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Neumann M, Kothare H, Ramanarayanan V. Multimodal speech biomarkers for remote monitoring of ALS disease progression. Comput Biol Med 2024; 180:108949. [PMID: 39126786 DOI: 10.1016/j.compbiomed.2024.108949] [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: 12/31/2023] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 08/12/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that severely impacts affected persons' speech and motor functions, yet early detection and tracking of disease progression remain challenging. The current gold standard for monitoring ALS progression, the ALS functional rating scale - revised (ALSFRS-R), is based on subjective ratings of symptom severity, and may not capture subtle but clinically meaningful changes due to a lack of granularity. Multimodal speech measures which can be automatically collected from patients in a remote fashion allow us to bridge this gap because they are continuous-valued and therefore, potentially more granular at capturing disease progression. Here we investigate the responsiveness and sensitivity of multimodal speech measures in persons with ALS (pALS) collected via a remote patient monitoring platform in an effort to quantify how long it takes to detect a clinically-meaningful change associated with disease progression. We recorded audio and video from 278 participants and automatically extracted multimodal speech biomarkers (acoustic, orofacial, linguistic) from the data. We find that the timing alignment of pALS speech relative to a canonical elicitation of the same prompt and the number of words used to describe a picture are the most responsive measures at detecting such change in both pALS with bulbar (n = 36) and non-bulbar onset (n = 107). Interestingly, the responsiveness of these measures is stable even at small sample sizes. We further found that certain speech measures are sensitive enough to track bulbar decline even when there is no patient-reported clinical change, i.e. the ALSFRS-R speech score remains unchanged at 3 out of a total possible score of 4. The findings of this study have the potential to facilitate improved, accelerated and cost-effective clinical trials and care.
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Affiliation(s)
| | | | - Vikram Ramanarayanan
- Modality.AI, Inc., San Francisco, CA, USA; University of California, San Francisco, CA, USA.
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2
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Baqué L, Machuca MJ. Dysfluency in primary progressive aphasia: Temporal speech parameters. CLINICAL LINGUISTICS & PHONETICS 2024:1-34. [PMID: 39104133 DOI: 10.1080/02699206.2024.2378345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024]
Abstract
Analysing spontaneous speech in individuals experiencing fluency difficulties holds potential for diagnosing speech and language disorders, including Primary Progressive Aphasia (PPA). Dysfluency in the spontaneous speech of patients with PPA has mostly been described in terms of abnormal pausing behaviour, but the temporal features related to speech have drawn little attention. This study compares speech-related fluency parameters in the three main variants of PPA and in typical speech. Forty-three adults participated in this research, thirteen with the logopenic variant of PPA (lvPPA), ten with the non-fluent variant (nfvPPA), nine with the semantic variant (svPPA), and eleven who were healthy age-matched adults. Participants' fluency was assessed through a picture description task from which 42 parameters were computed including syllable duration, speaking pace, the duration of speech chunks (i.e. interpausal units, IPU), and the number of linguistic units per IPU and per second. The results showed that each PPA variant exhibited abnormal speech characteristics reflecting various underlying factors, from motor speech deficits to higher-level issues. Out of the 42 parameters considered, 37 proved useful for characterising dysfluency in the three main PPA variants and 35 in distinguishing among them. Therefore, taking into account not only pausing behaviour but also temporal speech parameters can provide a fuller understanding of dysfluency in PPA. However, no single parameter by itself sufficed to distinguish one PPA group from the other two, further evidence that dysfluency is not dichotomous but rather multidimensional, and that complementary multiparametric analyses are needed.
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Affiliation(s)
- Lorraine Baqué
- Departament de Filologia Francesa i Romànica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María-Jesús Machuca
- Departament de Filologia Espanyola, Universitat Autònoma de Barcelona, Bellaterra, Spain
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3
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Connaghan KP, Green JR, Eshghi M, Haenssler AE, Scheier ZA, Clark A, Iyer A, Richburg BD, Rowe HP, Okada J, Johnson SA, Onnela JP, Burke KM, Berry JD. The relationship of rate and pause features to the communicative participation of people living with ALS. Muscle Nerve 2024; 70:217-225. [PMID: 38837773 PMCID: PMC11229383 DOI: 10.1002/mus.28170] [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: 08/22/2023] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION/AIMS Many people living with amyotrophic lateral sclerosis (PALS) report restrictions in their day-to-day communication (communicative participation). However, little is known about which speech features contribute to these restrictions. This study evaluated the effects of common speech symptoms in PALS (reduced overall speaking rate, slowed articulation rate, and increased pausing) on communicative participation restrictions. METHODS Participants completed surveys (the Communicative Participation Item Bank-short form; the self-entry version of the ALS Functional Rating Scale-Revised) and recorded themselves reading the Bamboo Passage aloud using a smartphone app. Rate and pause measures were extracted from the recordings. The association of various demographic, clinical, self-reported, and acoustic speech features with communicative participation was evaluated with bivariate correlations. The contribution of salient rate and pause measures to communicative participation was assessed using multiple linear regression. RESULTS Fifty seven people living with ALS participated in the study (mean age = 61.1 years). Acoustic and self-report measures of speech and bulbar function were moderately to highly associated with communicative participation (Spearman rho coefficients ranged from rs = 0.48 to rs = 0.77). A regression model including participant age, sex, articulation rate, and percent pause time accounted for 57% of the variance of communicative participation ratings. DISCUSSION Even though PALS with slowed articulation rate and increased pausing may convey their message clearly, these speech features predict communicative participation restrictions. The identification of quantitative speech features, such as articulation rate and percent pause time, is critical to facilitating early and targeted intervention and for monitoring bulbar decline in ALS.
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Affiliation(s)
- Kathryn P Connaghan
- Speech and Social Interaction Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, Massachusetts, USA
| | - Marziye Eshghi
- Speech, Physiology, and Neurobiology of Aging and Dementia Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Athinoula A. Martinos Centre for Biomedical Imaging, Boston, Massachusetts, USA
- Department of Radiology, MGH, Harvard Medical School, Boston, Massachusetts, USA
| | - Abigail E Haenssler
- Speech and Social Interaction Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Zoe A Scheier
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison Clark
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amrita Iyer
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian D Richburg
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Hannah P Rowe
- Speech Neuroscience Lab, Boston University, Boston, Massachusetts, USA
| | - June Okada
- Speech and Social Interaction Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Stephen A Johnson
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard University, Boston, Massachusetts, USA
| | - Katherine M Burke
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Berry
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, School of Medicine, Boston, Massachusetts, USA
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Meade G, Machulda MM, Clark HM, Duffy JR, Botha H, Whitwell JL, Josephs KA, Utianski RL. Identifying and Addressing Functional Communication Challenges in Patients With Behavioral Variant Frontotemporal Dementia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1573-1589. [PMID: 38843453 PMCID: PMC11253250 DOI: 10.1044/2024_ajslp-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them. METHOD Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing. RESULTS At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5-6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP. CONCLUSIONS This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25933762.
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Affiliation(s)
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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Sullivan L, Martin E, Allison KM. Effects of SPEAK OUT! & LOUD Crowd on Functional Speech Measures in Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1930-1951. [PMID: 38838243 DOI: 10.1044/2024_ajslp-23-00321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson's disease (PD). METHOD Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post-SPEAK OUT! time points, and one post-LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points. RESULTS Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant. CONCLUSIONS These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.
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Affiliation(s)
- Lauren Sullivan
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Elizabeth Martin
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Kristen M Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
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Cordella C, Di Filippo L, Kolachalama VB, Kiran S. Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2091-2128. [PMID: 38652820 PMCID: PMC11253646 DOI: 10.1044/2024_ajslp-23-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies. METHOD We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results. RESULTS Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence. CONCLUSIONS Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25537237.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren Di Filippo
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, MA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, MA
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, MA
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Neumann M, Kothare H, Ramanarayanan V. Multimodal Speech Biomarkers for Remote Monitoring of ALS Disease Progression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.26.24308811. [PMID: 38978682 PMCID: PMC11230328 DOI: 10.1101/2024.06.26.24308811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that severely impacts affected persons' speech and motor functions, yet early detection and tracking of disease progression remain challenging. The current gold standard for monitoring ALS progression, the ALS functional rating scale - revised (ALSFRS-R), is based on subjective ratings of symptom severity, and may not capture subtle but clinically meaningful changes due to a lack of granularity. Multimodal speech measures which can be automatically collected from patients in a remote fashion allow us to bridge this gap because they are continuous-valued and therefore, potentially more granular at capturing disease progression. Here we investigate the responsiveness and sensitivity of multimodal speech measures in persons with ALS (pALS) collected via a remote patient monitoring platform in an effort to quantify how long it takes to detect a clinically-meaningful change associated with disease progression. We recorded audio and video from 278 participants and automatically extracted multimodal speech biomarkers (acoustic, orofacial, linguistic) from the data. We find that the timing alignment of pALS speech relative to a canonical elicitation of the same prompt and the number of words used to describe a picture are the most responsive measures at detecting such change in both pALS with bulbar (n = 36) and non-bulbar onset (n = 107). Interestingly, the responsiveness of these measures is stable even at small sample sizes. We further found that certain speech measures are sensitive enough to track bulbar decline even when there is no patient-reported clinical change, i.e. the ALSFRS-R speech score remains unchanged at 3 out of a total possible score of 4. The findings of this study have the potential to facilitate improved, accelerated and cost-effective clinical trials and care.
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Affiliation(s)
| | | | - Vikram Ramanarayanan
- Modality.AI, Inc., San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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Shellikeri S, Cho S, Ash S, Gonzalez-Recober C, McMillan CT, Elman L, Quinn C, Amado DA, Baer M, Irwin DJ, Massimo L, Olm C, Liberman M, Grossman M, Nevler N. Digital markers of motor speech impairments in spontaneous speech of patients with ALS-FTD spectrum disorders. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:317-325. [PMID: 38050971 PMCID: PMC11023759 DOI: 10.1080/21678421.2023.2288106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To evaluate automated digital speech measures, derived from spontaneous speech (picture descriptions), in assessing bulbar motor impairments in patients with ALS-FTD spectrum disorders (ALS-FTSD). METHODS Automated vowel algorithms were employed to extract two vowel acoustic measures: vowel space area (VSA), and mean second formant slope (F2 slope). Vowel measures were compared between ALS with and without clinical bulbar symptoms (ALS + bulbar (n = 49, ALSFRS-r bulbar subscore: x¯ = 9.8 (SD = 1.7)) vs. ALS-nonbulbar (n = 23), behavioral variant frontotemporal dementia (bvFTD, n = 25) without a motor syndrome, and healthy controls (HC, n = 32). Correlations with bulbar motor clinical scales, perceived listener effort, and MRI cortical thickness of the orobuccal primary motor cortex (oral PMC) were examined. We compared vowel measures to speaking rate, a conventional metric for assessing bulbar dysfunction. RESULTS ALS + bulbar had significantly reduced VSA and F2 slope than ALS-nonbulbar (|d|=0.94 and |d|=1.04, respectively), bvFTD (|d|=0.89 and |d|=1.47), and HC (|d|=0.73 and |d|=0.99). These reductions correlated with worse bulbar clinical scores (VSA: R = 0.33, p = 0.043; F2 slope: R = 0.38, p = 0.011), greater listener effort (VSA: R=-0.43, p = 0.041; F2 slope: p > 0.05), and cortical thinning in oral PMC (F2 slope: β = 0.0026, p = 0.017). Vowel measures demonstrated greater sensitivity and specificity for bulbar impairment than speaking rate, while showing independence from cognitive and respiratory impairments. CONCLUSION Automatic vowel measures are easily derived from a brief spontaneous speech sample, are sensitive to mild-moderate stage of bulbar disease in ALS-FTSD, and may present better sensitivity to bulbar impairment compared to traditional assessments such as speaking rate.
