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Zhao W, Paixao L, Shimony JS, Nascimento FA. Teaching Video NeuroImage: Severe Facioglossal Weakness and Dysarthria Due to Bilateral Perisylvian Polymicrogyria. Neurology 2024; 102:e209361. [PMID: 38574323 DOI: 10.1212/wnl.0000000000209361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Wei Zhao
- From the Departments of Neurology (W.Z., L.P., F.A.N.) and Radiology (J.S.S.), Washington University School of Medicine, St. Louis, MO; and Department of Neurology (L.P.), University of Miami Miller School of Medicine, FL
| | - Luis Paixao
- From the Departments of Neurology (W.Z., L.P., F.A.N.) and Radiology (J.S.S.), Washington University School of Medicine, St. Louis, MO; and Department of Neurology (L.P.), University of Miami Miller School of Medicine, FL
| | - Joshua S Shimony
- From the Departments of Neurology (W.Z., L.P., F.A.N.) and Radiology (J.S.S.), Washington University School of Medicine, St. Louis, MO; and Department of Neurology (L.P.), University of Miami Miller School of Medicine, FL
| | - Fábio A Nascimento
- From the Departments of Neurology (W.Z., L.P., F.A.N.) and Radiology (J.S.S.), Washington University School of Medicine, St. Louis, MO; and Department of Neurology (L.P.), University of Miami Miller School of Medicine, FL
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Kasper E, Temp AGM, Köckritz V, Meier L, Machts J, Vielhaber S, Hermann A, Prudlo J. Verbal expressive language minimally affected in non-demented people living with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:308-316. [PMID: 38306019 DOI: 10.1080/21678421.2024.2307512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Objective: Language dysfunction is one of the most common cognitive impairments in amyotrophic lateral sclerosis (ALS). Although discourse capacities are essential for daily functioning, verbal expressive language has not been widely investigated in ALS. The existing research available suggests that discourse impairments are prevalent. This study investigates verbal expressive language in people living with ALS (plwALS) in contrast to healthy controls (HC).Methods: 64 plwALS and 49 age, gender and education-matched healthy controls were ask to describe the Cookie Theft Picture Task. The recordings were analyzed for discourse productivity, discourse content, syntactic complexity, speech fluency and verb processing. We applied the Bayesian hypothesis-testing framework, incorporating the effects of dysarthria, cognitive impairment status (CIS), and premorbid crystalline verbal IQ.Results: Compared to HC, plwALS only showed a single impairment: speech dysfluency. Discourse productivity, discourse content, syntactic complexity and verb processing were not impaired. Cognition and dysarthria exceeded the influence of verbal IQ for total words spoken and content density. Cognition alone seemed to explain dysfluency. Body-agent verbs were produced at even higher rates than other verb types. For the remaining outcomes, verbal IQ was the most decisive factor.Conclusions: In contrast to existing research, our data demonstrates no discernible impairment in verbal expressive language in ALS. What our findings show to be decisive is accounting for the influence of dysarthria, cognitive impairment status, and verbal IQ as variables on spontaneous verbal expressive language. Minor impairments in verbal expressive language appear to be influenced to a greater degree by executive dysfunctioning and dysarthria than by language impairment.
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Affiliation(s)
- Elisabeth Kasper
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Anna G M Temp
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Neurozentrum, Berufsgenossenschaftliches Klinikum Hamburg, Germany
| | - Verena Köckritz
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Lisa Meier
- Department of Neurology, University Medical Centre, Rostock, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Andreas Hermann
- Department of Neurology, University Medical Centre, Rostock, Germany
- Translational Neurodegeneration Section "Albrecht Kossel", University Medical Centre, Rostock
| | - Johannes Prudlo
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
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3
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Bagnato MR, Ciullo I, Diomedi M. Recurrent lacunar strokes in a patient with small vessel disease: rare but not negligible cause of Foix-Chavany-Marie syndrome. Neurol Sci 2024; 45:2401-2402. [PMID: 38296880 DOI: 10.1007/s10072-024-07358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Maria Rosaria Bagnato
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy.
