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Radakovic R, Carroll A, Altiero A, Reichwein C, Walsh S, Niven E, Abrahams S, Simmons Z. Self-perceived quality of life, cognitive and behavioural impairment in amyotrophic lateral sclerosis. J Neurol 2024:10.1007/s00415-024-12639-z. [PMID: 39196396 DOI: 10.1007/s00415-024-12639-z] [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: 05/23/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Self-perceived quality of life (QoL) is important in amyotrophic lateral sclerosis (ALS). Although caregiver burden and strain have been related to cognitive and behavioural impairment, there has been no comprehensive research looking at these impairments and how they may influence self-perceived QoL subdomains. AIMS To explore how cognitive and behavioural impairment are related to different areas of self-perceived QoL using disease-specific measures. METHODS This was a quantitative, cross-sectional, observational cohort study, utilising existing specialist ALS clinic data. Clinical and demographic variables were available as well as multidimensional measures, ALS-specific QoL Short Form (ALSsQoL-SF) results and the data from the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Group comparison and regression analyses were performed. RESULTS Data from 121 participants with ALS were analysed. 61.2% (N = 74) had either cognitive and/or behavioural impairment, with 28.9% (N = 35) with cognitive impairment (ALSci), 14.1% (N = 17) with behavioural impairment (ALSbi) and 18.2% (N = 22) with both (ALScbi). 38.8% (N = 47) were classified as having no impairments (ALSni). Those with ALSbi had significantly lower QoL in the domains of negative emotions and the interaction with people and the environment compared to those with ALSci and ALSni (ps < 0.05). Further, those with ALScbi had significantly lower QoL in the intimacy domains than those with ALSci and ALSni (ps < 0.05). Regression analysis showed specific cognitive and behavioural (inclusive of psychosis) predictors associated with specific QoL subdomains. CONCLUSIONS Behavioural impairments effect QoL in specific subdomains, namely relating to internalising (negative emotions) and externalising (interaction with people and the environment subdomains, intimacy).
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Affiliation(s)
- Ratko Radakovic
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK.
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Amy Carroll
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Alair Altiero
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Carrie Reichwein
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Susan Walsh
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Elaine Niven
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
- Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, DD1 4HN, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
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Dubbioso R, Spisto M, Verde L, Iuzzolino VV, Senerchia G, Salvatore E, De Pietro G, De Falco I, Sannino G. Voice signals database of ALS patients with different dysarthria severity and healthy controls. Sci Data 2024; 11:800. [PMID: 39030186 PMCID: PMC11271596 DOI: 10.1038/s41597-024-03597-2] [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: 01/17/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024] Open
Abstract
This paper describes a new publicly-available database of VOiCe signals acquired in Amyotrophic Lateral Sclerosis (ALS) patients (VOC-ALS) and healthy controls performing different speech tasks. This dataset consists of 1224 voice signals recorded from 153 participants: 51 healthy controls (32 males and 19 females) and 102 ALS patients (65 males and 37 females) with different severity of dysarthria. Each subject's voice was recorded using a smartphone application (Vox4Health) while performing several vocal tasks, including a sustained phonation of the vowels /a/, /e/, /i/, /o/, /u/ and /pa/, /ta/, /ka/ syllable repetition. Basic derived speech metrics such as harmonics-to-noise ratio, mean and standard deviation of fundamental frequency (F0), jitter and shimmer were calculated. The F0 standard deviation of vowels and syllables showed an excellent ability to identify people with ALS and to discriminate the different severity of dysarthria. These data represent the most comprehensive database of voice signals in ALS and form a solid basis for research on the recognition of voice impairment in ALS patients for use in clinical applications.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, 80131, Italy
| | - Myriam Spisto
- Department of Psychology of the University of Campania "Luigi Vanvitelli", Caserta, 81100, Italy
| | - Laura Verde
- Department of Mathematics and Physics of the University of Campania "Luigi Vanvitelli", Caserta, 81100, Italy
| | - Valentina Virginia Iuzzolino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, 80131, Italy
| | - Gianmaria Senerchia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, 80131, Italy
| | - Elena Salvatore
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, 80131, Italy
| | - Giuseppe De Pietro
- Department of Information Sciences and Technologies, Pegaso University, Naples, 80143, Italy
| | - Ivanoe De Falco
- National Research Council of Italy (CNR), Institute for High-Performance Computing and Networking (ICAR), Naples, 80131, Italy
| | - Giovanna Sannino
- National Research Council of Italy (CNR), Institute for High-Performance Computing and Networking (ICAR), Naples, 80131, Italy.
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Krajewski E, Lee J, Viswanathan N, Olmstead A, Simmons Z. The Effects of Interactive Context on Acoustic Characteristics of Speech in People With Dysarthria: A Preliminary Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1952-1964. [PMID: 38809826 DOI: 10.1044/2024_ajslp-23-00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The current study compared temporal and spectral acoustic contrast between vowel segments produced by speakers with dysarthria across three speech tasks-interactive, solo habitual, and solo clear. METHOD Nine speakers with dysarthria secondary to amyotrophic lateral sclerosis participated in the study. Each speaker was paired with a typical interlocutor over videoconferencing software. The speakers produced the vowels /i, ɪ, ɛ, æ/ in /h/-vowel-/d/ words. For the solo tasks, speakers read the stimuli aloud in both their habitual and clear speaking styles. For the interactive task, speakers produced a target stimulus for their interlocutor to select among the four possibilities. We measured the duration difference between long and short vowels, as well as the F1/F2 Euclidean distance between adjacent vowels, and also determined how well the vowels could be classified based on their acoustic characteristics. RESULTS Temporal contrast between long and short vowels was higher in the interactive task than in both solo tasks. Spectral distance between adjacent vowel pairs was also higher for some pairs in the interactive task than the habitual speech task. Finally, vowel classification accuracy was highest in the interactive task. CONCLUSIONS Overall, we found evidence that individuals with dysarthria produced vowels with greater acoustic contrast in structured interactions than they did in solo tasks. Furthermore, the speech adjustments they made to the vowel segments differed from those observed in solo speech.
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Affiliation(s)
- Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Navin Viswanathan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Anne Olmstead
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Zachary Simmons
- Departments of Neurology and Humanities, The Pennsylvania State University College of Medicine, Hershey
- Penn State Hershey ALS Clinic and Research Center
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4
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Silva AB, Littlejohn KT, Liu JR, Moses DA, Chang EF. The speech neuroprosthesis. Nat Rev Neurosci 2024; 25:473-492. [PMID: 38745103 DOI: 10.1038/s41583-024-00819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024]
Abstract
Loss of speech after paralysis is devastating, but circumventing motor-pathway injury by directly decoding speech from intact cortical activity has the potential to restore natural communication and self-expression. Recent discoveries have defined how key features of speech production are facilitated by the coordinated activity of vocal-tract articulatory and motor-planning cortical representations. In this Review, we highlight such progress and how it has led to successful speech decoding, first in individuals implanted with intracranial electrodes for clinical epilepsy monitoring and subsequently in individuals with paralysis as part of early feasibility clinical trials to restore speech. We discuss high-spatiotemporal-resolution neural interfaces and the adaptation of state-of-the-art speech computational algorithms that have driven rapid and substantial progress in decoding neural activity into text, audible speech, and facial movements. Although restoring natural speech is a long-term goal, speech neuroprostheses already have performance levels that surpass communication rates offered by current assistive-communication technology. Given this accelerated rate of progress in the field, we propose key evaluation metrics for speed and accuracy, among others, to help standardize across studies. We finish by highlighting several directions to more fully explore the multidimensional feature space of speech and language, which will continue to accelerate progress towards a clinically viable speech neuroprosthesis.
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Affiliation(s)
- Alexander B Silva
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Kaylo T Littlejohn
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Jessie R Liu
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - David A Moses
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA.
