)
- Indu Navar Bingham
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | | | - Esteban G. Roitberg
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Julián Peller
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Laboratorio de Neurociencias Cognitivas Computacionales, Humai, Buenos Aires, Argentina
| | - Marcos A Trevisan
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | | | - Diego E. Shalom
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | - Felipe Aguirre
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Iair Embon
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Alan Taitz
- SRI International, Menlo Park, CA, USA. This work was performed working at
| | - Donna Harris
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Amy Wright
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Katie Seaver
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Stacey Sullivan
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Jordan R. Green
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Lyle W. Ostrow
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Ernest Fraenkel
- Massachusetts Institute of Technology, Department of Biological Engineering, Cambridge, MA, USA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
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Kim Y, Thompson A, Nip ISB. Effects of Deep-Brain Stimulation on Speech: Perceptual and Acoustic Data. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1090-1106. [PMID: 38498664 PMCID: PMC11005955 DOI: 10.1044/2024_jslhr-23-00511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This study examined speech changes induced by deep-brain stimulation (DBS) in speakers with Parkinson's disease (PD) using a set of auditory-perceptual and acoustic measures. METHOD Speech recordings from nine speakers with PD and DBS were compared between DBS-On and DBS-Off conditions using auditory-perceptual and acoustic analyses. Auditory-perceptual ratings included voice quality, articulation precision, prosody, speech intelligibility, and listening effort obtained from 44 listeners. Acoustic measures were made for voicing proportion, second formant frequency slope, vowel dispersion, articulation rate, and range of fundamental frequency and intensity. RESULTS No significant changes were found between DBS-On and DBS-Off for the five perceptual ratings. Four of six acoustic measures revealed significant differences between the two conditions. While articulation rate and acoustic vowel dispersion increased, voicing proportion and intensity range decreased from the DBS-Off to DBS-On condition. However, a visual examination of the data indicated that the statistical significance was mostly driven by a small number of participants, while the majority did not show a consistent pattern of such changes. CONCLUSIONS Our data, in general, indicate no-to-minimal changes in speech production ensued from DBS stimulation. The findings are discussed with a focus on large interspeaker variability in PD in terms of their speech characteristics and the potential effects of DBS on speech.
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Affiliation(s)
- Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Austin Thompson
- Department of Communication Sciences and Disorders, University of Houston, TX
| | - Ignatius S. B. Nip
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
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Moya-Galé G, Hernández JD, Goudarzi A, Walsh SJ. ¿Notas La Diferencia? [Do You Hear the Difference?]: Perceptual Consequences of Intensive Voice Treatment in Spanish Speakers With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-21. [PMID: 38513128 DOI: 10.1044/2023_jslhr-23-00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The primary objective of this study was to explore the effects of intensive voice-focused treatment on speech parameters in Spanish speakers with dysarthria associated with Parkinson's disease (PD) as perceived by naïve listeners. METHOD Fifteen Spanish speakers with dysarthria associated with PD received the Lee Silverman Voice Treatment (LSVT LOUD) for a month. Voice and speech recordings were conducted pretreatment, posttreatment, and at a 1-month follow-up. Thirty naïve adult listeners rated the perceptual dimensions of ease of understanding (EoU), resonance, articulatory precision, prosody, and voice quality from sentences extracted from an emotional monologue on a visual analogue scale. RESULTS EoU, resonance, articulatory precision, and voice quality significantly improved pre- to posttreatment, but gains were not maintained at follow-up. Speech severity was a significant source of variance in mean listener response for all perceptual dimensions, although the interaction between speech severity and time was only significant for resonance and voice quality. CONCLUSIONS LSVT LOUD may be beneficial to improve perceptual speech domains affected by PD in Spanish speakers with dysarthria. Its impact on the different speech subsystems may reflect a universal distribution of effects when directly targeting the glottal source. Language-specific contributions of each perceptual domain to speech intelligibility should be explored in further research to determine linguistically sensitive treatment targets.
