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Bóna J. Speech rate and fluency in young-onset Parkinson's disease: A longitudinal case study from early to post brain surgery stage. CLINICAL LINGUISTICS & PHONETICS 2023; 37:385-397. [PMID: 36314241 DOI: 10.1080/02699206.2022.2138784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 05/20/2023]
Abstract
The aim of this study is to analyse the speech rate, pausing and fluency of a patient with young-onset Parkinson's Disease in different stages of the disease. Speech samples of the patient were recorded in the early stages of the disease until after the brain surgery. The recordings were compared to the speech of healthy control speakers. Speech rate, articulation rate, pausing and the frequency of disfluencies were analysed. Results show that all parameters are influenced by the severity of the disease, but articulation rate is the most affected.
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Affiliation(s)
- Judit Bóna
- Department of Applied Linguistics and Phonetics, ELTE Eötvös Loránd University, Budapest, Hungary
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Manes JL, Parkinson AL, Larson CR, Greenlee JD, Eickhoff SB, Corcos DM, Robin DA. Connectivity of the subthalamic nucleus and globus pallidus pars interna to regions within the speech network: a meta-analytic connectivity study. Hum Brain Mapp 2013; 35:3499-516. [PMID: 25050431 DOI: 10.1002/hbm.22417] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cortico-basal ganglia connections are involved in a range of behaviors within motor, cognitive, and emotional domains; however, the whole-brain functional connections of individual nuclei are poorly understood in humans. The first aim of this study was to characterize and compare the connectivity of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi) using meta-analytic connectivity modeling. Structure-based activation likelihood estimation meta-analyses were performed for STN and GPi seeds using archived functional imaging coordinates from the BrainMap database. Both regions coactivated with caudate, putamen, thalamus, STN, GPi, and GPe, SMA, IFG, and insula. Contrast analyses also revealed coactivation differences within SMA, IFG, insula, and premotor cortex. The second aim of this study was to examine the degree of overlap between the connectivity maps derived for STN and GPi and a functional activation map representing the speech network. To do this, we examined the intersection of coactivation maps and their respective contrasts (STN > GPi and GPi > STN) with a coordinate-based meta-analysis of speech function. In conjunction with the speech map, both STN and GPi coactivation maps revealed overlap in the anterior insula with GPi map additionally showing overlap in the supplementary motor area (SMA). Among cortical regions activated by speech tasks, STN was found to have stronger connectivity than GPi with regions involved in cognitive linguistic processes (pre-SMA, dorsal anterior insula, and inferior frontal gyrus), while GPi demonstrated stronger connectivity to regions involved in motor speech processes (middle insula, SMA, and premotor cortex).
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Speech acoustic markers of early stage and prodromal Huntington's disease: A marker of disease onset? Neuropsychologia 2012; 50:3273-8. [DOI: 10.1016/j.neuropsychologia.2012.09.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/26/2012] [Accepted: 09/04/2012] [Indexed: 11/23/2022]
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Skodda S. Effect of deep brain stimulation on speech performance in Parkinson's disease. PARKINSON'S DISEASE 2012; 2012:850596. [PMID: 23227426 PMCID: PMC3512320 DOI: 10.1155/2012/850596] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/17/2012] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) has been reported to be successful in relieving the core motor symptoms of Parkinson's disease (PD) and motor fluctuations in the more advanced stages of the disease. However, data on the effects of DBS on speech performance are inconsistent. While there are some series of patients documenting that speech function was relatively unaffected by DBS of the nucleus subthalamicus (STN), other investigators reported on improvements of distinct parameters of oral control and voice. Though, these ameliorations of single speech modalities were not always accompanied by an improvement of overall speech intelligibility. On the other hand, there are also indications for an induction of dysarthria as an adverse effect of STN-DBS occurring at least in some patients with PD. Since a deterioration of speech function has more often been observed under high stimulation amplitudes, this phenomenon has been ascribed to a spread of current-to-adjacent pathways which might also be the reason for the sporadic observation of an onset of dysarthria under DBS of other basal ganglia targets (e.g., globus pallidus internus/GPi or thalamus/Vim). The aim of this paper is to review and evaluate reports in the literature on the effects of DBS on speech function in PD.