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van Stuijvenberg OC, Samlal DPS, Vansteensel MJ, Broekman MLD, Jongsma KR. The ethical significance of user-control in AI-driven speech-BCIs: a narrative review. Front Hum Neurosci 2024; 18:1420334. [PMID: 39006157 PMCID: PMC11240287 DOI: 10.3389/fnhum.2024.1420334] [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: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
AI-driven brain-computed interfaces aimed at restoring speech for individuals living with locked-in-syndrome are paired with ethical implications for user's autonomy, privacy and responsibility. Embedding options for sufficient levels of user-control in speech-BCI design has been proposed to mitigate these ethical challenges. However, how user-control in speech-BCIs is conceptualized and how it relates to these ethical challenges is underdetermined. In this narrative literature review, we aim to clarify and explicate the notion of user-control in speech-BCIs, to better understand in what way user-control could operationalize user's autonomy, privacy and responsibility and explore how such suggestions for increasing user-control can be translated to recommendations for the design or use of speech-BCIs. First, we identified types of user control, including executory control that can protect voluntariness of speech, and guidance control that can contribute to semantic accuracy. Second, we identified potential causes for a loss of user-control, including contributions of predictive language models, a lack of ability for neural control, or signal interference and external control. Such a loss of user control may have implications for semantic accuracy and mental privacy. Third we explored ways to design for user-control. While embedding initiation signals for users may increase executory control, they may conflict with other aims such as speed and continuity of speech. Design mechanisms for guidance control remain largely conceptual, similar trade-offs in design may be expected. We argue that preceding these trade-offs, the overarching aim of speech-BCIs needs to be defined, requiring input from current and potential users. Additionally, conceptual clarification of user-control and other (ethical) concepts in this debate has practical relevance for BCI researchers. For instance, different concepts of inner speech may have distinct ethical implications. Increased clarity of such concepts can improve anticipation of ethical implications of speech-BCIs and may help to steer design decisions.
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Affiliation(s)
- O C van Stuijvenberg
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - D P S Samlal
- Department of Philosophy, Utrecht University, Utrecht, Netherlands
- Department of Anatomy, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - M J Vansteensel
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - M L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - K R Jongsma
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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6
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Bingham IN, Norel R, Roitberg EG, Peller J, Trevisan MA, Agurto C, Shalom DE, Aguirre F, Embon I, Taitz A, Harris D, Wright A, Seaver K, Sullivan S, Green JR, Ostrow LW, Fraenkel E, Berry JD. Listener effort quantifies clinically meaningful progression of dysarthria in people living with amyotrophic lateral sclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308140. [PMID: 38853969 PMCID: PMC11160879 DOI: 10.1101/2024.05.31.24308140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative motor neuron disease that causes progressive muscle weakness. Progressive bulbar dysfunction causes dysarthria and thus social isolation, reducing quality of life. The Everything ALS Speech Study obtained longitudinal clinical information and speech recordings from 292 participants. In a subset of 120 participants, we measured speaking rate (SR) and listener effort (LE), a measure of dysarthria severity rated by speech pathologists from recordings. LE intra- and inter-rater reliability was very high (ICC 0.88 to 0.92). LE correlated with other measures of dysarthria at baseline. LE changed over time in participants with ALS (slope 0.77 pts/month; p<0.001) but not controls (slope 0.005 pts/month; p=0.807). The slope of LE progression was similar in all participants with ALS who had bulbar dysfunction at baseline, regardless of ALS site of onset. LE could be a remotely collected clinically meaningful clinical outcome assessment for ALS clinical trials.
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Affiliation(s)
- Indu Navar Bingham
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | | | - Esteban G. Roitberg
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Julián Peller
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Laboratorio de Neurociencias Cognitivas Computacionales, Humai, Buenos Aires, Argentina
| | - Marcos A Trevisan
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | | | - Diego E. Shalom
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | - Felipe Aguirre
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Iair Embon
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Alan Taitz
- SRI International, Menlo Park, CA, USA. This work was performed working at
| | - Donna Harris
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Amy Wright
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Katie Seaver
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Stacey Sullivan
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Jordan R. Green
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Lyle W. Ostrow
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Ernest Fraenkel
- Massachusetts Institute of Technology, Department of Biological Engineering, Cambridge, MA, USA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
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Feng X, Feng X, Qin B, Liu T. Aligning Semantic in Brain and Language: A Curriculum Contrastive Method for Electroencephalography-to-Text Generation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3874-3883. [PMID: 37698960 DOI: 10.1109/tnsre.2023.3314642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Electroencephalography-to-Text generation (EEG-to-Text), which aims to directly generate natural text from EEG signals has drawn increasing attention in recent years due to the enormous potential for Brain-computer interfaces. However, the remarkable discrepancy between the subject-dependent EEG representation and the semantic-dependent text representation poses a great challenge to this task. To mitigate this, we devise a Curriculum Semantic-aware Contrastive Learning strategy (C- SCL), which effectively recalibrates the subject-dependent EEG representation to the semantic-dependent EEG representation, thereby reducing the discrepancy. Specifically, our C- SCL pulls semantically similar EEG representations together while pushing apart dissimilar ones. Besides, in order to introduce more meaningful contrastive pairs, we carefully employ curriculum learning to not only craft meaningful contrastive pairs but also make the learning progressively. We conduct extensive experiments on the ZuCo benchmark and our method combined with diverse models and architectures shows stable improvements across three types of metrics while achieving the new state-of-the-art. Further investigation proves not only its superiority in both the single-subject and low-resource settings but also its robust generalizability in the zero-shot setting. Our codes are available at: https://github.com/xcfcode/contrastive_eeg2text.
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8
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Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
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Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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9
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Conroy E, Vélez-Gómez B, O'Brien D, Heverin M, Hardiman O, Mcdermott C, Galvin M. IMPACT-ALS: summary of results from a European survey of people living with ALS. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-10. [PMID: 37661426 DOI: 10.1080/21678421.2023.2249515] [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: 12/13/2022] [Revised: 06/19/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The IMPACT-ALS survey collected the experiences of people living with ALS (plwALS) across nine European countries. We aimed to better understand the functional burden of ALS to ensure the experiences of plwALS inform the development of person-centered therapies. METHODS The content was informed by the US IMPACT-ALS survey, with adjustments relevant to the European population. Questionnaires consisted of four modules, each of which was pilot tested in advance of distribution. Data were captured using the Qualtrics software and were analyzed in SPSS. RESULTS 857 respondents completed the survey, with a participation rate ranging from 0.2% to 6.3% across the nine participating countries. The majority were male and aged 55-74 years old. In the previous 2 weeks, symptoms experienced included weakness (81%), fatigue (61%), speech impairment (38%), pain (27%), and depression and other mood changes (23%). Eighty-two percent of respondents reported fears, of which the most common were leaving family too soon (68%) and death from respiratory failure (50%). Lifestyle changes since diagnosis were reported by 89% of respondents, with less time spent doing most daily activities but more time on the internet (81%), reading (56%) and communicating with family and friends (55%). Stopping progression of ALS was the most desired impact for a new therapy for 68% respondents. CONCLUSIONS The European IMPACT-ALS survey has generated insights into the complex experiences of plwALS. The data provide unique patient perspectives on common symptoms, fears, functional limitations, lifestyle changes, and wishes for future therapies that will enhance patient-centric care in ALS.
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Affiliation(s)
- Eilis Conroy
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Beatriz Vélez-Gómez
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain, and
| | - David O'Brien
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Mark Heverin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Christopher Mcdermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Miriam Galvin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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10
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Metzger SL, Littlejohn KT, Silva AB, Moses DA, Seaton MP, Wang R, Dougherty ME, Liu JR, Wu P, Berger MA, Zhuravleva I, Tu-Chan A, Ganguly K, Anumanchipalli GK, Chang EF. A high-performance neuroprosthesis for speech decoding and avatar control. Nature 2023; 620:1037-1046. [PMID: 37612505 PMCID: PMC10826467 DOI: 10.1038/s41586-023-06443-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Speech neuroprostheses have the potential to restore communication to people living with paralysis, but naturalistic speed and expressivity are elusive1. Here we use high-density surface recordings of the speech cortex in a clinical-trial participant with severe limb and vocal paralysis to achieve high-performance real-time decoding across three complementary speech-related output modalities: text, speech audio and facial-avatar animation. We trained and evaluated deep-learning models using neural data collected as the participant attempted to silently speak sentences. For text, we demonstrate accurate and rapid large-vocabulary decoding with a median rate of 78 words per minute and median word error rate of 25%. For speech audio, we demonstrate intelligible and rapid speech synthesis and personalization to the participant's pre-injury voice. For facial-avatar animation, we demonstrate the control of virtual orofacial movements for speech and non-speech communicative gestures. The decoders reached high performance with less than two weeks of training. Our findings introduce a multimodal speech-neuroprosthetic approach that has substantial promise to restore full, embodied communication to people living with severe paralysis.