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Krajewski E, Lee J, Olmstead AJ, Simmons Z. Comparison of Vowel and Sentence Intelligibility in People With Dysarthria Secondary to Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-10. [PMID: 38376500 DOI: 10.1044/2024_jslhr-23-00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
PURPOSE In this study, we examined the utility of vowel intelligibility testing for assessing the impact of dysarthria on speech characteristics in people with amyotrophic lateral sclerosis (ALS). We tested the sensitivity and specificity of overall vowel identification, as well as that of vowel-specific identification, to dysarthria presence and severity. We additionally examined the relationship between vowel intelligibility and sentence intelligibility. METHOD Twenty-three people with ALS and 22 age- and sex-matched control speakers produced sentences from the Speech Intelligibility Test (SIT), as well as 10 American English monophthongs in /h/-vowel-/d/ words for the vowel intelligibility test (VIT). Data for SIT and VIT scores came from 135 listeners. Diagnostic accuracy of VIT measures was evaluated using the area under the curve of receiver operator characteristics. We then examined differences between control speakers, speakers with mild dysarthria, and speakers with severe dysarthria in their relationship between SIT and VIT scores. RESULTS The results suggest that the overall vowel intelligibility score showed high sensitivity and specificity in differentiating between speakers with and without dysarthria, even those with milder symptoms. In addition, single-vowel identification scores showed at least acceptable group differentiation between the mild and severe dysarthria groups, though fewer single vowels were acceptable discriminators between the control group and the group with mild dysarthria. Identification accuracy of /ɪ/ in particular showed excellent discrimination across all groups. Examination of the relationship between SIT and VIT scores suggests a severity-specific relationship. Speakers with SIT scores above 70% generally had higher SIT than VIT scores, whereas speakers with SIT below 70% generally had higher VIT than SIT scores. DISCUSSION Vowel intelligibility testing can detect speech impairments in speakers with mild dysarthria and residual articulatory function in speakers with severe dysarthria. Vowel intelligibility testing may, therefore, be a useful addition to intelligibility testing for individuals with dysarthria.
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Affiliation(s)
- Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Annie J Olmstead
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Zachary Simmons
- Penn State Hershey ALS Clinic and Research Center, The Pennsylvania State University College of Medicine, Hershey
- Department of Neurology, The Pennsylvania State University College of Medicine, Hershey
- Department of Humanities, The Pennsylvania State University College of Medicine, Hershey
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Houle N, Feaster T, Mira A, Meeks K, Stepp CE. Sex Differences in the Speech of Persons With and Without Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:96-116. [PMID: 37889201 PMCID: PMC11000784 DOI: 10.1044/2023_ajslp-22-00350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/24/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Sex differences are apparent in the prevalence and the clinical presentation of Parkinson's disease (PD), but their effects on speech have been less studied. METHOD Speech acoustics of persons with (34 females and 34 males) and without (age- and sex-matched) PD were examined, assessing the effects of PD diagnosis and sex on ratings of dysarthria severity and acoustic measures of phonation (fundamental frequency standard deviation, smoothed cepstral peak prominence), speech rate (net syllables per second, percent pause ratio), and articulation (articulatory-acoustic vowel space, release burst precision). RESULTS Most measures were affected by PD (dysarthria severity, fundamental frequency standard deviation) and sex (smoothed cepstral peak prominence, net syllables per second, percent pause ratio, articulatory-acoustic vowel space), but without interactions between them. Release burst precision was differentially affected by sex in PD. Relative to those without PD, persons with PD produced fewer plosives with a single burst: females more frequently produced multiple bursts, whereas males more frequently produced no burst at all. CONCLUSIONS Most metrics did not indicate that speech production is differentially affected by sex in PD. Sex was, however, associated with disparate effects on release burst precision in PD, which deserves further study. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24388666.