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Affiliation(s)
- Sanjana Shellikeri
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Sunghye Cho
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA
| | - Sharon Ash
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Carmen Gonzalez-Recober
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | | | - Colin Quinn
- Penn ALS Clinic, University of Pennsylvania, PA
| | | | | | - David J Irwin
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Lauren Massimo
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Chris Olm
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Mark Liberman
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA
- Department of Linguistics, University of Pennsylvania, Philadelphia, PA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Naomi Nevler
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, PA
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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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Tzeplaeff L, Jürs AV, Wohnrade C, Demleitner AF. Unraveling the Heterogeneity of ALS-A Call to Redefine Patient Stratification for Better Outcomes in Clinical Trials. Cells 2024; 13:452. [PMID: 38474416 PMCID: PMC10930688 DOI: 10.3390/cells13050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Despite tremendous efforts in basic research and a growing number of clinical trials aiming to find effective treatments, amyotrophic lateral sclerosis (ALS) remains an incurable disease. One possible reason for the lack of effective causative treatment options is that ALS may not be a single disease entity but rather may represent a clinical syndrome, with diverse genetic and molecular causes, histopathological alterations, and subsequent clinical presentations contributing to its complexity and variability among individuals. Defining a way to subcluster ALS patients is becoming a central endeavor in the field. Identifying specific clusters and applying them in clinical trials could enable the development of more effective treatments. This review aims to summarize the available data on heterogeneity in ALS with regard to various aspects, e.g., clinical, genetic, and molecular.
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Affiliation(s)
- Laura Tzeplaeff
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
| | - Alexandra V. Jürs
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Camilla Wohnrade
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Antonia F. Demleitner
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
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11
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Rowe HP, Stipancic KL, Campbell TF, Yunusova Y, Green JR. The association between longitudinal declines in speech sound accuracy and speech intelligibility in speakers with amyotrophic lateral sclerosis. CLINICAL LINGUISTICS & PHONETICS 2024; 38:227-248. [PMID: 37122073 PMCID: PMC10613582 DOI: 10.1080/02699206.2023.2202297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to examine how neurodegeneration secondary to amyotrophic lateral sclerosis (ALS) impacts speech sound accuracy over time and how speech sound accuracy, in turn, is related to speech intelligibility. Twenty-one participants with ALS read the Bamboo Passage over multiple data collection sessions across several months. Phonemic and orthographic transcriptions were completed for all speech samples. The percentage of phonemes accurately produced was calculated across each phoneme, sound class (i.e. consonants versus vowels), and distinctive feature (i.e. features involved in Manner of Articulation, Place of Articulation, Laryngeal Voicing, Tongue Height, and Tongue Advancement). Intelligibility was determined by calculating the percentage of words correctly transcribed orthographically by naive listeners. Linear mixed effects models were conducted to assess the decline of each distinctive feature over time and its impact on intelligibility. The results demonstrated that overall phonemic production accuracy had a nonlinear relationship with speech intelligibility and that a subset of features (i.e. those dependent on precise lingual and labial constriction and/or extensive lingual and labial movement) were more important for intelligibility and were more impacted over time than other features. Furthermore, findings revealed that consonants were more strongly associated with intelligibility than vowels, but consonants did not significantly differ from vowels in their decline over time. These findings have the potential to (1) strengthen mechanistic understanding of the physiological constraints imposed by neuronal degeneration on speech production and (2) inform the timing and selection of treatment and assessment targets for individuals with ALS.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Kaila L Stipancic
- Department of Communicative Disorders and Sciences, The State University of New York, Buffalo, New York, USA
| | - Thomas F Campbell
- Callier Center for Communication Disorders, University of Texas, Dallas, Texas, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
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12
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Simmatis LER, Robin J, Spilka MJ, Yunusova Y. Detecting bulbar amyotrophic lateral sclerosis (ALS) using automatic acoustic analysis. Biomed Eng Online 2024; 23:15. [PMID: 38311731 PMCID: PMC10838438 DOI: 10.1186/s12938-023-01174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/19/2023] [Indexed: 02/06/2024] Open
Abstract
Automatic speech assessments have the potential to dramatically improve ALS clinical practice and facilitate patient stratification for ALS clinical trials. Acoustic speech analysis has demonstrated the ability to capture a variety of relevant speech motor impairments, but implementation has been hindered by both the nature of lab-based assessments (requiring travel and time for patients) and also by the opacity of some acoustic feature analysis methods. These challenges and others have obscured the ability to distinguish different ALS disease stages/severities. Validation of automated acoustic analysis tools could enable detection of early signs of ALS, and these tools could be deployed to screen and monitor patients without requiring clinic visits. Here, we sought to determine whether acoustic features gathered using an automated assessment app could detect ALS as well as different levels of speech impairment severity resulting from ALS. Speech samples (readings of a standardized, 99-word passage) from 119 ALS patients with varying degrees of disease severity as well as 22 neurologically healthy participants were analyzed, and 53 acoustic features were extracted. Patients were stratified into early and late stages of disease (ALS-early/ALS-E and ALS-late/ALS-L) based on the ALS Functional Ratings Scale-Revised bulbar score (FRS-bulb) (median [interquartile range] of FRS-bulbar scores: 11[3]). The data were analyzed using a sparse Bayesian logistic regression classifier. It was determined that the current relatively small set of acoustic features could distinguish between ALS and controls well (area under receiver-operating characteristic curve/AUROC = 0.85), that the ALS-E patients could be separated well from control participants (AUROC = 0.78), and that ALS-E and ALS-L patients could be reasonably separated (AUROC = 0.70). These results highlight the potential for automated acoustic analyses to detect and stratify ALS.
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Affiliation(s)
- Leif E R Simmatis
- KITE-Toronto Rehabilitation Institute, UHN, Toronto, ON, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
| | | | | | - Yana Yunusova
- KITE-Toronto Rehabilitation Institute, UHN, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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13
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Robin J, Xu M, Kaufman LD, Simpson W, McCaughey S, Tatton N, Wolfus C, Ward M. Development of a Speech-based Composite Score for Remotely Quantifying Language Changes in Frontotemporal Dementia. Cogn Behav Neurol 2023; 36:237-248. [PMID: 37878468 PMCID: PMC10683975 DOI: 10.1097/wnn.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/07/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Changes to speech and language are common symptoms across different subtypes of frontotemporal dementia (FTD). These changes affect the ability to communicate, impacting everyday functions. Accurately assessing these changes may help clinicians to track disease progression and detect response to treatment. OBJECTIVE To determine which aspects of speech show significant change over time and to develop a novel composite score for tracking speech and language decline in individuals with FTD. METHOD We recruited individuals with FTD to complete remote digital speech assessments based on a picture description task. Speech samples were analyzed to derive acoustic and linguistic measures of speech and language, which were tested for longitudinal change over the course of the study and were used to compute a novel composite score. RESULTS Thirty-six (16 F, 20 M; M age = 61.3 years) individuals were enrolled in the study, with 27 completing a follow-up assessment 12 months later. We identified eight variables reflecting different aspects of language that showed longitudinal decline in the FTD clinical syndrome subtypes and developed a novel composite score based on these variables. The resulting composite score demonstrated a significant effect of change over time, high test-retest reliability, and a correlation with standard scores on various other speech tasks. CONCLUSION Remote digital speech assessments have the potential to characterize speech and language abilities in individuals with FTD, reducing the burden of clinical assessments while providing a novel measure of speech and language abilities that is sensitive to disease and relevant to everyday function.
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Affiliation(s)
- Jessica Robin
- Winterlight Labs, Incorporated, Toronto, Ontario, Canada
| | - Mengdan Xu
- Winterlight Labs, Incorporated, Toronto, Ontario, Canada
| | | | - William Simpson
- Winterlight Labs, Incorporated, Toronto, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Michael Ward
- Alector, Incorporated, San Francisco, California
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14
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Neel A, Krasilshchikova S, Richardson JD, Arenas R, Bennett L, Banks S, Ritter A, Bernick C. Articulation Rate, Pauses, and Disfluencies in Professional Fighters: Potential Speech Biomarkers for Repetitive Head Injury. J Head Trauma Rehabil 2023; 38:458-466. [PMID: 36701308 PMCID: PMC10368786 DOI: 10.1097/htr.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE As part of a larger study dedicated to identifying speech and language biomarkers of neurological decline associated with repetitive head injury (RHI) in professional boxers and mixed martial artists (MMAs), we examined articulation rate, pausing, and disfluency in passages read aloud by participants in the Professional Athletes Brain Health Study. SETTING A large outpatient medical center specializing in neurological care. PARTICIPANTS, DESIGN, AND MAIN MEASURES Passages read aloud by 60 boxers, 40 MMAs, and 55 controls were acoustically analyzed to determine articulation rate (the number of syllables produced per second), number and duration of pauses, and number and duration of disfluencies in this observational study. RESULTS Both boxers and MMAs differed from controls in articulation rate, producing syllables at a slower rate than controls by nearly half a syllable per second on average. Boxers produced significantly more pauses and disfluencies in passages read aloud than MMAs and controls. CONCLUSIONS Slower articulation rate in both boxers and MMA fighters compared with individuals with no history of RHI and the increased occurrence of pauses and disfluencies in the speech of boxers suggest changes in speech motor behavior that may relate to RHI. These speech characteristics can be measured in everyday speaking conditions and by automatic recognition systems, so they have the potential to serve as effective, noninvasive clinical indicators for RHI-associated neurological decline.
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Affiliation(s)
- Amy Neel
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque (Drs Neel, Richardson, and Arenas and Ms Krasilshchikova); Pickup Family Neurosciences Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California (Dr Bennett); Department of Neurosciences, University of California, San Diego, La Jolla (Dr Banks); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada (Drs Ritter and Bernick)
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15
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Simmatis L, Robin J, Spilka M, Yunusova Y. Detecting bulbar amyotrophic lateral sclerosis (ALS) using automatic acoustic analysis. RESEARCH SQUARE 2023:rs.3.rs-3306951. [PMID: 37720012 PMCID: PMC10503837 DOI: 10.21203/rs.3.rs-3306951/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Home-based speech assessments have the potential to dramatically improve ALS clinical practice and facilitate patient stratification for ALS clinical trials. Acoustic speech analysis has demonstrated the ability to capture a variety of relevant speech motor impairments, but implementation has been hindered by both the nature of lab-based assessments (requiring travel and time for patients) and also by the opacity of some acoustic feature analysis methods. Furthermore, these challenges and others have obscured the ability to distinguish different ALS disease stages/severities. Validation of remote-capable acoustic analysis tools could enable detection of early signs of ALS, and these tools could be deployed to screen and monitor patients without requiring clinic visits. Here, we sought to determine whether acoustic features gathered using a remote-capable assessment app could detect ALS as well as different levels of speech impairment severity resulting from ALS. Speech samples (readings of a standardized, 99-word passage) from 119 ALS patients with varying degrees of disease severity as well as 22 neurologically healthy participants were analyzed, and 53 acoustic features were extracted. Patients were stratified into early and late stages of disease (ALS-early/ALS-E and ALS-late/ALS-L) based on the ALS Functional Ratings Scale - Revised bulbar score (FRS-bulb). Data were analyzed using a sparse Bayesian logistic regression classifier. It was determined that the current relatively small set of acoustic features could distinguish between ALS and controls well (area under receiver operating characteristic curve/AUROC = 0.85), that the ALS-E patients could be separated well from control participants (AUROC = 0.78), and that ALS-E and ALS-L patients could be reasonably separated (AUROC = 0.70). These results highlight the potential for remote acoustic analyses to detect and stratify ALS.