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Affiliation(s)
- Sean L Metzger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Kaylo T Littlejohn
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Alexander B Silva
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - David A Moses
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret P Seaton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ran Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Maximilian E Dougherty
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jessie R Liu
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Peter Wu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | | | - Inga Zhuravleva
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Adelyn Tu-Chan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Karunesh Ganguly
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Gopala K Anumanchipalli
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA.
- University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA.
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11
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Meng K, Goodarzy F, Kim E, Park YJ, Kim JS, Cook MJ, Chung CK, Grayden DB. Continuous synthesis of artificial speech sounds from human cortical surface recordings during silent speech production. J Neural Eng 2023; 20:046019. [PMID: 37459853 DOI: 10.1088/1741-2552/ace7f6] [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: 01/18/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
Objective. Brain-computer interfaces can restore various forms of communication in paralyzed patients who have lost their ability to articulate intelligible speech. This study aimed to demonstrate the feasibility of closed-loop synthesis of artificial speech sounds from human cortical surface recordings during silent speech production.Approach. Ten participants with intractable epilepsy were temporarily implanted with intracranial electrode arrays over cortical surfaces. A decoding model that predicted audible outputs directly from patient-specific neural feature inputs was trained during overt word reading and immediately tested with overt, mimed and imagined word reading. Predicted outputs were later assessed objectively against corresponding voice recordings and subjectively through human perceptual judgments.Main results. Artificial speech sounds were successfully synthesized during overt and mimed utterances by two participants with some coverage of the precentral gyrus. About a third of these sounds were correctly identified by naïve listeners in two-alternative forced-choice tasks. A similar outcome could not be achieved during imagined utterances by any of the participants. However, neural feature contribution analyses suggested the presence of exploitable activation patterns during imagined speech in the postcentral gyrus and the superior temporal gyrus. In future work, a more comprehensive coverage of cortical surfaces, including posterior parts of the middle frontal gyrus and the inferior frontal gyrus, could improve synthesis performance during imagined speech.Significance.As the field of speech neuroprostheses is rapidly moving toward clinical trials, this study addressed important considerations about task instructions and brain coverage when conducting research on silent speech with non-target participants.
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Affiliation(s)
- Kevin Meng
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, Australia
| | - Farhad Goodarzy
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - EuiYoung Kim
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Republic of Korea
| | - Ye Jin Park
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - June Sic Kim
- Research Institute of Basic Sciences, Seoul National University, Seoul, Republic of Korea
| | - Mark J Cook
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Chun Kee Chung
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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12
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Peters B, Wiedrick J, Baylor C. Effects of Aided Communication on Communicative Participation for People With Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1450-1465. [PMID: 37335771 PMCID: PMC10473367 DOI: 10.1044/2023_ajslp-22-00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Many people with amyotrophic lateral sclerosis (PALS) experience speech changes, which may interfere with participation in communication situations. This study was designed to investigate the effects of aided communication on self-rated communicative participation among PALS and the relationship between speech function and communicative participation for PALS at various stages of speech impairment and communication aid use. METHOD Participants with amyotrophic lateral sclerosis completed an online questionnaire in which they identified their current communication methods, rated their speech function, and rated their communicative participation in various situations on a modified version of the Communicative Participation Item Bank short form. PALS who reported using aided communication rated their communicative participation under two conditions: with unaided communication only and with access to all of their communication methods. RESULTS Communication aids appeared to support communicative participation for many participants with dysarthria. Across all levels of speech function, PALS who use aided communication reported better participation under the all-methods condition than the unaided-only condition, with the largest benefits for participants with anarthria (Revised ALS Functional Rating Scale [ALSFRS-R] speech rating = 0). Communicative participation ratings worsened with more severe speech impairment under both conditions for most levels of speech function, but PALS with anarthria (ALSFRS-R speech rating = 0) reported better participation under the all-methods condition than those who used residual speech in combination with non speech methods (ALSFRS-R speech rating = 1). CONCLUSIONS Aided communication can help PALS continue to participate in various communication situations as their speech function deteriorates. Variability in self-rated communicative participation, even for PALS at the same level of speech function, highlights the need for an individualized approach and consideration of personal and environmental factors in augmentative and alternative communication intervention. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22782986.
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Affiliation(s)
- Betts Peters
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
- Systems Science Program, Portland State University, OR
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
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13
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Towards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations. J Neurol 2023; 270:1323-1336. [PMID: 36450968 PMCID: PMC9971103 DOI: 10.1007/s00415-022-11464-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022]
Abstract
Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain-computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.
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14
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Kaneoka A, Ueha R, Nagatomo M, Matsunaga, A, Umezaki S, Inokuchi H, Ogata, T. Esophageal Speech for a Patient with Amyotrophic Lateral Sclerosis Who Underwent a Central-part Laryngectomy to Prevent Aspiration: A Case Report. Prog Rehabil Med 2022; 7:20220064. [PMID: 36591556 PMCID: PMC9772933 DOI: 10.2490/prm.20220064] [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: 08/10/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background To prevent aspiration, patients with irreversible dysphagia may undergo surgeries that separate the esophagus and trachea. Such interventions result in loss of vocal function and require alternative communication methods. We report a patient with amyotrophic lateral sclerosis (ALS) who used esophageal speech after receiving a central-part laryngectomy (CPL) to prevent aspiration. Case A 64-year-old woman with ALS was admitted to our hospital. The patient maintained good cognitive and oral function and presented with mild dysarthria and dysphagia. Faced with rapidly worsening respiratory distress, saliva aspiration, and excessive sputum, she underwent a tracheostomy on the premise of invasive ventilation. Subsequently, the patient began using a voice-generating application for communication. Given the patient's sincere hope to prevent aspiration and aspiration pneumonia, achieve safe oral intake, and decrease caregiver burden for frequent suctioning, the patient underwent a CPL. Following surgery, belching was observed during meals, and the patient could phonate when she belched. This finding led to four speech therapy sessions to practice esophageal speech, allowing the patient to use the pseudo-speech technique for short conversations. Removal of the entire cricoid cartilage in the CPL decreases the upper esophageal sphincter (UES) pressure, thereby allowing air to easily pass through the UES. Therefore, the patient could use the air as a sound source for esophageal speech without extensive training. Discussion Esophageal speech may be an alternative to oral communication in patients undergoing CPL. Further research is warranted to generalize these findings to patients undergoing CPL.
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Affiliation(s)
- Asako Kaneoka
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan, University of Tokyo Hospital Swallowing Center, Tokyo,
Japan
| | - Rumi Ueha
- University of Tokyo Hospital Swallowing Center, Tokyo,
Japan, Department of Otolaryngology and Head and Neck Surgery,
Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miki Nagatomo
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Akiko Matsunaga,
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Shigeko Umezaki
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Haruhi Inokuchi
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan, University of Tokyo Hospital Swallowing Center, Tokyo,
Japan
| | - Toru Ogata,
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
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15
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Metzger SL, Liu JR, Moses DA, Dougherty ME, Seaton MP, Littlejohn KT, Chartier J, Anumanchipalli GK, Tu-Chan A, Ganguly K, Chang EF. Generalizable spelling using a speech neuroprosthesis in an individual with severe limb and vocal paralysis. Nat Commun 2022; 13:6510. [PMID: 36347863 PMCID: PMC9643551 DOI: 10.1038/s41467-022-33611-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Neuroprostheses have the potential to restore communication to people who cannot speak or type due to paralysis. However, it is unclear if silent attempts to speak can be used to control a communication neuroprosthesis. Here, we translated direct cortical signals in a clinical-trial participant (ClinicalTrials.gov; NCT03698149) with severe limb and vocal-tract paralysis into single letters to spell out full sentences in real time. We used deep-learning and language-modeling techniques to decode letter sequences as the participant attempted to silently spell using code words that represented the 26 English letters (e.g. "alpha" for "a"). We leveraged broad electrode coverage beyond speech-motor cortex to include supplemental control signals from hand cortex and complementary information from low- and high-frequency signal components to improve decoding accuracy. We decoded sentences using words from a 1,152-word vocabulary at a median character error rate of 6.13% and speed of 29.4 characters per minute. In offline simulations, we showed that our approach generalized to large vocabularies containing over 9,000 words (median character error rate of 8.23%). These results illustrate the clinical viability of a silently controlled speech neuroprosthesis to generate sentences from a large vocabulary through a spelling-based approach, complementing previous demonstrations of direct full-word decoding.