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Affiliation(s)
- Nichole Houle
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Taylor Feaster
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Amna Mira
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Kirsten Meeks
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head & Neck Surgery, Boston University School of Medicine, MA
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Stipancic KL, Golzy M, Zhao Y, Pinkerton L, Rohl A, Kuruvilla-Dugdale M. Improving Perceptual Speech Ratings: The Effects of Auditory Training on Judgments of Dysarthric Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4236-4258. [PMID: 37774738 PMCID: PMC10715846 DOI: 10.1044/2023_jslhr-23-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Auditory training has been shown to reduce rater variability in perceptual voice assessment. Because rater variability is also a central issue in the auditory-perceptual assessment of dysarthria, this study sought to determine if training produces a meaningful change in rater reliability, criterion validity, and scaling magnitude of four features: overall speech impairment, articulatory imprecision, monotony, and slow rate. METHOD Forty-four nonexperts randomized to training and nontraining listener groups completed a pretest and posttest. Only the former group underwent auditory training between pre- and posttests. For both testing and training, listeners rated samples from speakers with amyotrophic lateral sclerosis (ALS), speakers with Parkinson's disease (PD), and neurologically healthy control speakers using separate visual analog scales (VASs) for each of the four features. Intraclass correlation coefficients were used to compare inter- and intrarater reliability between pre- and posttest for both listener groups. For criterion validity, severity ratings from the two nonexpert listener groups were compared to those of two experienced listeners for all four features. To determine changes in scaling magnitude, raw VAS scores for each feature were compared from pre- to posttest within the two nonexpert listener groups. Scaling changes were also compared between the two listener groups for the pre- and posttest conditions. RESULTS AND CONCLUSIONS In the training group, a meaningful improvement in interrater reliability was observed for some features in all three speaker groups, but not in the nontraining group. In contrast, for intrarater reliability, in the nontraining group, a meaningful improvement was observed for many features in all three speaker groups, but only for PD monotony and slow rate in the training group. All ratings from the nonexpert listeners were valid except for monotony. Raw VAS scores did not meaningfully change from pre- to posttest for any of the features, but there was a trend toward lower scores posttraining, mainly for the ALS samples. Modifications to the auditory training paradigm to further improve reliability and validity, along with future goals for optimizing training, are discussed.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri, Columbia
| | - Yunxin Zhao
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia
| | - Louise Pinkerton
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Andrea Rohl
- Department of Neurosurgery, The University of Iowa, Iowa City
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Gutz SE, Maffei MF, Green JR. Feedback From Automatic Speech Recognition to Elicit Clear Speech in Healthy Speakers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2940-2959. [PMID: 37824377 PMCID: PMC10721250 DOI: 10.1044/2023_ajslp-23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/10/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study assessed the effectiveness of feedback generated by automatic speech recognition (ASR) for eliciting clear speech from young, healthy individuals. As a preliminary step toward exploring a novel method for eliciting clear speech in patients with dysarthria, we investigated the effects of ASR feedback in healthy controls. If successful, ASR feedback has the potential to facilitate independent, at-home clear speech practice. METHOD Twenty-three healthy control speakers (ages 23-40 years) read sentences aloud in three speaking modes: Habitual, Clear (over-enunciated), and in response to ASR feedback (ASR). In the ASR condition, we used Mozilla DeepSpeech to transcribe speech samples and provide participants with a value indicating the accuracy of the ASR's transcription. For speakers who achieved sufficiently high ASR accuracy, noise was added to their speech at a participant-specific signal-to-noise ratio to ensure that each participant had to over-enunciate to achieve high ASR accuracy. RESULTS Compared to habitual speech, speech produced in the ASR and Clear conditions was clearer, as rated by speech-language pathologists, and more intelligible, per speech-language pathologist transcriptions. Speech in the Clear and ASR conditions aligned on several acoustic measures, particularly those associated with increased vowel distinctiveness and decreased speaking rate. However, ASR accuracy, intelligibility, and clarity were each correlated with different speech features, which may have implications for how people change their speech for ASR feedback. CONCLUSIONS ASR successfully elicited outcomes similar to clear speech in healthy speakers. Future work should investigate its efficacy in eliciting clear speech in people with dysarthria.
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Affiliation(s)
- Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
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Teplansky KJ, Wisler A, Green JR, Heitzman D, Austin S, Wang J. Measuring Articulatory Patterns in Amyotrophic Lateral Sclerosis Using a Data-Driven Articulatory Consonant Distinctiveness Space Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3076-3088. [PMID: 36787156 PMCID: PMC10555455 DOI: 10.1044/2022_jslhr-22-00320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 05/20/2023]
Abstract
PURPOSE The aim of this study was to leverage data-driven approaches, including a novel articulatory consonant distinctiveness space (ACDS) approach, to better understand speech motor control in amyotrophic lateral sclerosis (ALS). METHOD Electromagnetic articulography was used to record tongue and lip movement data during the production of 10 consonants from healthy controls (n = 15) and individuals with ALS (n = 47). To assess phoneme distinctness, speech data were analyzed using two classification algorithms, Procrustes matching (PM) and support vector machine (SVM), and the area/volume of the ACDS. Pearson's correlation coefficient was used to examine the relationship between bulbar impairment and the ACDS. Analysis of variance was used to examine the effects of bulbar impairment on consonant distinctiveness and consonant classification accuracies in clinical subgroups. RESULTS There was a significant relationship between the ACDS and intelligible speaking rate (area, p = .003; volume, p = .010), and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore (area, p = .009; volume, p = .027). Consonant classification performance followed a consistent pattern with bulbar severity, where consonants produced by speakers with more severe ALS were classified less accurately (SVM = 75.27%; PM = 74.54%) than the healthy, asymptomatic, and mild-moderate groups. In severe ALS, area of the ACDS was significantly condensed compared to both asymptomatic (p = .004) and mild-moderate (p = .013) groups. There was no statistically significant difference in area between the severe ALS group and healthy speakers (p = .292). CONCLUSIONS Our comprehensive approach is sensitive to early oromotor changes in response due to disease progression. The preserved articulatory consonant space may capture the use of compensatory adaptations to counteract influences of neurodegeneration. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22044320.