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16
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Milella G, Sciancalepore D, Cavallaro G, Piccirilli G, Nanni AG, Fraddosio A, D’Errico E, Paolicelli D, Fiorella ML, Simone IL. Acoustic Voice Analysis as a Useful Tool to Discriminate Different ALS Phenotypes. Biomedicines 2023; 11:2439. [PMID: 37760880 PMCID: PMC10525613 DOI: 10.3390/biomedicines11092439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Approximately 80-96% of people with amyotrophic lateral sclerosis (ALS) become unable to speak during the disease progression. Assessing upper and lower motor neuron impairment in bulbar regions of ALS patients remains challenging, particularly in distinguishing spastic and flaccid dysarthria. This study aimed to evaluate acoustic voice parameters as useful biomarkers to discriminate ALS clinical phenotypes. Triangular vowel space area (tVSA), alternating motion rates (AMRs), and sequential motion rates (SMRs) were analyzed in 36 ALS patients and 20 sex/age-matched healthy controls (HCs). tVSA, AMR, and SMR values significantly differed between ALS and HCs, and between ALS with prevalent upper (pUMN) and lower motor neuron (pLMN) impairment. tVSA showed higher accuracy in discriminating pUMN from pLMN patients. AMR and SMR were significantly lower in patients with bulbar onset than those with spinal onset, both with and without bulbar symptoms. Furthermore, these values were also lower in patients with spinal onset associated with bulbar symptoms than in those with spinal onset alone. Additionally, AMR and SMR values correlated with the degree of dysphagia. Acoustic voice analysis may be considered a useful prognostic tool to differentiate spastic and flaccid dysarthria and to assess the degree of bulbar involvement in ALS.
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Affiliation(s)
- Giammarco Milella
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Diletta Sciancalepore
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
| | - Giada Cavallaro
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
| | - Glauco Piccirilli
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Alfredo Gabriele Nanni
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Angela Fraddosio
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Eustachio D’Errico
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Damiano Paolicelli
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Maria Luisa Fiorella
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
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Bouvier L, Green JR, Tapia CB, Tilton-Bolowsky V, Maffei MF, Fless Z, Seaver K, Huynh A, Gutz SE, Martino R, Abrahao A, Berry J, Zinman L, Yunusova Y. Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote: Test-Retest and Interrater Reliability of Candidate Items. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1884-1900. [PMID: 37494887 PMCID: PMC10561957 DOI: 10.1044/2023_ajslp-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] [Received: 05/31/2022] [Revised: 10/27/2022] [Accepted: 06/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The primary aim of this study was to establish the reliability of candidate items as a step in the development of the Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote (ALS-BDI-Remote), a novel tool being developed for the detection and monitoring of bulbar signs and symptoms in remote settings. METHOD The set of candidate items included 40 items covering three domains: cranial nerve examination, auditory-perceptual evaluation, and functional assessment. Forty-eight participants diagnosed with ALS and exhibiting a range of bulbar disease severity were included. Data collection for each participant took place on Zoom over three sessions. During Session 1, the participants were instructed to adjust their Zoom settings and to optimize their recording environment (e.g., lighting, background noise). Their cognition and eating were screened to determine their ability to follow instructions and their eligibility to perform the swallowing and chewing tasks. During Session 2, two speech-language pathologists (SLPs) administered the tool consecutively to determine the items' interrater reliability. During Session 3, one of the SLPs readministered the tool within 2 weeks of Session 1 to assess test-retest reliability. The reliability of each item was estimated using weighted kappa and the percentage of agreement. To be considered reliable, the items had to reach a threshold of 0.5 weighted kappa or 80% percentage agreement (if skewed distribution of the scores) for both interrater and test-retest reliability. RESULTS In total, 33 of the 40 candidate items reached the reliability cutoff for both reliability analyses. All assessment domains included reliable items. Items requiring very good visualization of structures or movements were generally less reliable. CONCLUSIONS This study resulted in the selection of reliable items to be included in the next version of the ALS-BDI-Remote, which will undergo psychometric evaluation (reliability, validity, and responsiveness analyses). Additionally, the results contributed to our understanding of the remote administration of SLP assessments for telehealth applications.
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Affiliation(s)
- Liziane Bouvier
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Carolina Barnett Tapia
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Victoria Tilton-Bolowsky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Zuzana Fless
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Katie Seaver
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Anna Huynh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Rosemary Martino
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Lorne Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yana Yunusova
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
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18
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Kothare H, Neumann M, Liscombe J, Green J, Ramanarayanan V. Responsiveness, Sensitivity and Clinical Utility of Timing-Related Speech Biomarkers for Remote Monitoring of ALS Disease Progression. INTERSPEECH 2023; 2023:2323-2327. [PMID: 39006831 PMCID: PMC11246071 DOI: 10.21437/interspeech.2023-2002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In this study, we describe the responsiveness of timing-related measures extracted from read speech in persons with ALS (pALS) collected via a remote patient monitoring platform in an effort to quantify how long it takes to detect a clinically-meaningful change associated with disease progression. We found that the timing alignment of pALS speech relative to a canonical elicitation of the same prompt is the most responsive measure, of the ones considered in this study, at detecting such change in both pALS with bulbar (n = 35) and non-bulbar onset (n = 94). We further evaluated the sensitivity of speech metrics in tracking disease progression in pALS while their ALSFRS-R speech score remained unchanged at 3 out of a total possible score of 4. We observed that timing-related speech metrics showed significant longitudinal changes even after accounting for learning effects. The findings of this study have the potential to inform disease prognosis and functional outcomes of clinical trials.
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Affiliation(s)
| | | | | | - Jordan Green
- MGH Institute of Healthcare Professions, Boston, MA USA
| | - Vikram Ramanarayanan
- Modality.AI, Inc., San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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Tröger J, Baltes J, Baykara E, Kasper E, Kring M, Linz N, Robin J, Schäfer S, Schneider A, Hermann A. PROSA-a multicenter prospective observational study to develop low-burden digital speech biomarkers in ALS and FTD. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-10. [PMID: 37516990 DOI: 10.1080/21678421.2023.2239312] [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: 03/24/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
Objective: There is a need for novel biomarkers that can indicate disease state, project disease progression, or assess response to treatment for amyotrophic lateral sclerosis (ALS) and associated neurodegenerative diseases such as frontotemporal dementia (FTD). Digital biomarkers are especially promising as they can be collected non-invasively and at low burden for patients. Speech biomarkers have the potential to objectively measure cognitive, motor as well as respiratory symptoms at low-cost and in a remote fashion using widely available technology such as telephone calls. Methods: The PROSA study aims to develop and evaluate low-burden frequent prognostic digital speech biomarkers. The main goal is to create a single, easy-to-perform battery that serves as a valid and reliable proxy for cognitive, respiratory, and motor domains in ALS and FTD. The study will be a multicenter 12-months observational study aiming to include 75 ALS and 75 FTD patients as well as 50 healthy controls and build on three established longitudinal cohorts: DANCER, DESCRIBE-ALS and DESCRIBE-FTD. In addition to the extensive clinical phenotyping in DESCRIBE, PROSA collects a comprehensive speech protocol in fully remote and automated fashion over the telephone at four time points. This longitudinal speech data, together with gold standard measures, will allow advanced speech analysis using artificial intelligence for the development of speech-based phenotypes of ALS and FTD patients measuring cognitive, motor and respiratory symptoms. Conclusion: Speech-based phenotypes can be used to develop diagnostic and prognostic models predicting clinical change. Results are expected to have implications for future clinical trial stratification as well as supporting innovative trial designs in ALS and FTD.
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Affiliation(s)
| | - Judith Baltes
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Elisabeth Kasper
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Martha Kring
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | | | | | | | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Andreas Hermann
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany, and
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, Rostock, Germany
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20
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Shellikeri S, Cho S, Ash S, Gonzalez-Recober C, McMillan CT, Elman L, Quinn C, Amado DA, Baer M, Irwin DJ, Massimo L, Olm C, Liberman M, Grossman M, Nevler N. Digital markers of motor speech impairments in natural speech of patients with ALS-FTD spectrum disorders. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.29.23289308. [PMID: 37205390 PMCID: PMC10187360 DOI: 10.1101/2023.04.29.23289308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background and objectives Patients with ALS-FTD spectrum disorders (ALS-FTSD) have mixed motor and cognitive impairments and require valid and quantitative assessment tools to support diagnosis and tracking of bulbar motor disease. This study aimed to validate a novel automated digital speech tool that analyzes vowel acoustics from natural, connected speech as a marker for impaired articulation due to bulbar motor disease in ALS-FTSD. Methods We used an automatic algorithm called Forced Alignment Vowel Extraction (FAVE) to detect spoken vowels and extract vowel acoustics from 1 minute audio-recorded picture descriptions. Using automated acoustic analysis scripts, we derived two articulatory-acoustic measures: vowel space area (VSA, in Bark 2 ) which represents tongue range-of-motion (size), and average second formant slope of vowel trajectories (F2 slope) which represents tongue movement speed. We compared vowel measures between ALS with and without clinically-evident bulbar motor disease (ALS+bulbar vs. ALS-bulbar), behavioral variant frontotemporal dementia (bvFTD) without a motor syndrome, and healthy controls (HC). We correlated impaired vowel measures with bulbar disease severity, estimated by clinical bulbar scores and perceived listener effort, and with MRI cortical thickness of the orobuccal part of the primary motor cortex innervating the tongue (oralPMC). We also tested correlations with respiratory capacity and cognitive impairment. Results Participants were 45 ALS+bulbar (30 males, mean age=61±11), 22 ALS-nonbulbar (11 males, age=62±10), 22 bvFTD (13 males, age=63±7), and 34 HC (14 males, age=69±8). ALS+bulbar had smaller VSA and shallower average F2 slopes than ALS-bulbar (VSA: | d |=0.86, p =0.0088; F2 slope: | d |=0.98, p =0.0054), bvFTD (VSA: | d |=0.67, p =0.043; F2 slope: | d |=1.4, p <0.001), and HC (VSA: | d |=0.73, p =0.024; F2 slope: | d |=1.0, p <0.001). Vowel measures declined with worsening bulbar clinical scores (VSA: R=0.33, p =0.033; F2 slope: R=0.25, p =0.048), and smaller VSA was associated with greater listener effort (R=-0.43, p =0.041). Shallower F2 slopes were related to cortical thinning in oralPMC (R=0.50, p =0.03). Neither vowel measure was associated with respiratory nor cognitive test scores. Conclusions Vowel measures extracted with automatic processing from natural speech are sensitive to bulbar motor disease in ALS-FTD and are robust to cognitive impairment.