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Affiliation(s)
- Sean L. Metzger
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.47840.3f0000 0001 2181 7878University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA USA
| | - Jessie R. Liu
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.47840.3f0000 0001 2181 7878University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA USA
| | - David A. Moses
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA
| | - Maximilian E. Dougherty
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Margaret P. Seaton
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Kaylo T. Littlejohn
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.47840.3f0000 0001 2181 7878Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA USA
| | - Josh Chartier
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA
| | - Gopala K. Anumanchipalli
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.47840.3f0000 0001 2181 7878Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA USA
| | - Adelyn Tu-Chan
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California, San Francisco, San Francisco, CA USA
| | - Karunesh Ganguly
- grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurology, University of California, San Francisco, San Francisco, CA USA
| | - Edward F. Chang
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA ,grid.47840.3f0000 0001 2181 7878University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA USA
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16
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Wilson BS, Tucci DL, Moses DA, Chang EF, Young NM, Zeng FG, Lesica NA, Bur AM, Kavookjian H, Mussatto C, Penn J, Goodwin S, Kraft S, Wang G, Cohen JM, Ginsburg GS, Dawson G, Francis HW. Harnessing the Power of Artificial Intelligence in Otolaryngology and the Communication Sciences. J Assoc Res Otolaryngol 2022; 23:319-349. [PMID: 35441936 PMCID: PMC9086071 DOI: 10.1007/s10162-022-00846-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 02/01/2023] Open
Abstract
Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg . Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications.
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Affiliation(s)
- Blake S. Wilson
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA
- Duke Hearing Center, Duke University School of Medicine, Durham, NC 27710 USA
- Department of Electrical & Computer Engineering, Duke University, Durham, NC 27708 USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708 USA
- Department of Otolaryngology – Head & Neck Surgery, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599 USA
| | - Debara L. Tucci
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA
- National Institute On Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892 USA
| | - David A. Moses
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94117 USA
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94117 USA
| | - Nancy M. Young
- Division of Otolaryngology, Ann and Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL 60611 USA
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
- Department of Communication, Knowles Hearing Center, Northwestern University, Evanston, IL 60208 USA
| | - Fan-Gang Zeng
- Center for Hearing Research, University of California, Irvine, Irvine, CA 92697 USA
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA 92697 USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697 USA
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA 92697 USA
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, CA 92697 USA
| | | | - Andrés M. Bur
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Hannah Kavookjian
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Caroline Mussatto
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Joseph Penn
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Sara Goodwin
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Shannon Kraft
- Department of Otolaryngology - Head and Neck Surgery, Medical Center, University of Kansas, Kansas City, KS 66160 USA
| | - Guanghui Wang
- Department of Computer Science, Ryerson University, Toronto, ON M5B 2K3 Canada
| | - Jonathan M. Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA
- ENT Department, Kaplan Medical Center, 7661041 Rehovot, Israel
| | - Geoffrey S. Ginsburg
- Department of Biomedical Engineering, Duke University, Durham, NC 27708 USA
- MEDx (Medicine & Engineering at Duke), Duke University, Durham, NC 27708 USA
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27710 USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710 USA
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710 USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710 USA
| | - Geraldine Dawson
- Duke Institute for Brain Sciences, Duke University, Durham, NC 27710 USA
- Duke Center for Autism and Brain Development, Duke University School of Medicine and the Duke Institute for Brain Sciences, NIH Autism Center of Excellence, Durham, NC 27705 USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701 USA
| | - Howard W. Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710 USA
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17
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Van Damme J, Kuspinar A, Johnston W, O'Connell C, Turnbull J, Chum M, Strachan P, Luth W, McCullum S, Peters N, MacDermid J, Dal Bello-Haas V. Refining items for a preference-based, amyotrophic lateral sclerosis specific, health-related quality of life scale. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:508-516. [PMID: 35147072 DOI: 10.1080/21678421.2022.2029898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: The aim of this study was to refine the items of a preference-based amyotrophic lateral sclerosis health-related quality of life scale (PB-ALS HRQL scale) based on domains generated in a previous study. Methods: Survey methodology was used to assess item importance rating (IR) and independence. Median importance was calculated for each item and a rating of "very important" was required for the item to remain. Correlations were used to examine item independence. Highly correlated items (rs > 0.7) were considered for removal. Cognitive debriefing (CD) interviews, conducted by Zoom, telephone, or email based on participant preference and communication needs, were used to identify potential issues. Participants provided feedback about wording, clarity, response options, and recall period on randomly selected items. Items were considered finalized when three sequential CD participants approved the item with no revisions. Results: Thirty-four people with ALS (PALS, n = 16 females; age range 44-78 years; ALS Functional Rating Scale-Revised [ALSFRS-R] range 0-48) in Canada completed the survey; a subset of 18 PALS completed CD interviews (n = 8 female; age range 44-71 years; ALSFRS-R range 0-48). Four items were highly correlated with one or more items, were not rated as very important, or were not approved via CD and were removed. Conclusions: The final four-response option PB-ALS Scale includes eight items: recreation and leisure, mobility, interpersonal interactions and relationships, eating and swallowing, handling objects, communicating, routine activities, and mood. The next step is to translate the PB-ALS Scale into French and develop a scoring algorithm based on PALS' preferences.
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Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Wendy Johnston
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Colleen O'Connell
- Dalhousie Medicine New Brunswick, Stan Cassidy Centre for Rehabilitation, Fredericton, Canada
| | - John Turnbull
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Marvin Chum
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Westerly Luth
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Shane McCullum
- Dalhousie Medicine New Brunswick, Stan Cassidy Centre for Rehabilitation, Fredericton, Canada
| | - Nicole Peters
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,School of Physical Therapy, Western University, London, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,School of Physical Therapy, Western University, London, Canada
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18
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Su XW, Simmons Z. Laryngospasm: A Frequently Underrecognized Symptom in Amyotrophic Lateral Sclerosis. Muscle Nerve 2022; 65:367-368. [PMID: 35092060 DOI: 10.1002/mus.27510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Xiaowei W Su
- Department of Neurology, Penn State Health M.S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zachary Simmons
- Department of Neurology, Penn State Health M.S. Hershey Medical Center, Hershey, Pennsylvania
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19
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Im YJ, Choi J, Kim YH, Chang WH. Transient Anarthria in a Patient With Non-Dominant Hemispheric Lesion: A Case Report. BRAIN & NEUROREHABILITATION 2022; 15:e8. [PMID: 36743848 PMCID: PMC9833467 DOI: 10.12786/bn.2022.15.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022] Open
Abstract
Anarthria is a complete loss of speech. It usually results from lesions in bilateral neural substrates that control articulation. Recently, lateralized cortical control of speech articulation in the dominant hemisphere has been reported. However, anarthria by non-dominant hemispheric lesion has not been reported yet. Here we report a rare case of transient anarthria caused by right hemispheric infarction after brain surgery in a right-handed patient. This report suggests that anarthria could be caused by a lesion not related to language lateralization. This report is expected to contribute to studies on neural correlates of anarthria lesions.
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Affiliation(s)
- Yu Jin Im
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihong Choi
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Departments of Health Science and Technology, Medical Device Management & Research, and Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Bolanos MC, Barrado Ballestero S, Puthusserypady S. Filter bank approach for enhancement of supervised Canonical Correlation Analysis methods for SSVEP-based BCI spellers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:337-340. [PMID: 34891304 DOI: 10.1109/embc46164.2021.9630838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Canonical correlation analysis (CCA) is one of the most used algorithms in the steady-state visual evoked potentials (SSVEP)-based brain-computer interface (BCI) systems due to its simplicity, efficiency, and robustness. Researchers have proposed modifications to CCA to improve its speed, allowing high-speed spelling and thus a more natural communication. In this work, we combine two approaches, the filter-bank (FB) approach to extract more information from the harmonics, and a range of different supervised methods which optimize the reference signals to improve the SSVEP detection. The proposed models are tested on the publicly available benchmark dataset for SSVEP-based BCIs and the results show improved performance compared to the state-of-the-art methods and, in particular, the proposed FBMwayCCA approach achieves the best results with an information transfer rate (ITR) of 134.8±8.4 bits/minute. This study indeed suggests the feasibility of combining the fundamental and harmonic SSVEP components with supervised methods in target identification to develop high-speed BCI spellers.