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Affiliation(s)
- Sabine Skodda
- Department of Neurology, Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
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Pouratian N, Thakkar S, Kim W, Bronstein JM. Deep brain stimulation for the treatment of Parkinson's disease: efficacy and safety. Degener Neurol Neuromuscul Dis 2012; 2012. [PMID: 24298202 DOI: 10.2147/dnnd.s25750] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) surgery has become increasingly utilized in the treatment of advanced Parkinson's disease. Over the past decade, a number of studies have demonstrated that DBS is superior to best medical management in appropriately selected patients. The primary targets for DBS in Parkinson's disease include the subthalamic nucleus and the internal segment of the globus pallidus, both of which improve the cardinal motor features in Parkinson's disease. Recent randomized studies have revealed that both targets are similarly effective in treating the motor symptoms of Parkinson's disease, but emerging evidence suggests that the globus pallidus may be the preferred target in many patients, based on differences in nonmotor outcomes. Here, we review appropriate patient selection, and the efficacy and safety of DBS therapy in Parkinson's disease. Best outcomes are achieved if the problems of the individual patient are considered when evaluating surgical candidates and considering whether the subthalamic nucleus or the globus pallidus internus should be targeted.
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Affiliation(s)
- Nader Pouratian
- Departments of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles ; Bioengineering, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
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Lundgren S, Saeys T, Karlsson F, Olofsson K, Blomstedt P, Linder J, Nordh E, Zafar H, van Doorn J. Deep brain stimulation of caudal zona incerta and subthalamic nucleus in patients with Parkinson's disease: effects on voice intensity. PARKINSON'S DISEASE 2011; 2011:658956. [PMID: 22028987 PMCID: PMC3199057 DOI: 10.4061/2011/658956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/31/2011] [Accepted: 07/18/2011] [Indexed: 11/20/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD) affects speech inconsistently. Recently, stimulation of the caudal zona incerta (cZi-DBS) has shown superior motor outcomes for PD patients, but effects on speech have not been systematically investigated. The aim of this study was to compare the effects of cZi-DBS and STN-DBS on voice intensity in PD patients. Mean intensity during reading and intensity decay during rapid syllable repetition were measured for STN-DBS and cZi-DBS patients (eight patients per group), before- and 12 months after-surgery on- and off-stimulation. For mean intensity, there were small significant differences on- versus off-stimulation in each group: 74.2 (2.0) dB contra 72.1 (2.2) dB (P = .002) for STN-DBS, and 71.6 (4.1) dB contra 72.8 (3.4) dB (P = .03) for cZi-DBS, with significant interaction (P < .001). Intensity decay showed no significant changes. The subtle differences found for mean intensity suggest that STN-DBS and cZi-DBS may influence voice intensity differently.
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Affiliation(s)
- Sofie Lundgren
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
| | - Thomas Saeys
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
| | - Fredrik Karlsson
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
| | - Katarina Olofsson
- Division of Otorhinolaryngology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
| | - Patric Blomstedt
- Division of Clinical Neuroscience, Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90185 Umeå, Sweden
| | - Jan Linder
- Division of Clinical Neuroscience, Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90185 Umeå, Sweden
| | - Erik Nordh
- Division of Clinical Neuroscience, Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90185 Umeå, Sweden
- Rehabilitation Research Chair, King Saud University, Riyadh 11433, Saudi Arabia
| | - Hamayun Zafar
- Rehabilitation Research Chair, King Saud University, Riyadh 11433, Saudi Arabia
- Division of Clinical Oral Physiology, Department of Odontology, Umeå University, SE-90185 Umeå, Sweden
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Jan van Doorn
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
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Karlsson F, Unger E, Wahlgren S, Blomstedt P, Linder J, Nordh E, Zafar H, van Doorn J. Deep brain stimulation of caudal zona incerta and subthalamic nucleus in patients with Parkinson's disease: effects on diadochokinetic rate. PARKINSONS DISEASE 2011; 2011:605607. [PMID: 22007342 PMCID: PMC3191820 DOI: 10.4061/2011/605607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/23/2011] [Accepted: 07/23/2011] [Indexed: 12/04/2022]
Abstract
The hypokinetic dysarthria observed in Parkinson's disease (PD) affects the range, speed, and accuracy of articulatory gestures in patients, reducing the perceived quality of speech acoustic output in continuous speech. Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) and of the caudal zona incerta (cZi-DBS) are current surgical treatment options for PD. This study aimed at investigating the outcome of STN-DBS (7 patients) and cZi-DBS (7 patients) in two articulatory diadochokinesis tasks (AMR and SMR) using measurements of articulation rate and quality of the plosive consonants (using the percent measurable VOT metric). The results indicate that patients receiving STN-DBS increased in articulation rate in the Stim-ON condition in the AMR task only, with no effect on production quality. Patients receiving cZi-DBS decreased in articulation rate in the Stim-ON condition and further showed a reduction in production quality. The data therefore suggest that cZi-DBS is more detrimental for extended articulatory movements than STN-DBS.