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Affiliation(s)
- Kristin J. Teplansky
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Alan Wisler
- Mathematics and Statistics Department, Utah State University, Logan
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Boston, MA
| | | | - Sara Austin
- Department of Neurology, The University of Texas at Austin
| | - Jun Wang
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Department of Neurology, The University of Texas at Austin
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Wolfrum V, Lehner K, Heim S, Ziegler W. Clinical Assessment of Communication-Related Speech Parameters in Dysarthria: The Impact of Perceptual Adaptation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-21. [PMID: 37486782 DOI: 10.1044/2023_jslhr-23-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE In current clinical practice, intelligibility of dysarthric speech is commonly assessed by speech-language therapists (SLTs), in most cases by the therapist caring for the patient being diagnosed. Since SLTs are familiar with dysarthria in general and with the speech of the individual patient to be assessed in particular, they have an adaptation advantage in understanding the patient's utterances. We examined whether and how listeners' assessments of communication-related speech parameters vary as a function of their familiarity with dysarthria in general and with the diagnosed patients in particular. METHOD Intelligibility, speech naturalness, and perceived listener effort were assessed in 20 persons with dysarthria (PWD). Patients' speech samples were judged by the individual treating therapists, five dysarthria experts who were unfamiliar with the patients, and crowdsourced naïve listeners. Adaptation effects were analyzed using (a) linear mixed models of overall scoring levels, (b) regression models of severity dependence, (c) network analyses of between-listener and between-parameter relationships, and (d) measures of intra- and interobserver consistency. RESULTS Significant advantages of dysarthria experts over laypeople were found in all parameters. An overall advantage of the treating therapists over nonfamiliar experts was only seen in listening effort. Severity-dependent adaptation effects occurred in all parameters. The therapists' responses were heterogeneous and inconsistent with those of the unfamiliar experts and the naïve listeners. CONCLUSIONS The way SLTs evaluate communication-relevant speech parameters of the PWD whom they care for is influenced not only by adaptation benefits but also by therapeutic biases. This finding weakens the validity of assessments of communication-relevant speech parameters by the treating therapists themselves and encourages the development and use of alternative methods.
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Affiliation(s)
- Vera Wolfrum
- Department of Neurology, Faculty of Medicine, RWTH Aachen University, Germany
| | - Katharina Lehner
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig Maximilian University of Munich, Germany
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Germany
- Research Center Jülich, Institute of Neurosciences and Medicine (INM-1), Germany
- JARA - Translational Brain Medicine, Aachen, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig Maximilian University of Munich, Germany
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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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Maffei MF, Green JR, Murton O, Yunusova Y, Rowe HP, Wehbe F, Diana K, Nicholson K, Berry JD, Connaghan KP. Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:872-887. [PMID: 36802910 PMCID: PMC10205101 DOI: 10.1044/2022_jslhr-22-00363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.