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21
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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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22
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Moses DA, Metzger SL, Liu JR, Anumanchipalli GK, Makin JG, Sun PF, Chartier J, Dougherty ME, Liu PM, Abrams GM, Tu-Chan A, Ganguly K, Chang EF. Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria. N Engl J Med 2021; 385:217-227. [PMID: 34260835 PMCID: PMC8972947 DOI: 10.1056/nejmoa2027540] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that decodes words and sentences directly from the cerebral cortical activity of such patients may represent an advancement over existing methods for assisted communication. METHODS We implanted a subdural, high-density, multielectrode array over the area of the sensorimotor cortex that controls speech in a person with anarthria (the loss of the ability to articulate speech) and spastic quadriparesis caused by a brain-stem stroke. Over the course of 48 sessions, we recorded 22 hours of cortical activity while the participant attempted to say individual words from a vocabulary set of 50 words. We used deep-learning algorithms to create computational models for the detection and classification of words from patterns in the recorded cortical activity. We applied these computational models, as well as a natural-language model that yielded next-word probabilities given the preceding words in a sequence, to decode full sentences as the participant attempted to say them. RESULTS We decoded sentences from the participant's cortical activity in real time at a median rate of 15.2 words per minute, with a median word error rate of 25.6%. In post hoc analyses, we detected 98% of the attempts by the participant to produce individual words, and we classified words with 47.1% accuracy using cortical signals that were stable throughout the 81-week study period. CONCLUSIONS In a person with anarthria and spastic quadriparesis caused by a brain-stem stroke, words and sentences were decoded directly from cortical activity during attempted speech with the use of deep-learning models and a natural-language model. (Funded by Facebook and others; ClinicalTrials.gov number, NCT03698149.).
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Affiliation(s)
- David A Moses
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Sean L Metzger
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Jessie R Liu
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Gopala K Anumanchipalli
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Joseph G Makin
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Pengfei F Sun
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Josh Chartier
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Maximilian E Dougherty
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Patricia M Liu
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Gary M Abrams
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Adelyn Tu-Chan
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Karunesh Ganguly
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
| | - Edward F Chang
- From the Department of Neurological Surgery (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., M.E.D., E.F.C.), the Weill Institute for Neuroscience (D.A.M., S.L.M., J.R.L., G.K.A., J.G.M., P.F.S., J.C., K.G., E.F.C.), and the Departments of Rehabilitation Services (P.M.L.) and Neurology (G.M.A., A.T.-C., K.G.), University of California, San Francisco (UCSF), San Francisco, and the Graduate Program in Bioengineering, University of California, Berkeley-UCSF, Berkeley (S.L.M., J.R.L., E.F.C.)
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Kruitwagen-Van Reenen ET, Scholten EWM, van Groenestijn A, Van Den Berg LH, Post MWM, Visser-Meily J. Participation and autonomy in the first 10 months after diagnosis of ALS: a longitudinal study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:459-466. [PMID: 33683160 DOI: 10.1080/21678421.2021.1893335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: More insight is needed into participation in daily activities and autonomy among patients with amyotrophic lateral sclerosis (ALS). Aims of this study were (1) to describe the course of participation restrictions and autonomy in participation during the first 10 months after diagnosis; (2) to study the influence of the rate of ALS progression on the course of participation. Methods: Secondary analysis of data from the longitudinal multicenter FACTS-2-ALS study. Self-report questionnaires were administered at inclusion (T0; n = 71), at 4 months (T1), 7 months (T2), 10 months (T3) after inclusion. Median duration of follow-up was 10.0 months. Participation restrictions were assessed using the sum of the Mobility Range and Social Behavior subscales of the Sickness Impact profile-68 (SIPSOC). Autonomy in participation was assessed using the Impact on Participation and Autonomy (IPA) Questionnaire. Fast disease progression was defined as an increase of 1.1 points per month or more on the ALS Functional Rating Scale. Results: Patients reported participation restrictions in all subscales while having mild physical limitations. There was a decrease of participation over time (restrictions and autonomy). This decrease was greatest in patients with fast disease progression. Disease progression negatively influenced movement-related participation more than social interaction domains. Rate of disease progression was more strongly related to SIPSOC scores compared to IPA scores. Discussion: Preserving participation may be an important determinant of quality of care for patients with ALS. Rate of progression of the disease should be taken into account as it was found to be significantly associated with the level of participation.
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Affiliation(s)
- Esther T Kruitwagen-Van Reenen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Eline W M Scholten
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Annerieke van Groenestijn
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leonard H Van Den Berg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands, and
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Stasolla F, Matamala-Gomez M, Bernini S, Caffò AO, Bottiroli S. Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic. Front Public Health 2021; 8:635426. [PMID: 33665181 PMCID: PMC7921156 DOI: 10.3389/fpubh.2020.635426] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.
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Affiliation(s)
| | - Marta Matamala-Gomez
- Department of Human Sciences for Education "Riccardo Massa", Center for Studies in Communication Sciences "Luigi Anolli" (CESCOM), University of Milano-Bicocca, Milan, Italy
| | - Sara Bernini
- Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Mondino Foundation, Pavia, Italy
| | - Alessandro O Caffò
- Department of Educational Sciences, Psychology and Communication, University of Bari, Bari, Italy
| | - Sara Bottiroli
- "Giustino Fortunato" University of Benevento, Benevento, Italy.,Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Mondino Foundation, Pavia, Italy
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Leite Neto L, Novais T, França Júnior M, Chun R. Repercussions of language difficulties in people with amyotrophic lateral sclerosis and the impact on their lives and on their caregivers. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/202123414120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to analyze the repercussions of language difficulties in people presented with Amyotrophic Lateral Sclerosis and in their caregivers, and the impact on their lives. Methods: a cross-sectional study and qualitative approach, structured according to the COREQ. Semi-structured interview was conducted with 30 participants, family members and/or caregivers of people with the disease, most of them diagnosed for less than 5 years, and then transcribed and analyzed under repetition and relevance criteria. Results: most participants were women, spouses, between 50 and 70 years of age, in average being a caregiver for less than 3 years. Most interviewees reported the absence of communication difficulties with the disease, little use of Augmentative and Alternative Communication, restricted social interaction, and the perception of signs of discouragement and sadness in the person under their care. Regarding themselves, they mentioned anguish related to the prognosis, emotional overload, and intense change of routine in their lives. Conclusion: language difficulties were not frequently reported, despite the observation of restricted and social interactions. These findings showed the negative impacts on the quality of life of individuals and that of their family members and caregivers, which are experienced as anguish.
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26
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Leite Neto L, França Júnior MC, Chun RYS. Amyotrophic lateral sclerosis, dysarthria, and language disorders - type of research and approaches in different areas: an integrative literature review. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212318220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to identify the knowledge produced in national and international researches on speech and language disorders in Amyotrophic Lateral Sclerosis, regarding the type of research and approach in different areas. Methods: an integrative review performed on databases, using the following descriptors: Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement and Speech Disorders. The inclusion criteria covered articles that addressed motor speech and language disorders from 2013 to 2018, excluding duplications, and categorizing valid articles for analysis. Results: 83 articles were selected, after screening the titles and abstracts. A large scientific production from different countries and areas, mainly Speech Therapy and Neurology, was found. Most of them was clinical research (65.06%), with a main focus on speech motor disorders (42.16%), speech and language motor disorders, cognition and behavior (27.71%), and language disorders (12.06%). Conclusion: researches found were mostly clinical and aimed at determining the diagnosis of disorders in different areas of knowledge. With regard to communication, few studies have been found in Brazil, and international studies addressed high technology. The results confirmed the heterogeneous nature of the disease, which shows, in addition to motor impairment of speech, cognitive, behavioral and language impairments.