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21
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Picher-Martel V, Magnussen C, Blais M, Bubela T, Das S, Dionne A, Evans AC, Genge A, Greiner R, Iturria-Medina Y, Johnston W, Jones K, Kaneb H, Karamchandani J, Moradipoor S, Robertson J, Rogaeva E, Taylor DM, Vande Velde C, Yunusova Y, Zinman L, Kalra S, Dupré N. CAPTURE ALS: the comprehensive analysis platform to understand, remedy and eliminate ALS. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:33-39. [PMID: 35195049 DOI: 10.1080/21678421.2022.2041668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The absence of disease modifying treatments for amyotrophic lateral sclerosis (ALS) is in large part a consequence of its complexity and heterogeneity. Deep clinical and biological phenotyping of people living with ALS would assist in the development of effective treatments and target specific biomarkers to monitor disease progression and inform on treatment efficacy. The objective of this paper is to present the Comprehensive Analysis Platform To Understand Remedy and Eliminate ALS (CAPTURE ALS), an open and translational platform for the scientific community currently in development. CAPTURE ALS is a Canadian-based platform designed to include participants' voices in its development and through execution. Standardized methods will be used to longitudinally characterize ALS patients and healthy controls through deep clinical phenotyping, neuroimaging, neurocognitive and speech assessments, genotyping and multisource biospecimen collection. This effort plugs into complementary Canadian and international initiatives to share common resources. Here, we describe in detail the infrastructure, operating procedures, and long-term vision of CAPTURE ALS to facilitate and accelerate translational ALS research in Canada and beyond.
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Affiliation(s)
- Vincent Picher-Martel
- CERVO Brain Research Centre, Université Laval, Quebec, QC, Canada.,Neuroscience Axis, CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Claire Magnussen
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Mathieu Blais
- Neuroscience Axis, CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Samir Das
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Annie Dionne
- Neuroscience Axis, CHU de Québec - Université Laval, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Alan C Evans
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Angela Genge
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Russell Greiner
- Department of Computing Science, Faculty of Science, Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | - Yasser Iturria-Medina
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Wendy Johnston
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kelvin Jones
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Hannah Kaneb
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Jason Karamchandani
- The Montreal Neurological Institute- Hospital, McGill University Montreal, Québec, QC, Canada
| | - Sara Moradipoor
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Janice Robertson
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | | | - Christine Vande Velde
- Department of Neurosciences, Université de Montréal, and CHUM Research Center, Montréal, QC, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada, and
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sanjay Kalra
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicolas Dupré
- Neuroscience Axis, CHU de Québec - Université Laval, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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22
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Guarin DL, Taati B, Abrahao A, Zinman L, Yunusova Y. Video-Based Facial Movement Analysis in the Assessment of Bulbar Amyotrophic Lateral Sclerosis: Clinical Validation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4667-4678. [PMID: 36367528 PMCID: PMC9940890 DOI: 10.1044/2022_jslhr-22-00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE Facial movement analysis during facial gestures and speech provides clinically useful information for assessing bulbar amyotrophic lateral sclerosis (ALS). However, current kinematic methods have limited clinical application due to the equipment costs. Recent advancements in consumer-grade hardware and machine/deep learning made it possible to estimate facial movements from videos. This study aimed to establish the clinical validity of a video-based facial analysis for disease staging classification and estimation of clinical scores. METHOD Fifteen individuals with ALS and 11 controls participated in this study. Participants with ALS were stratified into early and late bulbar ALS groups based on their speaking rate. Participants were recorded with a three-dimensional (3D) camera (color + depth) while repeating a simple sentence 10 times. The lips and jaw movements were estimated, and features related to sentence duration and facial movements were used to train a machine learning model for multiclass classification and to predict the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore and speaking rate. RESULTS The classification model successfully separated healthy controls, the early ALS group, and the late ALS group with an overall accuracy of 96.1%. Video-based features demonstrated a high ability to estimate the speaking rate (adjusted R 2 = .82) and a moderate ability to predict the ALSFRS-R bulbar subscore (adjusted R 2 = .55). CONCLUSIONS The proposed approach based on a 3D camera and machine learning algorithms represents an easy-to-use and inexpensive system that can be included as part of a clinical assessment of bulbar ALS to integrate facial movement analysis with other clinical data seamlessly.
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Affiliation(s)
- Diego L. Guarin
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville
| | - Babak Taati
- KITE–Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Computer Science, University of Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Lorne Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Cognitive Neurology, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Yana Yunusova
- KITE–Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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23
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Moon AM, Kim HP, Cook S, Blanchard RT, Haley KL, Jacks A, Shafer JS, Fried MW. Speech patterns and enunciation for encephalopathy determination-A prospective study of hepatic encephalopathy. Hepatol Commun 2022; 6:2876-2885. [PMID: 35861546 PMCID: PMC9512449 DOI: 10.1002/hep4.2054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/01/2022] [Accepted: 06/22/2022] [Indexed: 01/05/2023] Open
Abstract
Hepatic encephalopathy (HE) is a complication of cirrhosis that benefits from early diagnosis and treatment. We aimed to characterize speech patterns of individuals with HE to investigate its potential to diagnose and monitor HE. This was a single-center prospective cohort study that included participants with cirrhosis with HE (minimal HE [MHE] and overt HE [OHE]), cirrhosis without HE, and participants without liver disease. Audio recordings of reading, sentence repetition, and picture description tasks were obtained from these groups. Two certified speech-language pathologists assessed speech rate (words per minute) and articulatory precision. An overall severity metric was derived from these measures. Cross-sectional analyses were performed using nonparametric Wilcoxon statistics to evaluate group differences. Change over time in speech measures was analyzed descriptively for individuals with HE. The study included 43 total participants. Speech results differed by task, but the overall pattern showed slower speech rate and less precise articulation in participants with OHE compared to other groups. When speech rate and precision ratings were combined into a single speech severity metric, the impairment of participants with OHE was more severe than all other groups, and MHE had greater speech impairment than non-liver disease controls. As OHE improved clinically, participants showed notable improvement in speech rate. Participants with OHE demonstrated impaired speech rate, precision, and speech severity compared with non-liver disease and non-HE cirrhosis. Participants with MHE had less pronounced impairments. Speech parameters improved as HE clinically improved. Conclusion: These data identify speech patterns that could improve HE diagnosis, grading, and remote monitoring.
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Affiliation(s)
- Andrew M. Moon
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Hannah P. Kim
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sarah Cook
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Renee T. Blanchard
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Katarina L. Haley
- Division of Speech and Hearing SciencesDepartment of Allied Health SciencesUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Adam Jacks
- Division of Speech and Hearing SciencesDepartment of Allied Health SciencesUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Jennifer S. Shafer
- Division of Speech and Hearing SciencesDepartment of Allied Health SciencesUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Michael W. Fried
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
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24
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Gutz SE, Rowe HP, Tilton-Bolowsky VE, Green JR. Speaking with a KN95 face mask: a within-subjects study on speaker adaptation and strategies to improve intelligibility. Cogn Res Princ Implic 2022; 7:73. [PMID: 35907167 PMCID: PMC9339031 DOI: 10.1186/s41235-022-00423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Mask-wearing during the COVID-19 pandemic has prompted a growing interest in the functional impact of masks on speech and communication. Prior work has shown that masks dampen sound, impede visual communication cues, and reduce intelligibility. However, more work is needed to understand how speakers change their speech while wearing a mask and to identify strategies to overcome the impact of wearing a mask. Data were collected from 19 healthy adults during a single in-person session. We investigated the effects of wearing a KN95 mask on speech intelligibility, as judged by two speech-language pathologists, examined speech kinematics and acoustics associated with mask-wearing, and explored KN95 acoustic filtering. We then considered the efficacy of three speaking strategies to improve speech intelligibility: Loud, Clear, and Slow speech. To inform speaker strategy recommendations, we related findings to self-reported speaker effort. Results indicated that healthy speakers could compensate for the presence of a mask and achieve normal speech intelligibility. Additionally, we showed that speaking loudly or clearly-and, to a lesser extent, slowly-improved speech intelligibility. However, using these strategies may require increased physical and cognitive effort and should be used only when necessary. These results can inform recommendations for speakers wearing masks, particularly those with communication disorders (e.g., dysarthria) who may struggle to adapt to a mask but can respond to explicit instructions. Such recommendations may further help non-native speakers and those communicating in a noisy environment or with listeners with hearing loss.
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Affiliation(s)
- Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA USA
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Building 79/96, 2nd floor, 13th Street, Boston, MA 02129 USA
| | - Victoria E. Tilton-Bolowsky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Building 79/96, 2nd floor, 13th Street, Boston, MA 02129 USA
| | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA USA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Building 79/96, 2nd floor, 13th Street, Boston, MA 02129 USA
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25
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Da Cunha E, Plonka A, Arslan S, Mouton A, Meyer T, Robert P, Meunier F, Manera V, Gros A. Logogenic Primary Progressive Aphasia or Alzheimer Disease: Contribution of Acoustic Markers in Early Differential Diagnosis. Life (Basel) 2022; 12:933. [PMID: 35888023 PMCID: PMC9316974 DOI: 10.3390/life12070933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
The logopenic variant of Primary Progressive Aphasia (lvPPA), a syndromic disorder centered on language impairment, often presents variable underlying neurodegenerative pathologies such as Alzheimer Disease (AD). Actual language assessment tests and lumbar puncture, focused on AD diagnosis, cannot precisely distinguish the symptoms, or predict their progression at onset time. We analyzed acoustic markers, aiming to discriminate lvPPA and AD as well as the influence of AD biomarkers on acoustic profiles at the beginning of the disease. We recruited people with AD (n = 8) and with lvPPA (n = 8), with cerebrospinal fluid biomarker profiles determined by lumbar puncture. The participants performed a sentence repetition task that allows assessing potential lvPPA phonological loop deficits. We found that temporal and prosodic markers significantly differentiate the lvPPA and AD group at an early stage of the disease. Biomarker and acoustic profile comparisons discriminated the two lvPPA subgroups according to their biomarkers. For lvPPA with AD biomarkers, acoustic profile equivalent to an atypical AD form with a specific alteration of the phonological loop is shown. However, lvPPA without AD biomarkers has an acoustic profile approximating the one for DLFT. Therefore, these results allow us to classify lvPPA differentially from AD based on acoustic markers from a sentence repetition task. Furthermore, our results suggest that acoustic analysis would constitute a clinically efficient alternative to refused lumbar punctures. It offers the possibility to facilitate early, specific, and accessible neurodegenerative diagnosis and may ease early care with speech therapy, preventing the progression of symptoms.