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Affiliation(s)
- Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
| | - Olivia Murton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kathleen Diana
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - James D. Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Cordella C, Gutz SE, Eshghi M, Stipancic KL, Schliep M, Dickerson BC, Green JR. Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4112-4132. [PMID: 36306508 PMCID: PMC9940887 DOI: 10.1044/2022_jslhr-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21401778.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | | | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Fletcher AR, Wisler AA, Gruver ER, Borrie SA. Beyond Speech Intelligibility: Quantifying Behavioral and Perceived Listening Effort in Response to Dysarthric Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4060-4070. [PMID: 36198057 PMCID: PMC9940894 DOI: 10.1044/2022_jslhr-22-00136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE This study investigated whether listener processing of dysarthric speech requires the recruitment of more cognitive resources (i.e., higher levels of listening effort) than neurotypical speech. We also explored relationships between behavioral listening effort, perceived listening effort, and objective measures of word transcription accuracy. METHOD A word recall paradigm was used to index behavioral listening effort. The primary task involved word transcription, whereas a memory task involved recalling words from previous sentences. Nineteen listeners completed the paradigm twice, once while transcribing dysarthric speech and once while transcribing neurotypical speech. Perceived listening effort was rated using a visual analog scale. RESULTS Results revealed significant effects of dysarthria on the likelihood of correct word recall, indicating that the transcription of dysarthric speech required higher levels of behavioral listening effort relative to neurotypical speech. There was also a significant relationship between transcription accuracy and measures of behavioral listening effort, such that listeners who were more accurate in understanding dysarthric speech exhibited smaller changes in word recall when listening to dysarthria. The subjective measure of perceived listening effort did not have a statistically significant correlation with measures of behavioral listening effort or transcription accuracy. CONCLUSIONS Results suggest that cognitive resources, particularly listeners' working memory capacity, are more taxed when deciphering dysarthric versus neurotypical speech. An increased demand on these resources may affect a listener's ability to remember aspects of their conversations with people with dysarthria, even when the speaker is fully intelligible.
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Affiliation(s)
- Annalise R. Fletcher
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Alan A. Wisler
- Department of Mathematics and Statistics, Utah State University, Logan
| | - Emily R. Gruver
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton
| | - Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
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15
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Stipancic KL, van Brenk F, Kain A, Wilding G, Tjaden K. Clear Speech Variants: An Investigation of Intelligibility and Speaker Effort in Speakers With Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2789-2805. [PMID: 36327495 PMCID: PMC9911091 DOI: 10.1044/2022_ajslp-22-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE This study investigated the effects of three clear speech variants on sentence intelligibility and speaking effort for speakers with Parkinson's disease (PD) and age- and sex-matched neurologically healthy controls. METHOD Fourteen speakers with PD and 14 neurologically healthy speakers participated. Each speaker was recorded reading 18 sentences from the Speech Intelligibility Test in their habitual speaking style and for three clear speech variants: clear (SC; given instructions to speak clearly), hearing impaired (HI; given instructions to speak with someone with a hearing impairment), and overenunciate (OE; given instructions to overenunciate each word). Speakers rated the amount of physical and mental effort exerted during each speaking condition using visual analog scales (averaged to yield a metric of overall speaking effort). Sentence productions were orthographically transcribed by 50 naive listeners. Linear mixed-effects models were used to compare intelligibility and speaking effort across the clear speech variants. RESULTS Intelligibility was reduced for the PD group in comparison to the control group only in the habitual condition. All clear speech variants significantly improved intelligibility above habitual levels for the PD group, with OE maximizing intelligibility, followed by the SC and HI conditions. Both groups rated speaking effort to be significantly higher for both the OE and HI conditions versus the SC and habitual conditions. DISCUSSION For speakers with PD, all clear speech variants increased intelligibility to a level comparable to that of healthy controls. All clear speech variants were also associated with higher levels of speaking effort than habitual speech for the speakers with PD. Clinically, findings suggest that clear speech training programs consider using the instruction "overenunciate" for maximizing intelligibility. Future research is needed to identify if high levels of speaking effort elicited by the clear speech variants affect long-term sustainability of the intelligibility benefit.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Frits van Brenk
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | - Alexander Kain
- Department of Pediatrics, Oregon Health & Science University, Portland
| | | | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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16
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Connaghan KP, Baylor C, Romanczyk M, Rickwood J, Bedell G. Communication and Social Interaction Experiences of Youths With Congenital Motor Speech Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2609-2627. [PMID: 36215658 PMCID: PMC9911099 DOI: 10.1044/2022_ajslp-22-00034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to explore the communication and social interaction experiences of adolescents with congenital motor speech disorders due to cerebral palsy or Down syndrome, with the aim of identifying clinical and research needs to support the development and implementation of speech-language interventions. METHOD Five male youths (ages 14-18 years) with congenital motor speech disorders and one of their parents participated in face-to-face, semistructured interviews designed to understand communication and social experiences in daily life. Interviews were audio-recorded and orthographically transcribed offline. Content was coded according to topic areas emerging in the data. Themes were developed to illustrate the most salient and representative aspects of participants' experiences according to the phenomenological tradition that recognizes that participants are experts in their "lived experience." RESULTS Participants described the youths' day-to-day communication experiences, including facilitators and barriers to successful social interactions. Thematic analysis revealed three main themes: (a) strong core relationships amidst sparse, superficial interactions in daily life; (b) the complicated picture of why; and (c) how speech-language pathologists can help. CONCLUSIONS Participants reported that the impact of congenital motor speech disorders on social interactions and experiences became more apparent in adolescence than in earlier childhood. Addressing communication challenges to meet the unique social demands of this period requires tailored interventions that target multiple contributing factors beyond speech impairment, such as social communication skills, negative communication partner attitudes, and participation opportunities. Shifting practice toward a life participation approach to communication intervention stands to substantially improve the long-term social outcomes of adolescents with motor speech disorders.