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27
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Cave R, Bloch S. Voice banking for people living with motor neurone disease: Views and expectations. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:116-129. [PMID: 33350040 DOI: 10.1111/1460-6984.12588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND More than 80% of people living with MND (plwMND) develop difficulties with their speech, affecting communication, self-identity and quality of life. Most plwMND eventually use an augmentative and alternative communication device (AAC) to communicate. Some AAC devices provide a synthesized voice for speech, however these voices are often viewed as impersonal and a factor in AAC acceptance. Voice banking creates an approximation of the person's own voice that can be used in AAC and is argued to go some way to preserve a person's identity when natural voice is lost, but there has been little supporting research. AIMS To understand what plwMND consider when deciding whether or not to bank their voice, what their expectations are, and the expectations of significant communication partners. METHODS Semi-structured interviews were undertaken with plwMND who had either decided to bank their voice or had decided not to. Thematic analysis was used to provide a qualitative analysis of the data. PROCEDURES Participants were an opportunistic sample of plwMND within England recruited via an open advert distributed by the MND Association (MNDA). OUTCOMES AND RESULTS Twelve plwMND were interviewed with nine significant others. Nine participants had decided to bank their voice and three decided not to. The data suggest 'preserving identity' is the overarching motivation in decision making for voice banking. Participants who decided to voice bank considered it would help to maintain their identity and preserve their social and work networks. Participants deciding not to bank their voice highlighted it could not replace their natural voice or preserve their identity. However, few in either group showed an awareness of how a voice bank is used in AAC, and how communication using AAC is significantly different to natural speech. CONCLUSIONS AND IMPLICATIONS This research is the first study of its kind to examine the considerations for decision making around voice banking for plwMND. Preserving identity is central to decision making when considering whether or not to voice bank. However, the reality of using AAC and voice banking for communication is poorly understood. Professionals have a role to provide plwMND with more information about voice banking in the wider context of using AAC for communication. It may be that the process of voice banking itself is seen as a positive act for plwMND, independent of how it is used later. Further research with associated professionals and stakeholders is indicated. What this paper adds What is already known on this subject Voice banking creates an approximation of the person.s own voice that can be used in AAC, and is argued to go some way to preserve a person's identity when natural voice is lost. There is significant and growing interest in voice banking from the MND community, but there has been little supporting research. What this study adds This research is the first study of its kind to examine decision making surrounding voice banking. It shows how preserving identity is critically important in how people deal with a diagnosis of MND. For those choosing to voice bank, it is seen as an effective way of preserving their identity, a way of 'fighting back' and giving a positive psychological benefit. Those deciding against voice banking do not believe it could maintain their identity and cannot bring back the natural voice they once had. Clinical implications of this study The reality of using AAC and voice banking for communication may be poorly understood. It would be helpful for professionals to provide information about voice banking as part of a wider discussion about the range of options for communication as the condition progresses. It is important that this includes the opportunity to listen to a voice bank to support understanding of how it is used in a communication device, and how different it sounds to natural speech.
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Affiliation(s)
- Richard Cave
- Language and Cognition, University College London, London, UK
| | - Steven Bloch
- Language and Cognition, University College London, London, UK
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Humoral Influence of Repeated Lineage-Negative Stem/Progenitor Cell Administration on Articulatory Functions in ALS Patients. Stem Cells Int 2020; 2020:8888271. [PMID: 33381192 PMCID: PMC7755492 DOI: 10.1155/2020/8888271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) remains a fatal, neurodegenerative disease frequently leading to dysarthria and impaired swallowing. Better understanding of ALS pathophysiology is prompting the use of humoral cell therapies. Hence, a repeated cellular therapy was applied to ALS patients as an attempt to prevent speech deterioration. Autologous bone marrow-derived lineage-negative (Lin−) cells were intrathecally administered three times at six-week intervals to 42 sporadic ALS patients. Patients were examined for articulatory functions using subjective (VHI) and objective (FDA) scales. Selected trophic, proinflammatory factors and expression profiles of miRNA were measured in cerebrospinal fluid (CSF) and plasma by multiplex Luminex and q-PCR in different timepoints. Of the 42 patients who received the Lin− cells, 6 showed improvement in articulatory functions, 27 remained stable, and 9 deteriorated after 18 weeks of therapy according to FDA scale. Clinical improvement was particularly evident by the 7th day of each cell application and concerned better cough and swallow reflex, soft palate, laryngeal time, pitch, and volume. These results correlated with significant changes in the concentration of various trophic and proinflammatory factors and miRNA expression profiles. A multiple application of Lin− cells proved to be safe and feasible. The repeated procedure can potentate a humoral effect and prevent speech deterioration. A short-lasting trophic effect of each Lin− cells administration was observed on local and systemic level. However, further in-depth studies are necessary to sustain the beneficial effect.
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Geronimo A, Simmons Z. TeleBCI: remote user training, monitoring, and communication with an evoked-potential brain-computer interface. BRAIN-COMPUTER INTERFACES 2020; 7:57-69. [PMID: 33763499 DOI: 10.1080/2326263x.2020.1848134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Brain-computer interfaces (BCIs) are a movement-independent form of augmentative and alternative communication (AAC) for individuals with amyotrophic lateral sclerosis (ALS). The rare utilization of such devices in the homes of patients stems from a number of factors, one of which is the complexity of providing training and support for users. This paper describes the teleBCI interface used to train the patient and facilitator in the operation of a virtual keyboard using an evoked potential BCI. Fifteen patients with motor neuron disease and their communication partners were included in the study, participating from their homes while receiving remote support from the research team. Patient/caregiver teams completed 8 sessions each of P300 BCI training virtually with the researcher. As they participated in subsequent training sessions, participant teams required less help to complete physical, computer, and BCI-specific tasks associated with device use. A subset of users experienced improved performance over sessions, progressing to utilize the full functionality of the speller and communicate with a nurse partner over a telemedicine interface. Perceptions of device utility varied with accuracy of the BCI system. In the management of ALS, the integration of telemedicine provides new opportunities for care delivery, including how BCI-AAC are deployed and used.
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Affiliation(s)
- A Geronimo
- Department of Neurosurgery, 500 University Drive, Hershey, PA 17033
| | - Zachary Simmons
- Departments of Neurology and Humanities, 500 University Drive, Hershey, PA 17033
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Feasibility and validity of EQ-5D-5L proxy by nurses in measuring health-related quality of life of nursing home residents. Qual Life Res 2020; 30:713-720. [PMID: 33067756 DOI: 10.1007/s11136-020-02673-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our study examined the feasibility and validity of the EQ-5D-5L proxy questionnaire in measuring health-related quality of life (HRQoL) of nursing home residents. METHODS Twenty-four nurses and 229 residents from 3 nursing homes in Singapore participated in this cross-sectional study. Nurses assessed residents under their care with the EQ-5D-5L proxy questionnaire. Two experienced mappers conducted Dementia Care Mapping (DCM) within 1 month in a subsample of the residents. Feasibility was evaluated according to percentage of unanswered EQ-5D-5L items and proportion of nurses who failed to respond to all items. Convergent validity was assessed by examining the correlation between EQ-5D-5L measures and DCM scores. Known-groups validity was assessed by comparing differences in EQ-5D-5L scores for residents with varying communication abilities and physical functions. RESULTS The nurses' mean age was 35.4 years while the residents' was 73.4 years. Most residents were female (51.3%) and had the ability to communicate (81.3%). For 6 of the 229 residents (2.6%), not all items in the EQ-5D-5L were completed. The EQ-5D-5L index score correlated positively and moderately with the DCM's well/ill-being score (r = 0.433, n = 90, P < 0.01). Residents who were able to communicate effectively or had better physical function were assessed to have less severe health problems and better EQ-5D-5L scores. CONCLUSION The EQ-5D-5L proxy questionnaire has adequate feasibility and validity when used by nurses to assess the HRQoL of nursing home residents. As it is brief and can be conveniently administered, it can be deployed on a larger scale to assess HRQoL of nursing home residents.