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Affiliation(s)
- Eloïse Da Cunha
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
| | - Alexandra Plonka
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
- Institut NeuroMod, Université Côte d’Azur, 06902 Sophia-Antipolis, France
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
| | - Seçkin Arslan
- BCL, CNRS UMR7320, Campus Saint Jean d’Angely—SJA3/MSHS-SE, Université Côte d’Azur, 06300 Nice, France; (S.A.); (F.M.)
| | - Aurélie Mouton
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
| | - Tess Meyer
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
| | - Philippe Robert
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
| | - Fanny Meunier
- BCL, CNRS UMR7320, Campus Saint Jean d’Angely—SJA3/MSHS-SE, Université Côte d’Azur, 06300 Nice, France; (S.A.); (F.M.)
| | - Valeria Manera
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
| | - Auriane Gros
- Speech Therapy Department of Nice, Faculty of medicine, Université Côte d’Azur, 06000 Nice, France; (A.P.); (A.M.); (T.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France;
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
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26
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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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27
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Apreleva Kolomeytseva AT, Brylev L, Eshghi M, Bottaeva Z, Zhang J, Fachner JC, Street AJ. Home-Based Music Therapy to Support Bulbar and Respiratory Functions of Persons with Early and Mid-Stage Amyotrophic Lateral Sclerosis-Protocol and Results from a Feasibility Study. Brain Sci 2022; 12:494. [PMID: 35448025 PMCID: PMC9027911 DOI: 10.3390/brainsci12040494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Respiratory failure, malnutrition, aspiration pneumonia, and dehydration are the precursors to mortality in ALS. Loss of natural communication is considered one of the worst aspects of ALS. This first study to test the feasibility of a music therapy protocol for bulbar and respiratory rehabilitation in ALS employs a mixed-methods case study series design with repeated measures. Newly diagnosed patients meeting the inclusion criteria were invited to participate, until the desired sample size (n = 8) was achieved. The protocol was delivered to participants in their homes twice weekly for six weeks. Individualised exercise sets for independent practice were provided. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation and personal impressions) were collected. Bulbar and respiratory changes were objectively measured. Results. A high recruitment rate (100%), a high retention rate (87.5%) and high mean adherence to treatment (95.4%) provide evidence for the feasibility of the study protocol. The treatment was well tolerated. Mean adherence to the suggested independent exercise routine was 53%. The outcome measurements to evaluate the therapy-induced change in bulbar and respiratory functions were defined. Findings suggest that the protocol is safe to use in early- and mid-stage ALS and that music therapy was beneficial for the participants' bulbar and respiratory functions. Mean trends suggesting that these functions were sustained or improved during the treatment period were observed for most outcome parameters: Maximal Inspiratory Pressure, Maximal Expiratory Pressure, Peak Expiratory Flow, the Center for Neurologic Study-Bulbar Function Scale speech and swallowing subscales, Maximum Phonation Time, Maximum Repetition Rate-Alternating, Maximum Repetition Rate-Sequential, Jitter, Shimmer, NHR, Speaking rate, Speech-pause ratio, Pause frequency, hypernasality level, Time-to-Laryngeal Vestibule Closure, Maximum Pharyngeal Constriction Area, Peak Position of the Hyoid Bone, Total Pharyngeal Residue C24area. Conclusion. The suggested design and protocol are feasible for a larger study, with some modifications, including aerodynamic measure of nasalance, abbreviated voice sampling and psychological screening.
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Affiliation(s)
| | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, 115419 Moscow, Russia;
- Institute of Higher Nervous Activity and Neurophysiology, 115419 Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, 115419 Moscow, Russia
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129-4557, USA;
| | - Zhanna Bottaeva
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, 119180 Moscow, Russia;
| | - Jufen Zhang
- Faculty of Health, Education, Medicine & Social Care, School of Medicine, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Jörg C. Fachner
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Alexander J. Street
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
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28
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Yunusova Y, Waito A, Barnett C, Huynh A, Martino R, Abrahao A, Pattee GL, Berry JD, Zinman L, Green JR. Protocol for psychometric evaluation of the Amyotrophic Lateral Sclerosis - Bulbar Dysfunction Index (ALS-BDI): a prospective longitudinal study. BMJ Open 2022; 12:e060102. [PMID: 35260465 PMCID: PMC8905936 DOI: 10.1136/bmjopen-2021-060102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Current clinical bulbar assessment tools are lacking, while existing physiological instrumental assessments are often inaccessible and cost-prohibitive for clinical application. The goal of our research is to develop and validate a brief and reliable, clinician-administered assessment tool-the ALS-Bulbar Dysfunction Index (ALS-BDI). This publication describes the study protocol that has been established to ascertain the tools' psychometric properties. METHODS AND ANALYSIS The ALD-BDI's development closely follows guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Through the proposed study protocol, we expect to establish psychometric properties of both individual test items of the ALS-BDI as well as the final version of the entire tool, including test-retest and inter-rater reliability, construct validity using gold-standard assessment methods and responsiveness. ETHICS AND DISSEMINATION This study has been reviewed and approved by research ethics boards at two data collection sites: Sunnybrook Health Science Centre, primary (Toronto, Canada; ID3080) and Mass General Brigham (#2013P001746, Boston, USA). Prior to participation in the study, the participants sign the informed consent in accordance with the Declaration of Helsinki. Once validated, the ALS-BDI will be disseminated to key stakeholders. Following validation, the ALS-BDI and any required training material will be implemented for clinical use in a context of a multidisciplinary ALS clinic and used as an outcome measure for clinical trials in ALS research.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ashley Waito
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Carolina Barnett
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Anna Huynh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - James D Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, Massachusetts, USA
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29
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Stipancic KL, Palmer KM, Rowe HP, Yunusova Y, Berry JD, Green JR. "You Say Severe, I Say Mild": Toward an Empirical Classification of Dysarthria Severity. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4718-4735. [PMID: 34762814 PMCID: PMC9150682 DOI: 10.1044/2021_jslhr-21-00197] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/07/2021] [Accepted: 08/12/2021] [Indexed: 05/19/2023]
Abstract
PURPOSE The main purpose of this study was to create an empirical classification system for speech severity in patients with dysarthria secondary to amyotrophic lateral sclerosis (ALS) by exploring the reliability and validity of speech-language pathologists' (SLPs') ratings of dysarthric speech. METHOD Ten SLPs listened to speech samples from 52 speakers with ALS and 20 healthy control speakers. SLPs were asked to rate the speech severity of the speakers using five response options: normal, mild, moderate, severe, and profound. Four severity-surrogate measures were also calculated: SLPs transcribed the speech samples for the calculation of speech intelligibility and rated the effort it took to understand the speakers on a visual analog scale. In addition, speaking rate and intelligible speaking rate were calculated for each speaker. Intrarater and interrater reliability were calculated for each measure. We explored the validity of clinician-based severity ratings by comparing them to the severity-surrogate measures. Receiver operating characteristic (ROC) curves were conducted to create optimal cutoff points for defining dysarthria severity categories. RESULTS Intrarater and interrater reliability for the clinician-based severity ratings were excellent and were comparable to reliability for the severity-surrogate measures explored. Clinician severity ratings were strongly associated with all severity-surrogate measures, suggesting strong construct validity. We also provided a range of values for each severity-surrogate measure within each severity category based on the cutoff points obtained from the ROC analyses. CONCLUSIONS Clinician severity ratings of dysarthric speech are reliable and valid. We discuss the underlying challenges that arise when selecting a stratification measure and offer recommendations for a classification scheme when stratifying patients and research participants into speech severity categories.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Kira M. Palmer
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Hannah P. Rowe
- 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
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Geraudie A, Battista P, García AM, Allen IE, Miller ZA, Gorno-Tempini ML, Montembeault M. Speech and language impairments in behavioral variant frontotemporal dementia: A systematic review. Neurosci Biobehav Rev 2021; 131:1076-1095. [PMID: 34673112 DOI: 10.1016/j.neubiorev.2021.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/11/2023]
Abstract
Although behavioral variant frontotemporal dementia (bvFTD) is classically defined by behavioral and socio-emotional changes, impairments often extend to other cognitive functions. These include early speech and language deficits related to the disease's core neural disruptions. Yet, their scope and clinical relevance remains poorly understood. This systematic review characterizes such disturbances in bvFTD, considering clinically, neuroanatomically, genetically, and neuropathologically defined subgroups. We included 181 experimental studies, with at least 5 bvFTD patients diagnosed using accepted criteria, comparing speech and language outcomes between bvFTD patients and healthy controls or between bvFTD subgroups. Results reveal extensive and heterogeneous deficits across cohorts, with (a) consistent lexico-semantic, reading & writing, and prosodic impairments; (b) inconsistent deficits in motor speech and grammar; and (c) relative preservation of phonological skills. Also, preliminary findings suggest that the severity of speech and language deficits might be associated with global cognitive impairment, predominantly temporal or fronto-temporal atrophy and MAPT mutations (vs C9orf72). Although under-recognized, these impairments contribute to patient characterization and phenotyping, while potentially informing diagnosis and management.
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Affiliation(s)
- Amandine Geraudie
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Petronilla Battista
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, USA; Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo, Bari, Italy
| | - Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, USA; Universidad De San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Isabel E Allen
- Global Brain Health Institute, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, USA
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA.
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Shellikeri S, Marzouqah R, Brooks BR, Zinman L, Green JR, Yunusova Y. Psychometric Properties of Rapid Word-Based Rate Measures in the Assessment of Bulbar Amyotrophic Lateral Sclerosis: Comparisons With Syllable-Based Rate Tasks. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4178-4191. [PMID: 34699273 PMCID: PMC9499363 DOI: 10.1044/2021_jslhr-21-00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
Purpose Rapid maximum performance repetition tasks have increasingly demonstrated their utility as clinimetric markers supporting diagnosis and monitoring of bulbar disease in amyotrophic lateral sclerosis (ALS). A recently developed protocol uses novel real-word repetitions instead of traditional nonword/syllable sequences in hopes of improving sensitivity to motor speech impairments by adding a phonological target constraint that would activate a greater expanse of the motor speech neuroanatomy. This study established the psychometric properties of this novel clinimetric protocol in its assessment of bulbar ALS and compared performance to traditional syllable sequence dysdiadochokinetic (DDK) tasks. Specific objectives were to (a) compare rates between controls and speakers with symptomatic versus presymptomatic bulbar disease, (b) characterize their discriminatory ability in detecting presymptomatic bulbar disease compared to healthy speech, (c) determine their articulatory movement underpinnings, and (d) establish within-individual longitudinal changes. Method DDK and novel tongue ("ticker"-TAR) and labial ("pepper"-LAR) articulatory rates were compared between n = 18 speakers with presymptomatic bulbar disease, n = 10 speakers with symptomatic bulbar disease, and n = 13 healthy controls. Bulbar disease groups were determined by a previously validated speaking rate cutoff. Discriminatory ability was determined using receiver operating characteristic analysis. Within-individual change over time was characterized in a subset of 16 participants with available longitudinal data using linear mixed-effects models. Real-time articulatory movements of the tongue front, tongue dorsum, jaw, and lips were captured using 3-D electromagnetic articulography; effects of movement displacement and speed on clinimetric rates were determined using stepwise linear regressions. Results All clinimetric rates (traditional DDK tasks and novel tasks) were reduced in speakers with symptomatic bulbar disease; only TAR was reduced in speakers with presymptomatic bulbar disease and was able to detect this group with an excellent discrimination ability (area under the curve = 0.83). Kinematic analyses revealed associations with expected articulators, greater motor complexity, and differential articulatory patterns for the novel real-word repetitions than their DDK counterparts. Only LAR significantly declined longitudinally over the disease course. Conclusion Novel real-word clinimetric rate tasks evaluating tongue and labial articulatory dysfunction are valid and effective markers for early detection and tracking of bulbar disease in ALS.