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Affiliation(s)
- Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Carolyn Baylor
- Department of Rehabilitation Sciences, University of Washington, Seattle
| | - Megan Romanczyk
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Jessica Rickwood
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Gary Bedell
- Department of Occupational Therapy, Tufts University, Medford, MA
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Rate of speech decline in individuals with amyotrophic lateral sclerosis. Sci Rep 2022; 12:15713. [PMID: 36127362 PMCID: PMC9489769 DOI: 10.1038/s41598-022-19651-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Although speech declines rapidly in some individuals with amyotrophic lateral sclerosis (ALS), longitudinal changes in speech have rarely been characterized. The study objectives were to model the rate of decline in speaking rate and speech intelligibility as a function of disease onset site, sex, and age at onset in 166 individuals with ALS; and estimate time to speech loss from symptom onset. We also examined the association between clinical (speaking rate/intelligibility) measures and patient-reported measures of ALS progression (ALSFRS-R). Speech measures declined faster in the bulbar-onset group than in the spinal-onset group. The rate of decline was not significantly affected by sex and age. Functional speech was still maintained at 60 months since disease onset for most patients with spinal onset. However, the time to speech loss was 23 months based on speaking rate < 120 (w/m) and 32 months based on speech intelligibility < 85% in individuals with ALS-bulbar onset. Speech measures were more responsive to functional decline than were the patient-reported measures. The findings of this study will inform future work directed toward improving speech prognosis in ALS, which is critical for determining the appropriate timing of interventions, providing appropriate counseling for patients, and evaluating functional changes during clinical trials.
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Hirsch ME, Thompson A, Kim Y, Lansford KL. The Reliability and Validity of Speech-Language Pathologists’ Estimations of Intelligibility in Dysarthria. Brain Sci 2022; 12:brainsci12081011. [PMID: 36009074 PMCID: PMC9406197 DOI: 10.3390/brainsci12081011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
This study examined the reliability and validity of speech-language pathologists’ (SLP) estimations of speech intelligibility in dysarthria, including a visual analog scale (VAS) method and a percent estimation method commonly used in clinical settings. Speech samples from 20 speakers with dysarthria of varying etiologies were used to collect orthographic transcriptions from naïve listeners n=70 and VAS ratings and percent estimations of intelligibility from SLPs n=21. Intra- and interrater reliability for the two SLP intelligibility measures were evaluated, and the relationship between these measures was assessed. Finally, linear regression was used to evaluate the relationship between the naïve listeners’ orthographic transcription scores and the two SLP intelligibility measures. The results indicated that the intrarater reliability for both SLP intelligibility measures was strong, and the interrater reliability between the SLP ratings was moderate to excellent. A moderate positive relationship between SLPs’ VAS ratings and percent estimations was also observed. Finally, both SLPs’ percent estimations and VAS ratings were predictive of naïve listeners’ orthographic transcription scores, with SLPs’ percent estimations being the strongest predictor. In conclusion, the average SLP percent estimations and VAS ratings are valid and reliable intelligibility measures. However, the validity and reliability of these measures vary between SLPs.