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Brizzi KT, Bridges JFP, Yersak J, Balas C, Thakur N, Galvin M, Hardiman O, Heatwole C, Ravits J, Simmons Z, Bruijn L, Chan J, Bedlack R, Berry JD. Understanding the needs of people with ALS: a national survey of patients and caregivers. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:355-363. [DOI: 10.1080/21678421.2020.1760889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kate T. Brizzi
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Chad Heatwole
- Medical Center, University of Rochester, Rochester, NY, USA,
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, CA, USA,
| | | | - Lucie Bruijn
- Translational Medicine, EMEA, AVeXis, London, UK,
| | - James Chan
- Center for Biostatistics, Massachusetts General Hospital, Boston, MA, USA,
| | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
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Repova B, Zabrodsky M, Plzak J, Kalfert D, Matousek J, Betka J. Text-to-speech synthesis as an alternative communication means after total laryngectomy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:192-197. [PMID: 32367081 DOI: 10.5507/bp.2020.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS Total laryngectomy still plays an essential part in the treatment of laryngeal cancer and loss of voice is the most feared consequence of the surgery. Commonly used rehabilitation methods include esophageal voice, electrolarynx, and implantation of voice prosthesis. In this paper we focus on a new perspective of vocal rehabilitation utilizing alternative and augmentative communication (AAC) methods. METHODS AND PATIENTS 61 consecutive patients treated by means of total laryngectomy with or w/o voice prosthesis implantation were included in the study. All were offered voice banking and personalized speech synthesis (PSS). They had to voluntarily express their willingness to participate and to prove the ability to use modern electronic communication devices. RESULTS Of 30 patients fulfilling the study criteria, only 18 completed voice recording sufficient for voice reconstruction and synthesis. Eventually, only 7 patients started to use this AAC technology during the early postoperative period. The frequency and total usage time of the device gradually decreased. Currently, only 6 patients are active users of the technology. CONCLUSION The influence of communication with the surrounding world on the quality of life of patients after total laryngectomy is unquestionable. The possibility of using the spoken word with the patient's personalized voice is an indisputable advantage. Such a form of voice rehabilitation should be offered to all patients who are deemed eligible.
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Affiliation(s)
- Barbora Repova
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Michal Zabrodsky
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - David Kalfert
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jindrich Matousek
- Department of Cybernetics, University of West Bohemia in Pilsen, Pilsen, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
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Olmstead AJ, Lee J, Viswanathan N. The Role of the Speaker, the Listener, and Their Joint Contributions During Communicative Interactions: A Tripartite View of Intelligibility in Individuals With Dysarthria. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1106-1114. [PMID: 32302251 DOI: 10.1044/2020_jslhr-19-00233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose We present a tripartite view of intelligibility in which the contributions of both the speaker and listener, as well as their joint effort during interaction, are considered. While considerable research has examined communicative interactions in situ, there is a critical gap in current knowledge on how speech intelligibility unfolds during such interactions. Here, we argue that research examining speech intelligibility in communicative interactions may provide important groundwork for advancement in clinical interventions for individuals with dysarthria. Method First, we describe the view and argue for its consideration as a powerful way of thinking about speech intelligibility. We then briefly situate the view in the relevant literature on speech intelligibility and existing theoretical frameworks. We then identify suitable methodological paradigms for studying joint contributions to intelligibility and, lastly, discuss the clinical application and potential impact of this tripartite view. Conclusions Speech communication occurs through interaction; however, in the laboratory and clinic, emphasis is usually placed on individual speakers and listeners. We have proposed that it is critical to consider how the joint contributions of speakers and listeners affect speech intelligibility in communicative interaction. This conceptualization is well aligned with the International Classification of Functioning, Disability and Health, and the findings from such an approach will allow us to better understand how to maximize available resources to enhance speech intelligibility.
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Affiliation(s)
- Annie J Olmstead
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Jimin Lee
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Navin Viswanathan
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
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Rosa Silva JP, Santiago Júnior JB, Dos Santos EL, de Carvalho FO, de França Costa IMP, Mendonça DMFD. Quality of life and functional independence in amyotrophic lateral sclerosis: A systematic review. Neurosci Biobehav Rev 2020; 111:1-11. [PMID: 31917162 DOI: 10.1016/j.neubiorev.2019.12.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/29/2019] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) leads to functional capacity decline, generating great impact in quality of life. Quality of life is directly related to physical integrity and functional independence. This systematic review aimed to analyze treatment protocols and their outcomes from clinical trials with focus on ALS rehabilitation that evaluated the effects on quality of life and functional independence from their intervention process. A literature search was conducted through MEDLINE-PubMed, Science Direct, Web of Science and Scopus databases. A total of 3630 articles were identified. Eleven studies met the inclusion criteria. They focused on different aspects of quality of life or functional independence, which are: respiratory care, mental health, communication skills and exercises. Use of bipap and inspiratory muscle training, anxiety and depression, communication devices implementation and exercises safety and tolerability were considered as key points. However, the drastic evolution of the disease is a limiting factor to the perception of quality of life improvement by patients. Further studies should be done to validate the benefits on patients' quality of life.
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Affiliation(s)
- Jéssica Paloma Rosa Silva
- Department of Physical Therapy, Federal University of Sergipe, Lagarto, SE, Brazil; Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - José Bomfim Santiago Júnior
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Elizabete Lima Dos Santos
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Fernanda Oliveira de Carvalho
- Department of Physical Therapy, Federal University of Sergipe, Lagarto, SE, Brazil; Health Sciences Post-Graduation Nucleus, Federal University of Sergipe, SE, Brazil
| | | | - Deise Maria Furtado de Mendonça
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil.
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Turcotte EL, Abi-Aad KR, Hess RA, Welz ME, Patra DP, Krishna C, Bendok BR. Restoring Speech Using Neuroprosthetic Technology: A New Frontier for Patients with Aphasia. World Neurosurg 2019; 132:437-438. [PMID: 31810144 DOI: 10.1016/j.wneu.2019.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Ryan A Hess
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
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Neumann S, Quinting J, Rosenkranz A, de Beer C, Jonas K, Stenneken P. Quality of life in adults with neurogenic speech-language-communication difficulties: A systematic review of existing measures. JOURNAL OF COMMUNICATION DISORDERS 2019; 79:24-45. [PMID: 30851625 DOI: 10.1016/j.jcomdis.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Sandra Neumann
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Jana Quinting
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Anna Rosenkranz
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Carola de Beer
- SFB 1287 - Project B01, University of Potsdam, Campus Golm, Haus 14, 2.04, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany.
| | - Kristina Jonas
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Prisca Stenneken
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
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Theme 14 Palliative care and decision making. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:375-388. [DOI: 10.1080/21678421.2018.1510584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Felgoise SH, Feinberg R, Stephens HE, Barkhaus P, Boylan K, Caress J, Clawson LL, Elman L, Goutman SA, Mccluskey L, Russell J, Tiryaki E, Weiss M, Simmons Z. Amyotrophic lateral sclerosis-specific quality of life-short form (ALSSQOL-SF): A brief, reliable, and valid version of the ALSSQOL-R. Muscle Nerve 2018; 58:646-654. [PMID: 30028537 DOI: 10.1002/mus.26203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The Amyotrophic Lateral Sclerosis (ALS)-Specific Quality of Life instrument and its revised version (ALSSQOL and ALSSQOL-R) have strong psychometric properties, and have demonstrated research and clinical utility. In this study we aimed to develop a short form (ALSSQOL-SF) suitable for limited clinic time and patient stamina. METHODS The ALSSQOL-SF was created using Item Response Theory and confirmatory factor analysis on 389 patients. A cross-validation sample of 162 patients assessed convergent, divergent, and construct validity of the ALSSQOL-SF compared with psychosocial and physical functioning measures. RESULTS The ALSSQOL-SF consisted of 20 items. Compared with the ALSSQOL-R, optimal precision was retained, and completion time was reduced from 15-25 minutes to 2-4 minutes. Psychometric properties for the ALSSQOL-SF and its subscales were strong. DISCUSSION The ALSSQOL-SF is a disease-specific global QOL instrument that has a short administration time suitable for clinical use, and can provide clinically useful, valid information about persons with ALS. Muscle Nerve 58: 646-654, 2018.