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Affiliation(s)
- Sanjana Shellikeri
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Benjamin Rix Brooks
- Department of Neurology, Carolinas Medical Center, Carolinas Neuromuscular/ALS-MDA Care Center Atrium Health Neurosciences Institute, University of North Carolina, Charlotte
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Ontario, Canada
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Suárez‐González A, Cassani A, Gopalan R, Stott J, Savage S. When it is not primary progressive aphasia: A scoping review of spoken language impairment in other neurodegenerative dementias. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12205. [PMID: 34485677 PMCID: PMC8409087 DOI: 10.1002/trc2.12205] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive difficulties with spoken language occur across the spectrum of degenerative dementia. When not a primary presenting and dominant symptom, language difficulties may be overlooked in favor of more prominent cognitive, behavior, or motor deficits. The aim of this scoping review is to examine the extent and nature of the research evidence describing (1) the spoken language impairments found in non-language led dementias, (2) their impact on everyday living, and (3) the reported language interventions. METHODS We searched PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and SpeechBITE using terms related to spoken language for the following dementia types: Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), cortico-basal syndrome (CBS), behavior variant frontotemporal dementia (bvFTD), early-onset Alzheimer's disease (EOAD), posterior cortical atrophy (PCA), and motor neuron disease associated with FTD (MND+FTD). Risk of bias was assessed with the QualSyst tool. RESULTS Seventy-three eligible studies were included. A wide range of spoken language impairments were reported, involving both linguistic (e.g., syntactic processing) and other cognitive (e.g., sustained attention) underlying mechanisms. Although the severity of these deficits was scarcely reported, in some cases they manifested as non-fluent, dynamic, and global aphasias. No papers in the review described either the impact of these language impairments on everyday living or language therapies to treat them. DISCUSSION There is a need to understand better the level of disability produced by language impairment in people living with non-language-led dementias. Our findings suggest three calls for action: (1) research studies should assess the clinical relevance of any spoken language deficits examined, (2) both linguistic and cognitive underlying mechanisms should be fully described (to inform the design of effective language and behavioral interventions), and (3) trials of language therapy should be conducted in those groups of individuals where significant language impairment is proved.
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Affiliation(s)
- Aida Suárez‐González
- Dementia Research CentreUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Alice Cassani
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Ragaviveka Gopalan
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Joshua Stott
- Research Department of ClinicalEducational and Health PsychologyUniversity College LondonLondonUK
| | - Sharon Savage
- School of PsychologyUniversity of NewcastleNewcastleNew South WalesAustralia
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Lee J, Madhavan A, Krajewski E, Lingenfelter S. Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence. Muscle Nerve 2021; 64:520-531. [PMID: 34296769 DOI: 10.1002/mus.27361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022]
Abstract
Bulbar dysfunction is a common presentation of amyotrophic lateral sclerosis (ALS) and significantly impacts quality of life of people with ALS (PALS). The current paper reviews measurements of dysarthria and dysphagia specific to ALS to identify efficient and valid assessment measures. Using such assessment measures will lead to improved management of bulbar dysfunction in ALS. Measures reviewed for dysarthria in PALS are organized into three categories: acoustic, kinematic, and strength. A set of criteria are used to evaluate the effectiveness of the measures' identification of speech impairments, measurement of functional verbal communication, and clinical applicability. Assessments reviewed for dysphagia in PALS are organized into six categories: patient reported outcomes, dietary intake, pulmonary function and airway defense capacity, bulbar function, dysphagia/aspiration screens, and instrumental evaluations. Measurements that have good potential for clinical use are highlighted in both topic areas. Additionally, areas of improvement for clinical practice and research are identified and discussed. In general, no single speech measure fulfilled all the criteria, although a few measures were identified as potential diagnostic tools. Similarly, few objective measures that were validated and replicated with large sample sizes were found for diagnosis of dysphagia in PALS. Importantly, clinical applicability was found to be limited; thus, a collaborative team focused on implementation science would be helpful to improve the clinical uptake of assessments. Overall, the review highlights the need for further development of clinically viable and efficient measurements that use a multidisciplinary approach.
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Affiliation(s)
- Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sydney Lingenfelter
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
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Rong P, Heidrick L. Spatiotemporal Control of Articulation During Speech and Speechlike Tasks in Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1382-1399. [PMID: 33630657 DOI: 10.1044/2020_ajslp-20-00136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study examined the articulatory control of speech and speechlike tasks in individuals with amyotrophic lateral sclerosis (ALS) and neurologically healthy individuals with the aim to identify the most useful set of articulatory features and tasks for assessing bulbar motor involvement in ALS. Method Tongue and jaw kinematics were recorded in 12 individuals with bulbar ALS and 10 healthy controls during a speech task and two speechlike tasks (i.e., alternating motion rate [AMR], sequential motion rate [SMR]). Eight articulatory features were derived for each participant per task, including the range, maximum speed, and acceleration time of tongue and jaw movements as well as the coupling and timing between tongue and jaw movements. The effects of task (i.e., AMR, SMR, speech) and group (i.e., ALS, control) on these articulatory features were evaluated. For each feature, the task that yielded the largest difference between the ALS and control groups was identified. The diagnostic efficacy of these task-specific features was assessed using the receiver operating characteristic analysis; the relation of these task-specific features to a well-established bulbar severity index-speaking rate-was determined using Spearman's rank correlation. Results Seven task-specific articulatory features were identified, including (a) tongue and jaw acceleration time during the AMR task, (b) tongue-jaw coupling during the SMR task, and (c) range of tongue movement, maximum tongue and jaw speed, and temporal lag between tongue and jaw movements during the speech task. Among these features, tongue and jaw acceleration time and their temporal lag showed relatively high accuracy (i.e., 0.83-0.95) in differentiating individuals with ALS from healthy controls. Range of tongue movement and maximum tongue and jaw speed showed significant correlations with speaking rate. Conclusion Findings provided preliminary evidence for the utility of task-specific articulatory measurements as a novel quantitative assessment to detect and predict bulbar motor involvement in ALS.
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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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Stipancic KL, Yunusova Y, Campbell TF, Wang J, Berry JD, Green JR. Two Distinct Clinical Phenotypes of Bulbar Motor Impairment in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:664713. [PMID: 34220673 PMCID: PMC8244731 DOI: 10.3389/fneur.2021.664713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Understanding clinical variants of motor neuron diseases such as amyotrophic lateral sclerosis (ALS) is critical for discovering disease mechanisms and across-patient differences in therapeutic response. The current work describes two clinical subgroups of patients with ALS that, despite similar levels of bulbar motor involvement, have disparate clinical and functional speech presentations. Methods: Participants included 47 healthy control speakers and 126 speakers with ALS. Participants with ALS were stratified into three clinical subgroups (i.e., bulbar asymptomatic, bulbar symptomatic high speech function, and bulbar symptomatic low speech function) based on clinical metrics of bulbar motor impairment. Acoustic and lip kinematic analytics were derived from each participant's recordings of reading samples and a rapid syllable repetition task. Group differences were reported on clinical scales of ALS and bulbar motor severity and on multiple speech measures. Results: The high and low speech-function subgroups were found to be similar on many of the dependent measures explored. However, these two groups were differentiated on the basis of an acoustic measure used as a proxy for tongue movement. Conclusion: This study supports the hypothesis that high and low speech-function subgroups do not differ solely in overall severity, but rather, constitute two distinct bulbar motor phenotypes. The findings suggest that the low speech-function group exhibited more global involvement of the bulbar muscles than the high speech-function group that had relatively intact lingual function. This work has implications for clinical measures used to grade bulbar motor involvement, suggesting that a single bulbar measure is inadequate for capturing differences among phenotypes.
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Affiliation(s)
- Kaila L Stipancic
- Speech and Feeding Disorders Lab, Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States.,UB Motor Speech Disorders Lab, Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Yana Yunusova
- Speech Production Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Thomas F Campbell
- Speech, Language, Cognition, and Communication Lab, Department of Communication Sciences and Disorders, University of Texas at Dallas, Dallas, TX, United States
| | - Jun Wang
- Speech Disorders and Technology Lab, Department of Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, United States
| | - James D Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, MA, United States
| | - Jordan R Green
- Speech and Feeding Disorders Lab, Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States
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Abstract
OBJECTIVE To investigate the impact of cognitive impairment on spoken language produced by speakers with multiple sclerosis (MS) with and without dysarthria. METHOD Sixty speakers comprised operationally defined groups. Speakers produced a spontaneous speech sample to obtain speech timing measures of speech rate, articulation rate, and silent pause frequency and duration. Twenty listeners judged the overall perceptual severity of the samples using a visual analog scale that ranged from no impairment to severe impairment (speech severity). A 2 × 2 factorial design examined main and interaction effects of dysarthria and cognitive impairment on speech timing measures and speech severity in individuals with MS. Each speaker group with MS was further compared to a healthy control group. Exploratory regression analyses examined relationships between cognitive and biopsychosocial variables and speech timing measures and perceptual judgments of speech severity, for speakers with MS. RESULTS Speech timing was significantly slower for speakers with dysarthria compared to speakers with MS without dysarthria. Silent pause durations also significantly differed for speakers with both dysarthria and cognitive impairment compared to MS speakers without either impairment. Significant interactions between dysarthria and cognitive factors revealed comorbid dysarthria and cognitive impairment contributed to slowed speech rates in MS, whereas dysarthria alone impacted perceptual judgments of speech severity. Speech severity was strongly related to pause duration. CONCLUSIONS The findings suggest the nature in which dysarthria and cognitive symptoms manifest in objective, acoustic measures of speech timing and perceptual judgments of severity is complex.
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Tăuţan AM, Ionescu B, Santarnecchi E. Artificial intelligence in neurodegenerative diseases: A review of available tools with a focus on machine learning techniques. Artif Intell Med 2021; 117:102081. [PMID: 34127244 DOI: 10.1016/j.artmed.2021.102081] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Neurodegenerative diseases have shown an increasing incidence in the older population in recent years. A significant amount of research has been conducted to characterize these diseases. Computational methods, and particularly machine learning techniques, are now very useful tools in helping and improving the diagnosis as well as the disease monitoring process. In this paper, we provide an in-depth review on existing computational approaches used in the whole neurodegenerative spectrum, namely for Alzheimer's, Parkinson's, and Huntington's Diseases, Amyotrophic Lateral Sclerosis, and Multiple System Atrophy. We propose a taxonomy of the specific clinical features, and of the existing computational methods. We provide a detailed analysis of the various modalities and decision systems employed for each disease. We identify and present the sleep disorders which are present in various diseases and which represent an important asset for onset detection. We overview the existing data set resources and evaluation metrics. Finally, we identify current remaining open challenges and discuss future perspectives.
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Affiliation(s)
- Alexandra-Maria Tăuţan
- University "Politehnica" of Bucharest, Splaiul Independenţei 313, 060042 Bucharest, Romania.
| | - Bogdan Ionescu
- University "Politehnica" of Bucharest, Splaiul Independenţei 313, 060042 Bucharest, Romania.
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, 330 Brookline Avenue, Boston, United States.
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Communication Efficiency in a Face Transplant Recipient: Determinants and Therapeutic Implications. J Craniofac Surg 2021; 31:e528-e530. [PMID: 32649536 DOI: 10.1097/scs.0000000000006727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We longitudinally assessed speech intelligibility (percent words correct/pwc), communication efficiency (intelligible words per minute/iwpm), temporal control markers (speech and pause coefficients of variation), and formant frequencies associated with lip motion in a 41-year-old face transplant recipient. Pwc and iwpm at 13 months post-transplantation were both higher than preoperative values. Multivariate regression demonstrated that temporal markers and all formant frequencies associated with lip motion were significant predictors (P < 0.05) of communication efficiency, highlighting the interplay of these variables in generating intelligible and effective speech. These findings can guide us in developing personalized rehabilitative approaches in face transplant recipients for optimal speech outcomes.