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Affiliation(s)
- Fredrik Karlsson
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, SE-90185 Umeå, Sweden
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Murdoch BE, Ng ML, Barwood CHS. Retracted: Treatment of articulatory dysfunction in Parkinson’s disease using repetitive transcranial magnetic stimulation. Eur J Neurol 2011; 19:340-7. [DOI: 10.1111/j.1468-1331.2011.03524.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lansford KL, Liss JM, Caviness JN, Utianski RL. A cognitive-perceptual approach to conceptualizing speech intelligibility deficits and remediation practice in hypokinetic dysarthria. PARKINSONS DISEASE 2011; 2011:150962. [PMID: 21918728 PMCID: PMC3171761 DOI: 10.4061/2011/150962] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/14/2011] [Accepted: 07/13/2011] [Indexed: 11/20/2022]
Abstract
Hypokinetic dysarthria is a common manifestation of Parkinson's disease, which negatively influences quality of life. Behavioral techniques that aim to improve speech intelligibility constitute the bulk of intervention strategies for this population, as the dysarthria does not often respond vigorously to medical interventions. Although several case and group studies generally support the efficacy of behavioral treatment, much work remains to establish a rigorous evidence base. This absence of definitive research leaves both the speech-language pathologist and referring physician with the task of determining the feasibility and nature of therapy for intelligibility remediation in PD. The purpose of this paper is to introduce a novel framework for medical practitioners in which to conceptualize and justify potential targets for speech remediation. The most commonly targeted deficits (e.g., speaking rate and vocal loudness) can be supported by this approach, as well as underutilized and novel treatment targets that aim at the listener's perceptual skills.
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Affiliation(s)
- Kaitlin L Lansford
- Motor Speech Disorders Laboratory, Department of Speech and Hearing Science, Arizona State University, P.O. Box 870102, Tempe, AZ 85287-0102, USA
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Ahlberg E, Laakso K, Hartelius L. Perceived Changes in Communication as an Effect of STN Surgery in Parkinson's Disease: A Qualitative Interview Study. PARKINSONS DISEASE 2011; 2011:540158. [PMID: 21876840 PMCID: PMC3159130 DOI: 10.4061/2011/540158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/31/2011] [Accepted: 07/03/2011] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to explore four individuals' perspective of the way their speech and communication changed as a result of subthalamic nucleus deep brain stimulation treatment for Parkinson's disease. Interviews of two men and two women were analyzed using qualitative content analysis. Three themes emerged as a result of the analysis. The first theme included sub-themes describing both increased and unexpected communication difficulties such as a more vulnerable speech function, re-emerging stuttering and cognitive difficulties affecting communication. The second theme comprised strategies to improve communication, using different speech techniques and communicative support, as well as trying to achieve changes in medical and stimulation parameters. The third theme included descriptions of mixed feelings surrounding the surgery. Participants described the surgery as an unavoidable dramatic change, associated both with improved quality of life but also uncertainty and lack of information, particularly regarding speech and communication changes. Despite negative effects on speech, the individuals were generally very pleased with the surgical outcome. More information before surgery regarding possible side effects on speech, meeting with a previously treated patient and possibly voice and speech therapy before or after surgery are suggested to facilitate the adjustment to the new speech conditions.
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Affiliation(s)
- Emilia Ahlberg
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, the University of Gothenburg, 405 30 Göteborg, Sweden
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