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Teplansky KJ, Wisler A, Green JR, Campbell T, Heitzman D, Austin SG, Wang J. Tongue and Lip Acceleration as a Measure of Speech Decline in Amyotrophic Lateral Sclerosis. Folia Phoniatr Logop 2022; 75:23-34. [PMID: 35760064 PMCID: PMC9792632 DOI: 10.1159/000525514] [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: 09/08/2021] [Accepted: 06/02/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The goal of this study was to examine the efficacy of acceleration-based articulatory measures in characterizing the decline in speech motor control due to amyotrophic lateral sclerosis (ALS). METHOD Electromagnetic articulography was used to record tongue and lip movements during the production of 20 phrases. Data were collected from 50 individuals diagnosed with ALS. Articulatory kinematic variability was measured using the spatiotemporal index of both instantaneous acceleration and speed signals. Linear regression models were used to analyze the relationship between variability measures and intelligible speaking rate (a clinical measure of disease progression). A machine learning algorithm (support vector regression, SVR) was used to assess whether acceleration or speed features (e.g., mean, median, maximum) showed better performance at predicting speech severity in patients with ALS. RESULTS As intelligible speaking rate declined, the variability of acceleration of tongue and lip movement patterns significantly increased (p < 0.001). The variability of speed and vertical displacement did not significantly predict speech performance measures. Additionally, based on R2 and root mean square error (RMSE) values, the SVR model was able to predict speech severity more accurately from acceleration features (R2 = 0.601, RMSE = 38.453) and displacement features (R2 = 0.218, RMSE = 52.700) than from speed features (R2 = 0.554, RMSE = 40.772). CONCLUSION Results from these models highlight differences in speech motor control in participants with ALS. The variability in acceleration of tongue and lip movements increases as speech performance declines, potentially reflecting physiological deviations due to the progression of ALS. Our findings suggest that acceleration is a more sensitive indicator of speech deterioration due to ALS than displacement and speed and may contribute to improved algorithm designs for monitoring disease progression from speech signals.
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Affiliation(s)
- Kristin J Teplansky
- Speech, Language, and Hearing Sciences, University of Texas, Austin, Texas, USA,
| | - Alan Wisler
- Mathematics and Statistics, Utah State University, Logan, Utah, USA
| | - Jordan R Green
- Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Boston, Massachusetts, USA
| | - Thomas Campbell
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, Texas, USA
| | | | - Sara G Austin
- Neurology, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Jun Wang
- Speech, Language, and Hearing Sciences, University of Texas, Austin, Texas, USA
- Neurology, Dell Medical School, University of Texas, Austin, Texas, USA
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Gutz SE, Stipancic KL, Yunusova Y, Berry JD, Green JR. Validity of Off-the-Shelf Automatic Speech Recognition for Assessing Speech Intelligibility and Speech Severity in Speakers With Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2128-2143. [PMID: 35623334 PMCID: PMC9567308 DOI: 10.1044/2022_jslhr-21-00589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE There is increasing interest in using automatic speech recognition (ASR) systems to evaluate impairment severity or speech intelligibility in speakers with dysarthria. We assessed the clinical validity of one currently available off-the-shelf (OTS) ASR system (i.e., a Google Cloud ASR API) for indexing sentence-level speech intelligibility and impairment severity in individuals with amyotrophic lateral sclerosis (ALS), and we provided guidance for potential users of such systems in research and clinic. METHOD Using speech samples collected from 52 individuals with ALS and 20 healthy control speakers, we compared word recognition rate (WRR) from the commercially available Google Cloud ASR API (Machine WRR) to clinician-provided judgments of impairment severity, as well as sentence intelligibility (Human WRR). We assessed the internal reliability of Machine and Human WRR by comparing the standard deviation of WRR across sentences to the minimally detectable change (MDC), a clinical benchmark that indicates whether results are within measurement error. We also evaluated Machine and Human WRR diagnostic accuracy for classifying speakers into clinically established categories. RESULTS Human WRR achieved better accuracy than Machine WRR when indexing speech severity, and, although related, Human and Machine WRR were not strongly correlated. When the speech signal was mixed with noise (noise-augmented ASR) to reduce a ceiling effect, Machine WRR performance improved. Internal reliability metrics were worse for Machine than Human WRR, particularly for typical and mildly impaired severity groups, although sentence length significantly impacted both Machine and Human WRRs. CONCLUSIONS Results indicated that the OTS ASR system was inadequate for early detection of speech impairment and grading overall speech severity. While Machine and Human WRR were correlated, ASR should not be used as a one-to-one proxy for transcription speech intelligibility or clinician severity ratings. Overall, findings suggested that the tested OTS ASR system, Google Cloud ASR, has limited utility for grading clinical speech impairment in speakers with ALS.