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Leite Neto L, França Júnior MC, Chun RYS. Speech intelligibility in people with Amyotrophic Lateral Sclerosis (ALS). Codas 2021; 33:e20190214. [PMID: 33533830 DOI: 10.1590/2317-1782/20202019214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS). METHODS Quantitative-descriptive study approved by REC under No. CAAE 62912416.4.0000.5404, comprised of 19 individuals with sporadic or familiar ALS. Data were collected using the Dysarthria Protocol and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-Re). We used visual analogue scale (VAS) to assess speech intelligibility and summary measures; and Spearman's coefficients of correlation for the instruments with significance level of 5%. RESULTS Speech intelligibility is compromised (41.37±39.73) in varied degrees with positive correlation with the general degree of dysarthria (p=<.0001), and with all the analyzed speech parameters, indicating impact on the speech deterioration of the studied group. There is negative correlation between speech intelligibility and the results of the bulbar sections - speech and deglutition (p=0.0166), arm - activities with the upper limb (p=0.0064) and leg - activities with the lower limb (p=0.0391). Breathing (p=0.0178), phonation (p=0.0334) and resonance (p=0.0053) parameters showed a negative correlation with the item "speech" of the ALSFRS-Re. CONCLUSION Results show impaired speech intelligibility and dysarthria, and evidence breathing, phonation and resonance as important markers of the disease progression. A thorough and early evaluation of the oral motor production allows for a better management of alterations in ALS.
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Affiliation(s)
- Lavoisier Leite Neto
- Programa de Pós-graduação Saúde, Interdisciplinaridade e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil
| | | | - Regina Yu Shon Chun
- Programa de Pós-graduação Saúde, Interdisciplinaridade e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil
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Waito AA, Wehbe F, Marzouqah R, Barnett C, Shellikeri S, Cui C, Abrahao A, Zinman L, Green JR, Yunusova Y. Validation of Articulatory Rate and Imprecision Judgments in Speech of Individuals With Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:137-149. [PMID: 33290086 PMCID: PMC8740582 DOI: 10.1044/2020_ajslp-20-00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 05/29/2023]
Abstract
Purpose Perceptual judgments of articulatory function are commonly used by speech-language pathologists to evaluate articulatory performance in individuals with amyotrophic lateral sclerosis (ALS). The goal of this study was to evaluate the psychometric properties (e.g., reliability, validity) of these perceptual measures to inform their application as part of a comprehensive bulbar assessment tool in ALS. Method Preexisting data from 51 individuals with ALS were obtained from a larger longitudinal study. Five independent raters provided perceptual judgments of articulatory rate and imprecision in a sentence task. Inter- and intrarater reliability of these judgments were assessed. Perceptual ratings were correlated with an acoustic measure of articulatory rate, in syllables per second, obtained from passage-reading recordings. Both perceptual and acoustic measures were correlated with gold-standard kinematic tongue and jaw movement measures, recorded from sentences using electromagnetic articulography. Results The results revealed good inter- and intrarater reliability of perceptual judgments of articulatory function. Strong correlations were observed between perceptual ratings of articulatory rate and imprecision and acoustic measures of articulatory rate and kinematic measures of tongue speed. Conclusions These findings support the clinical application of perceptual judgments of articulatory function as valid and reliable measures of underlying articulatory changes in bulbar ALS. Additional research is needed to understand the responsiveness of these measures to clinical changes in articulatory function in ALS.
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Affiliation(s)
- Ashley A. Waito
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sanjana Shellikeri
- Department of Neurology, University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia
| | - Cindy Cui
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lorne Zinman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- L. C. Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA
| | - Yana Yunusova
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Kelly M, Lavrov A, Garcia-Gancedo L, Parr J, Hart R, Chiwera T, Shaw CE, Al-Chalabi A, Marsden R, Turner MR, Talbot K. The use of biotelemetry to explore disease progression markers in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:563-573. [PMID: 32573278 DOI: 10.1080/21678421.2020.1773501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore novel, real-world biotelemetry disease progression markers in patients with amyotrophic lateral sclerosis (ALS) and to compare with clinical gold-standard measures. Methods: This was an exploratory, non-controlled, non-drug 2-phase study comprising a variable length Pilot Phase (n = 5) and a 48-week Core study Phase (n = 25; NCT02447952). Patients with mild or moderate ALS wore biotelemetry sensors for ∼3 days/month at home, measuring physical activity, heart rate variability (HRV), and speech over 48 weeks. These measures were assessed longitudinally in relation to ALS Functional Rating Scale-Revised (ALSFRS-R) score and forced vital capacity (FVC); assessed by telephone [monthly] and clinic visits [every 12 weeks]). Results: Pilot Phase data supported progression into the Core Phase, where a decline in physical activity from baseline followed ALS progression as measured by ALSFRS-R and FVC. Four endpoints showed moderate or strong between-patient correlations with ALSFRS-R total and gross motor domain scores (defined as a correlation coefficient of ≥0.5 or >0.7, respectively): average daytime active; percentage of daytime active; total daytime activity score; total 24-hour activity score. Moderate correlations were observed between speech endpoints and ALSFRS-R bulbar domain scores; HRV data quality was insufficient for reliable assessment. The sensor was generally well tolerated; 6/25 patients reported mostly mild or moderate intensity skin and subcutaneous tissue disorder adverse events. Conclusions: Biotelemetry measures of physical activity in this Pilot Study tracked ALS progression over time, highlighting their potential as endpoints for future clinical trials. A larger, formally powered study is required to further support activity endpoints as novel disease progression markers.
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Affiliation(s)
- Madeline Kelly
- Clinical Translational Medicine, Future Pipeline Discovery, GSK R&D, Hertfordshire, UK
| | - Arseniy Lavrov
- Clinical Translational Medicine, Future Pipeline Discovery, GSK R&D, Middlesex, UK
| | | | - Jim Parr
- McLaren Applied Technologies, Surrey, UK
| | | | - Theresa Chiwera
- United Kingdom Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher E Shaw
- United Kingdom Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | - Rachael Marsden
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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42
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Nevler N, Ash S, McMillan C, Elman L, McCluskey L, Irwin DJ, Cho S, Liberman M, Grossman M. Automated analysis of natural speech in amyotrophic lateral sclerosis spectrum disorders. Neurology 2020; 95:e1629-e1639. [PMID: 32675077 DOI: 10.1212/wnl.0000000000010366] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We implemented automated methods to analyze speech and evaluate the hypothesis that cognitive and motor factors impair prosody in partially distinct ways in patients with amyotrophic lateral sclerosis (ALS). METHODS We recruited 213 participants, including 67 with ALS (44 with motor ALS, 23 with ALS and frontotemporal degeneration [FTD]), 33 healthy controls, and neurodegenerative reference groups with behavioral variant FTD (n = 90) and nonfluent/agrammatic primary progressive aphasia (n = 23). Digitized, semistructured speech samples obtained from picture descriptions were automatically segmented with a Speech Activity Detector; continuous speech segments were pitch-tracked; and duration measures for speech and silent pause segments were extracted. Acoustic measures were calculated, including fundamental frequency (f0) range, mean speech and pause segment durations, total speech duration, and pause rate (pause count per minute of speech). Group comparisons related performance on acoustic measures to clinical scales of cognitive and motor impairments and explored MRI cortical thinning in ALS and ALS-FTD. RESULTS The f0 range was significantly impaired in ALS spectrum disorders and was related to bulbar motor disease, and regression analyses related this to cortical thickness in primary motor cortex and perisylvian regions. Impaired speech and pause duration measures were related to the degree of cognitive impairment in ALS spectrum disorders, and regressions related duration measures to bilateral frontal opercula and left anterior insula. CONCLUSION Automated analyses of acoustic speech properties dissociate motor and cognitive components of speech deficits in ALS spectrum disorders.
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Affiliation(s)
- Naomi Nevler
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia.
| | - Sharon Ash
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Corey McMillan
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Lauren Elman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Leo McCluskey
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - David J Irwin
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Sunghye Cho
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Mark Liberman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia.
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Barnett C, Green JR, Marzouqah R, Stipancic KL, Berry JD, Korngut L, Genge A, Shoesmith C, Briemberg H, Abrahao A, Kalra S, Zinman L, Yunusova Y. Reliability and validity of speech & pause measures during passage reading in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:42-50. [PMID: 32138555 PMCID: PMC7080316 DOI: 10.1080/21678421.2019.1697888] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Objective: The use of speech measures is becoming a common practice in the assessment of bulbar disease progression in amyotrophic lateral sclerosis (ALS). This study aimed to establish psychometric properties (e.g. reliability, validity, sensitivity, specificity) of speech and pause timing measures during a standardized passage. Methods: A large number of passage recordings (ALS N = 775; Neurotypical controls N = 323) was analyzed using a semi-automatic method (Speech and Pause Analysis, SPA). Results: The results revealed acceptable reliability of the speech and pause measures across repeated recording by the control participants. Strong construct validity was established via significant group differences between patients and controls and correlation statistics with clinical measures of overall ALS and bulbar disease severity. Speaking rate, pause events, and mean pause duration were able to detect ALS participants at the presymptomatic stage of bulbar disease with a good discrimination ability (AUC 0.81). Conclusions: Based on the current psychometric evaluation, performing passage recording and speech and pause timing analysis was deemed useful for detecting early and progressive changes associated with bulbar ALS.
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Affiliation(s)
- Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, USA
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Kaila L Stipancic
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - James D Berry
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA,
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Angela Genge
- Montreal Neurological Institute, Neurosurgery, McGill University, Montreal, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Hannah Briemberg
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Agessandro Abrahao
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Division of Neurology, University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Toronto, Canada, and
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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44
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Sluis RA, Angus D, Wiles J, Back A, Gibson T(A, Liddle J, Worthy P, Copland D, Angwin AJ. An Automated Approach to Examining Pausing in the Speech of People With Dementia. Am J Alzheimers Dis Other Demen 2020; 35:1533317520939773. [PMID: 32648470 PMCID: PMC10623991 DOI: 10.1177/1533317520939773] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia is a common neurodegenerative condition involving the deterioration of cognitive and communication skills. Pausing in the speech of people with dementia is a dysfluency that may be used to signal conversational trouble in social interaction. This study aimed to examine the speech-pausing profile within picture description samples from people with dementia and healthy controls (HCs) within the DementiaBank database using the Calpy computational speech processing toolkit. Sixty English-speaking participants between the ages of 53 and 88 years (Mage = 67.43, SD = 8.33; 42 females) were included in the study: 20 participants with mild cognitive impairment, 20 participants with moderate cognitive impairment, and 20 HCs. Quantitative analysis shows a progressive increase in the duration of pausing between HCs, the mild dementia group, and the moderate dementia group, respectively.
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Affiliation(s)
- Rachel A. Sluis
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Daniel Angus
- School of Communication, Queensland University of Technology, Brisbane, Australia
| | - Janet Wiles
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Andrew Back
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Tingting (Amy) Gibson
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Peter Worthy
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Anthony J Angwin
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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45
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Zhao Y, Kuruvilla-Dugdale M, Song M. Voice Conversion for Persons with Amyotrophic Lateral Sclerosis. IEEE J Biomed Health Inform 2019; 24:2942-2949. [PMID: 31880571 DOI: 10.1109/jbhi.2019.2961844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) results in progressive paralysis of voluntary muscles throughout the body. As speech deteriorates, individuals rely on pre-programmed messages available on commercial speech generating devices to communicate using one of the generic electronic voices on the device. To replace these generic voices and restore vocal identity, our aim is to develop personalized voices for people with ALS via the approach of voice conversion. The task is challenging because very few people have large quantities of their premorbid healthy speech recorded. Therefore, we have to rely on small quantities of dysarthric speech concomitant with an individual's disease stage. Further, progressive fatigue prohibits acquisition of large speech datasets and individuals display a range of dysarthria severities resulting from breathing, voice, articulation, resonance, and prosody disturbances. As the first step to address these problems, we use healthy source speakers and propose the approach of combining a structured sparse spectral transform with multiple linear regression-based frequency warping prediction for spectral conversion, and interpolating the transformed spectral frames for speech rate modification. Our experimental data included four healthy source speakers from the ARCTIC dataset, and four target ALS speakers with mild to severe dysarthria, forming 16 speaker pairs. Subjective listening evaluations showed that on average, (i) the proposed approach improved speech intelligibility by about 80% over the target speakers' speech, (ii) the converted voice was 3 times more similar to the target speakers' speech than to the source speakers' speech, and (iii) the converted speech quality was close to the MOS scale "good" relative to the source speakers' speech being "excellent."