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Affiliation(s)
- Stephanie H Felgoise
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Richard Feinberg
- National Board of Medical Examiners, Philadelphia, Pennsylvania, USA
| | - Helen E Stephens
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin Boylan
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - James Caress
- Department of Neurology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Lora L Clawson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Elman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Russell
- Department of Neurology, Lahey Clinic, Burlington, Massachusetts, USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
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Judge S, Bloch S, McDermott CJ. Communication change in ALS: engaging people living with ALS and their partners in future research. Disabil Rehabil Assist Technol 2018; 14:675-681. [DOI: 10.1080/17483107.2018.1498924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Simon Judge
- Assistive Technology Team, Barnsley Hospital, Barnsley, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven Bloch
- Department of Language and Cognition, University College London, London, UK
| | - Christopher J. McDermott
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
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Disability in amyotrophic lateral sclerosis compared with traumatic brain injury using the World Health Organization Disability Assessment Schedule 2.0 and the International Classification of Functioning minimal generic set. Int J Rehabil Res 2018; 41:224-229. [PMID: 30095553 DOI: 10.1097/mrr.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set. Two years after diagnosis, no significant differences between the two diagnosis groups were found in overall functioning or in working ability using either patient or proxy WHODAS or physician-rated minimal generic set. In single items, however, clear differences were found. Patients and significant others rated household activities, mobility, and self-care as more impaired in the group with ALS, and learning, concentrating, and maintaining friendships in the group with TBI. There were no differences between the two diagnosis groups in the WHODAS items emotional functions, engaging in community, relating with strangers, or in working ability. Both brief ICF-based generic scales, WHODAS and the ICF generic set, could show differences between these patient groups with severe disability. The results of this study should promote assessment of disability with WHODAS 2.0 in ALS and TBI.
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Lee J, Bell M. Articulatory Range of Movement in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:996-1009. [PMID: 29800071 DOI: 10.1044/2018_ajslp-17-0064] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The current study examined overall articulatory range of movement (ROM) in individuals with amyotrophic lateral sclerosis (ALS). Differential involvement of articulators was also tested using articulatory working space in individuals with varying degrees of dysarthria severity and in typically aging individuals. A strong association between overall articulatory ROM and severity measures among individuals with ALS was hypothesized. In addition, it was hypothesized that differential involvement of articulators would be detected using overall articulatory ROM measures. METHOD Twenty-two speakers with dysarthria secondary to ALS and 22 typically aging speakers participated. Speech intelligibility and speaking rate were used as indices of severity. Movement range and overall articulatory working space area (convex hull) of the tongue, lower lip, and jaw were each measured by electromagnetic articulography while the speakers produced the Rainbow Passage. RESULTS Tongue convex hull size was significantly correlated with both indices of severity. A significant interaction between articulators and groups was observed. Individuals with severe dysarthria had reduced tongue convex hull size and exaggerated lower lip convex hull size. ROM in the anterior-posterior dimension showed a more notable differential involvement pattern than ROM in the superior-inferior dimension. Results in the area under a receiver operating characteristic curve analysis revealed group-specific ROM sensitivity. CONCLUSIONS The findings indicate that tongue ROM is reduced in individuals with more severe dysarthria when estimated using a standardized paragraph containing all American English phonemes. The articulatory working space measure could be useful for estimating speech dysfunction in ALS. ROM of the tongue decreases, but ROM of the lower lip and jaw each increase in individuals with severe dysarthria. Differential involvement of the articulators in the anterior-posterior dimension needs to be further investigated.
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Affiliation(s)
- Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Michael Bell
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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Linse K, Aust E, Joos M, Hermann A. Communication Matters-Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:603. [PMID: 30100896 PMCID: PMC6072854 DOI: 10.3389/fneur.2018.00603] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, leading to progressive paralysis, dysarthria, dysphagia, and respiratory disabilities. Therapy is mostly focused on palliative interventions. During the course of the disease, verbal as well as nonverbal communicative abilities become more and more impaired. In this light, communication has been argued to be “the essence of human life” and crucial for patients' quality of life. High-tech augmentative and alternative communication (HT-AAC) technologies such as eyetracking based computer devices and brain-computer-interfaces provide the possibility to maintain caregiver-independent communication and environmental control even in the advanced disease state of ALS. Thus, they enable patients to preserve social participation and to independently communicate end-of-life-decisions. In accordance with these functions of HT-AAC, their use is reported to strengthen self-determination, increase patients' quality of life and reduce caregiver burden. Therefore, HT-AAC should be considered as standard of (palliative) care for people with ALS. On the other hand, the supply with individually tailored HT-AAC technologies is limited by external and patient-inherent variables. This review aims to provide an overview of the possibilities and limitations of HT-AAC technologies and discuss their role in the palliative care for patients with ALS.
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Affiliation(s)
- Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Dresden GmbH, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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Rezeika A, Benda M, Stawicki P, Gembler F, Saboor A, Volosyak I. Brain-Computer Interface Spellers: A Review. Brain Sci 2018; 8:brainsci8040057. [PMID: 29601538 PMCID: PMC5924393 DOI: 10.3390/brainsci8040057] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022] Open
Abstract
A Brain-Computer Interface (BCI) provides a novel non-muscular communication method via brain signals. A BCI-speller can be considered as one of the first published BCI applications and has opened the gate for many advances in the field. Although many BCI-spellers have been developed during the last few decades, to our knowledge, no reviews have described the different spellers proposed and studied in this vital field. The presented speller systems are categorized according to major BCI paradigms: P300, steady-state visual evoked potential (SSVEP), and motor imagery (MI). Different BCI paradigms require specific electroencephalogram (EEG) signal features and lead to the development of appropriate Graphical User Interfaces (GUIs). The purpose of this review is to consolidate the most successful BCI-spellers published since 2010, while mentioning some other older systems which were built explicitly for spelling purposes. We aim to assist researchers and concerned individuals in the field by illustrating the highlights of different spellers and presenting them in one review. It is almost impossible to carry out an objective comparison between different spellers, as each has its variables, parameters, and conditions. However, the gathered information and the provided taxonomy about different BCI-spellers can be helpful, as it could identify suitable systems for first-hand users, as well as opportunities of development and learning from previous studies for BCI researchers.
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Affiliation(s)
- Aya Rezeika
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
| | - Mihaly Benda
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
| | - Piotr Stawicki
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
| | - Felix Gembler
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
| | - Abdul Saboor
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
| | - Ivan Volosyak
- Faculty of Technology and Bionics, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany.
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44
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Makkonen T, Ruottinen H, Puhto R, Helminen M, Palmio J. Speech deterioration in amyotrophic lateral sclerosis (ALS) after manifestation of bulbar symptoms. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:385-392. [PMID: 29159848 DOI: 10.1111/1460-6984.12357] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 09/18/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The symptoms and their progression in amyotrophic lateral sclerosis (ALS) are typically studied after the diagnosis has been confirmed. However, many people with ALS already have severe dysarthria and loss of adequate speech at the time of diagnosis. Speech-and-language therapy interventions should be targeted timely based on communicative need in ALS. AIMS To investigate how long natural speech will remain functional and to identify the changes in the speech of persons with ALS. METHODS & PROCEDURES Altogether 30 consecutive participants were studied and divided into two groups based on the initial type of ALS, bulbar or spinal. Their speech disorder was evaluated on severity, articulation rate and intelligibility during the 2-year follow-up. OUTCOME & RESULTS The ability to speak deteriorated to poor and necessitated augmentative and alternative communication (AAC) methods with 60% of the participants. Their speech remained adequate on average for 18 months from the first bulbar symptom. Severity, articulation rate and intelligibility declined with nearly all participants during the study. To begin with speech deteriorated more in the bulbar group than in the spinal group and the difference remained during the whole follow-up with some exceptions. CONCLUSIONS & IMPLICATIONS The onset of bulbar symptoms indicated the time to loss of speech better than when assessed from ALS diagnosis or the first speech therapy evaluation. In clinical work, it is important to take the initial type of ALS into consideration when determining the urgency of AAC measures as people with bulbar-onset ALS are more susceptible to delayed evaluation and AAC intervention.
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Affiliation(s)
- Tanja Makkonen
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hanna Ruottinen
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Riitta Puhto
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, Tampere, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmio
- Neuromuscular Research Center, University of Tampere and, Tampere University Hospital, Tampere, Finland
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45
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Oh J, Hong GRS, Kim SH, Kim JA. Translation and Psychometric Evaluation of a Korean Version of the Amyotrophic Lateral Sclerosis-Specific Quality of Life – Revised. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:92-98. [DOI: 10.1080/21678421.2016.1249885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Juyeon Oh
- Division of Nursing, Hanyang University, Seoul, Korea,
- Cell therapy Center for Intractable Disorders, Hanyang University Hospital, Seoul, Korea, and
| | | | - Seung Hyun Kim
- Cell therapy Center for Intractable Disorders, Hanyang University Hospital, Seoul, Korea, and
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jung A Kim
- Division of Nursing, Hanyang University, Seoul, Korea,
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