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Affiliation(s)
- Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston
| | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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21
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Stipancic KL, Tjaden K. Minimally Detectable Change of Speech Intelligibility in Speakers With Multiple Sclerosis and Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1858-1866. [PMID: 35442761 PMCID: PMC9559772 DOI: 10.1044/2022_jslhr-21-00648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 05/19/2023]
Abstract
PURPOSE This study sought to determine the minimally detectable change (MDC) of sentence intelligibility for speakers with multiple sclerosis (MS) and Parkinson's disease (PD). METHOD Speakers included 78 participants consisting of 32 neurologically healthy control speakers, 30 speakers with MS, and 16 speakers with PD. All speakers were recorded reading 11 sentences comprising the Speech Intelligibility Test (SIT), which were subsequently transcribed by inexperienced listeners. Percent correct scores were calculated for each sentence. An average percent correct score was also calculated for each speaker. The MDC at the 95% confidence interval was calculated using the following formula: MDC95 = 1.96 × √2 × standard error of measurement. Speakers were divided into operationally defined categories of severity, and MDCs were calculated for each category to permit comparison to MDCs reported for speakers with amyotrophic lateral sclerosis (ALS). Kruskal-Wallis tests were conducted to compare MDCs between groups and severity categories. RESULTS The average MDC95 for control speakers was 5.53% (range = 3.21%-7.47%) and was statistically smaller than MDCs for speakers with MS (average = 10.08%, range = 5.30%-15.62%) and those for speakers with PD (average = 10.98%, range = 8.60%-13.98%). Statistical analyses further revealed significant differences between MDCs across severity categories. CONCLUSIONS In agreement with previous work in ALS conducted under similar conditions (i.e., orthographic transcription of SIT sentences in a quiet listening environment), the MDC95 of speech intelligibility ranged from 3% to 10% for speakers with MS and PD who have mildly impaired speech. These estimates are a step toward the development of a universal language with which to evaluate speech changes in a variety of patient populations.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York
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22
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Lévêque N, Slis A, Lancia L, Bruneteau G, Fougeron C. Acoustic Change Over Time in Spastic and/or Flaccid Dysarthria in Motor Neuron Diseases. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1767-1783. [PMID: 35412848 DOI: 10.1044/2022_jslhr-21-00434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aims to investigate acoustic change over time as biomarkers to differentiate among spastic-flaccid dysarthria associated with amyotrophic lateral sclerosis (ALS), spastic dysarthria associated with primary lateral sclerosis (PLS), flaccid dysarthria associated with spinal and bulbar muscular atrophy (SBMA), and to explore how these acoustic parameters are affected by dysarthria severity. METHOD Thirty-three ALS patients with mixed flaccid-spastic dysarthria, 17 PLS patients with pure spastic dysarthria, 18 SBMA patients with pure flaccid dysarthria, and 70 controls, all French speakers, were included in the study. Speakers produced vowel-glide sequences targeting different vocal tract shape changes. The mean and coefficient of variation of the total squared change of mel frequency cepstral coefficients were used to capture the degree and variability of acoustic changes linked to vocal tract modifications over time. Differences in duration of acoustic events were also measured. RESULTS All pathological groups showed significantly less acoustic change compared to controls, reflecting less acoustic contrast in sequences. Spastic and mixed spastic-flaccid dysarthric speakers showed smaller acoustic changes and slower sequence production compared to flaccid dysarthria. For dysarthria subtypes associated with a spastic component, reduced degree of acoustic change was also associated with dysarthria severity. CONCLUSIONS The acoustic parameters partially differentiated among the dysarthria subtypes in relation to motor neuron diseases. While similar acoustic patterns were found in spastic-flaccid and spastic dysarthria, crucial differences were found between these two subtypes relating to variability. The acoustic patterns were much more variable in ALS. This method forms a promising clinical tool as a diagnostic marker of articulatory impairment, even at mild stage of dysarthria progression in all subtypes.
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Affiliation(s)
- Nathalie Lévêque
- Laboratoire de Phonétique et de Phonologie, UMR 7018, CNRS/University Sorbonne-Nouvelle, Paris, France
- Assistance Publique - Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, ALS Reference Center, Paris, France
| | - Anneke Slis
- Laboratoire de Phonétique et de Phonologie, UMR 7018, CNRS/University Sorbonne-Nouvelle, Paris, France
| | - Leonardo Lancia
- Laboratoire de Phonétique et de Phonologie, UMR 7018, CNRS/University Sorbonne-Nouvelle, Paris, France
| | - Gaëlle Bruneteau
- Assistance Publique - Hôpitaux de Paris, Department of Neurology, Hôpital Pitié-Salpêtrière, ALS Reference Center, Paris, France
| | - Cécile Fougeron
- Laboratoire de Phonétique et de Phonologie, UMR 7018, CNRS/University Sorbonne-Nouvelle, Paris, France
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