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46
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Garcia-Gancedo L, Kelly ML, Lavrov A, Parr J, Hart R, Marsden R, Turner MR, Talbot K, Chiwera T, Shaw CE, Al-Chalabi A. Objectively Monitoring Amyotrophic Lateral Sclerosis Patient Symptoms During Clinical Trials With Sensors: Observational Study. JMIR Mhealth Uhealth 2019; 7:e13433. [PMID: 31859676 PMCID: PMC6942190 DOI: 10.2196/13433] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background Objective symptom monitoring of patients with Amyotrophic Lateral Sclerosis (ALS) has the potential to provide an important source of information to evaluate the impact of the disease on aspects of real-world functional capacity and activities of daily living in the home setting, providing useful objective outcome measures for clinical trials. Objective This study aimed to investigate the feasibility of a novel digital platform for remote data collection of multiple symptoms—physical activity, heart rate variability (HRV), and digital speech characteristics—in 25 patients with ALS in an observational clinical trial setting to explore the impact of the devices on patients’ everyday life and to record tolerability related to the devices and study procedures over 48 weeks. Methods In this exploratory, noncontrolled, nondrug study, patients attended a clinical site visit every 3 months to perform activity reference tasks while wearing a sensor, to conduct digital speech tests and for conventional ALS monitoring. In addition, patients wore the sensor in their daily life for approximately 3 days every month for the duration of the study. Results The amount and quality of digital speech data captured at the clinical sites were as intended, and there were no significant issues. All the home monitoring sensor data available were propagated through the system and were received as expected. However, the amount and quality of physical activity home monitoring data were lower than anticipated. A total of 3 or more days (or partial days) of data were recorded for 65% of protocol time points, with no data collected for 24% of time points. At baseline, 24 of 25 patients provided data, reduced to 13 of 18 patients at Week 48. Lower-than-expected quality HRV data were obtained, likely because of poor contact between the sensor and the skin. In total, 6 of 25 patients had mild or moderate adverse events (AEs) in the skin and subcutaneous tissue disorders category because of skin irritation caused by the electrode patch. There were no reports of serious AEs or deaths. Most patients found the sensor comfortable, with no or minimal impact on daily activities. Conclusions The platform can measure physical activity in patients with ALS in their home environment; patients used the equipment successfully, and it was generally well tolerated. The quantity of home monitoring physical activity data was lower than expected, although it was sufficient to allow investigation of novel physical activity end points. Good-quality in-clinic speech data were successfully captured for analysis. Future studies using objective patient monitoring approaches, combined with the most current technological advances, may be useful to elucidate novel digital biomarkers of disease progression.
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Affiliation(s)
- Luis Garcia-Gancedo
- Advanced Biostatistics & Data Analytics Centre of Excellence, R&D Projects Clinical Platforms & Sciences, GlaxoSmithKline, Stevenage, United Kingdom
| | - Madeline L Kelly
- Translational Medicine, Future Pipeline Discovery, GlaxoSmithKline, Stevenage, United Kingdom
| | - Arseniy Lavrov
- Clinical Development, AveXis, Bannockburn, IL, United States
| | - Jim Parr
- McLaren Technology Centre, McLaren Applied Technologies, Woking, United Kingdom
| | - Rob Hart
- McLaren Technology Centre, McLaren Applied Technologies, Woking, United Kingdom
| | - Rachael Marsden
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Theresa Chiwera
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
| | - Christopher E Shaw
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
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47
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Chiaramonte R, Bonfiglio M. Acoustic analysis of voice in bulbar amyotrophic lateral sclerosis: a systematic review and meta-analysis of studies. LOGOP PHONIATR VOCO 2019; 45:151-163. [DOI: 10.1080/14015439.2019.1687748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rita Chiaramonte
- Department of Physical Medicine and Rehabilitation, University of Catania, Catania, Italy
| | - Marco Bonfiglio
- Department for Health Activities, ASP Siracusa, Siracusa, Italy
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48
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Rong P, Yunusova Y, Eshghi M, Rowe HP, Green JR. A speech measure for early stratification of fast and slow progressors of bulbar amyotrophic lateral sclerosis: lip movement jitter. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:34-41. [PMID: 31694409 DOI: 10.1080/21678421.2019.1681454] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To assess the utility of novel measures derived from a rapid syllable repetition task (i.e. oral dysdiadochokinesis [DDK]) in early stratification of fast and slow progressive bulbar amyotrophic lateral sclerosis (ALS) and prediction of bulbar disease progression rate. Methods: Fifty-four individuals with ALS were tracked longitudinally on their oral DDK and global bulbar/speech performance (i.e. bulbar subscore on the ALS Functional Rating Scale-Revised [ALSFRS-R]; articulation rate during passage reading) for a four-month average duration. Based on the bulbar deterioration rate over the tracked period, the participants were stratified as 14 fast bulbar progressors and 40 slow bulbar progressors using a posteriori classification approach. To determine if oral DDK performance predicts the differential bulbar disease progression trajectories in these individuals during the early stages of the tracked period (prior to significant bulbar/speech signs), twenty-two measures of lip motor performance in an oral DDK task were derived to (1) differentiate fast and slow bulbar progressors using the Receiver Operating Characteristic analysis and (2) predict bulbar disease progression rates across all individuals using linear regressions. Results: Movement jitter, a measure of temporal variability of alternating lip movement during DDK, showed 80% sensitivity and 95% specificity in differentiating fast and slow bulbar progressors early in the disease, and outperformed the ALSFRS-R bulbar subscore and articulation rate. Movement jitter also predicted bulbar disease progression rates across participants. Conclusion: Findings provided preliminary validation of the clinical value of movement jitter during oral DDK in patient stratification and bulbar disease prognosis.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KA, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Marziye Eshghi
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, Boston, MA, USA, and
| | - Hannah P Rowe
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, Boston, MA, USA, and
| | - Jordan R Green
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, Boston, MA, USA, and.,Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, USA
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49
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Berry JD, Paganoni S, Carlson K, Burke K, Weber H, Staples P, Salinas J, Chan J, Green JR, Connaghan K, Barback J, Onnela JP. Design and results of a smartphone-based digital phenotyping study to quantify ALS progression. Ann Clin Transl Neurol 2019; 6:873-881. [PMID: 31139685 PMCID: PMC6529832 DOI: 10.1002/acn3.770] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Objective The amyotrophic lateral sclerosis (ALS) trial outcome measures are clinic based. Active and passive smartphone data can provide important longitudinal information about ALS progression outside the clinic. Methods We used Beiwe, a research platform for smartphone‐based digital phenotyping, to collect active (self‐report ALSFRS‐R surveys and speech recordings) and passive (phone sensors and logs) data from patients with ALS for approximately 24 weeks. In clinics, at baseline and every 3 months, we collected vital capacity, ALSFRS‐R, and ALS‐CBS at enrollment, week 12, and week 24. We also collected ALSFRS‐R by telephone at week 6. Results Baseline in‐clinic ALSFRS‐R and smartphone self‐report correlation was 0.93 (P < 0.001). ALSFRS‐R slopes were equivalent and within‐subject standard deviation was smaller for smartphone‐based self‐report (0.26 vs. 0.56). Use of Beiwe afforded weekly collection of speech samples amenable to a variety of analyses, and we found mean pause time to increase by 0.02 sec per month across the sample. Interpretation Smartphone‐based digital phenotyping in people with ALS is feasible and informative. Self‐administered smartphone ALSFRS‐R scores correlate highly with clinic‐based ALSFRS‐R scores, have low variability, and could be used in clinical trials. More research is required to fully analyze speech recordings and passive data, and to identify optimal digital markers for use in future ALS clinical trials.
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Affiliation(s)
- James D Berry
- School of Medicine Harvard Medical School Boston Massachusetts.,Neurological Clinical Research Institute Department of Neurology Massachusetts General Hospital Boston Massachusetts
| | - Sabrina Paganoni
- School of Medicine Harvard Medical School Boston Massachusetts.,Neurological Clinical Research Institute Department of Neurology Massachusetts General Hospital Boston Massachusetts.,Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital Boston Massachusetts
| | - Kenzie Carlson
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - Katherine Burke
- Neurological Clinical Research Institute Department of Neurology Massachusetts General Hospital Boston Massachusetts.,MGH Institute of Health Professions Charlestown Massachusetts
| | - Harli Weber
- Neurological Clinical Research Institute Department of Neurology Massachusetts General Hospital Boston Massachusetts
| | - Patrick Staples
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - Joel Salinas
- School of Medicine Harvard Medical School Boston Massachusetts.,Neurological Clinical Research Institute Department of Neurology Massachusetts General Hospital Boston Massachusetts.,Department of Neurology Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston Massachusetts
| | - James Chan
- Department of Biostatistics Massachusetts General Hospital Boston Massachusetts
| | - Jordan R Green
- MGH Institute of Health Professions Charlestown Massachusetts
| | | | - Josh Barback
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - Jukka Pekka Onnela
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts
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50
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Cordella C, Quimby M, Touroutoglou A, Brickhouse M, Dickerson BC, Green JR. Quantification of motor speech impairment and its anatomic basis in primary progressive aphasia. Neurology 2019; 92:e1992-e2004. [PMID: 30944238 PMCID: PMC6511075 DOI: 10.1212/wnl.0000000000007367] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate whether a quantitative speech measure is effective in identifying and monitoring motor speech impairment (MSI) in patients with primary progressive aphasia (PPA) and to investigate the neuroanatomical basis of MSI in PPA. Methods Sixty-four patients with PPA were evaluated at baseline, with a subset (n = 39) evaluated longitudinally. Articulation rate (AR), a quantitative measure derived from spontaneous speech, was measured at each time point. MRI was collected at baseline. Differences in baseline AR were assessed across PPA subtypes, separated by severity level. Linear mixed-effects models were conducted to assess groups differences across PPA subtypes in rate of decline in AR over a 1-year period. Cortical thickness measured from baseline MRIs was used to test hypotheses about the relationship between cortical atrophy and MSI. Results Baseline AR was reduced for patients with nonfluent variant PPA (nfvPPA) compared to other PPA subtypes and controls, even in mild stages of disease. Longitudinal results showed a greater rate of decline in AR for the nfvPPA group over 1 year compared to the logopenic and semantic variant subgroups. Reduced baseline AR was associated with cortical atrophy in left-hemisphere premotor and supplementary motor cortices. Conclusions The AR measure is an effective quantitative index of MSI that detects MSI in mild disease stages and tracks decline in MSI longitudinally. The AR measure also demonstrates anatomic localization to motor speech–specific cortical regions. Our findings suggest that this quantitative measure of MSI might have utility in diagnostic evaluation and monitoring of MSI in PPA.
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Affiliation(s)
- Claire Cordella
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Megan Quimby
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Alexandra Touroutoglou
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Michael Brickhouse
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Bradford C Dickerson
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Jordan R Green
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA.
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