| | - Ilaria Ciullo
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy
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Isaev DY, Vlasova RM, Di Martino JM, Stephen CD, Schmahmann JD, Sapiro G, Gupta AS. Uncertainty of Vowel Predictions as a Digital Biomarker for Ataxic Dysarthria. Cerebellum 2024; 23:459-470. [PMID: 37039956 PMCID: PMC10826261 DOI: 10.1007/s12311-023-01539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Dysarthria is a common manifestation across cerebellar ataxias leading to impairments in communication, reduced social connections, and decreased quality of life. While dysarthria symptoms may be present in other neurological conditions, ataxic dysarthria is a perceptually distinct motor speech disorder, with the most prominent characteristics being articulation and prosody abnormalities along with distorted vowels. We hypothesized that uncertainty of vowel predictions by an automatic speech recognition system can capture speech changes present in cerebellar ataxia. Speech of participants with ataxia (N=61) and healthy controls (N=25) was recorded during the "picture description" task. Additionally, participants' dysarthric speech and ataxia severity were assessed on a Brief Ataxia Rating Scale (BARS). Eight participants with ataxia had speech and BARS data at two timepoints. A neural network trained for phoneme prediction was applied to speech recordings. Average entropy of vowel tokens predictions (AVE) was computed for each participant's recording, together with mean pitch and intensity standard deviations (MPSD and MISD) in the vowel segments. AVE and MISD demonstrated associations with BARS speech score (Spearman's rho=0.45 and 0.51), and AVE demonstrated associations with BARS total (rho=0.39). In the longitudinal cohort, Wilcoxon pairwise signed rank test demonstrated an increase in BARS total and AVE, while BARS speech and acoustic measures did not significantly increase. Relationship of AVE to both BARS speech and BARS total, as well as the ability to capture disease progression even in absence of measured speech decline, indicates the potential of AVE as a digital biomarker for cerebellar ataxia.
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Affiliation(s)
- Dmitry Yu Isaev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Roza M Vlasova
- Department of Psychiatry, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Christopher D Stephen
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guillermo Sapiro
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Departments of Mathematics & Computer Science, Duke University, Durham, NC, USA
| | - Anoopum S Gupta
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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5
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Perry SE, Troche M, Huber JE, Curtis J, Kiefer B, Sevitz J, Dennard Q, Borders J, Browy JR, Dakin A, Gonzalez V, Chapman J, Wu T, Katz L, Britton D. Behavioral Management of Respiratory/Phonatory Dysfunction for Dysarthria Associated With Neurodegenerative Disease: A Systematic Review. Am J Speech Lang Pathol 2024; 33:1069-1097. [PMID: 38232176 DOI: 10.1044/2023_ajslp-23-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease. METHOD Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. RESULTS The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators. A large range of therapeutic approaches have been added to the evidence base since the last review, including expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy. Evidence for treatment in several different population groups-including cerebellar ataxia, myotonic dystrophy, autosomal recessive spastic ataxia of Charlevoix-Saguenay, Huntington's disease, multiple system atrophy, and Lewy body dementia-were added to the current review. Synthesis of evidence quality provided strong evidence in support of only one behavioral intervention: Lee Silverman Voice Treatment Program (LSVT LOUD) in people with Parkinson's disease. No other treatment approach or population included in this review demonstrated more than limited evidence, reflecting that these approaches/populations require urgent further examination. CONCLUSION Suggestions about where future research efforts could be significantly strengthened and how clinicians can apply research findings to their practice are provided. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24964473.
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Affiliation(s)
- Sarah E Perry
- University of Canterbury/Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch
| | - Michelle Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jessica E Huber
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - James Curtis
- Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Brianna Kiefer
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento
| | - Jordanna Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Qiana Dennard
- Department of Speech & Hearing Sciences, Portland State University, OR
| | - James Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | - Avery Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | | | - Tiffany Wu
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Lily Katz
- Department of Otolaryngology, University of Wisconsin Health University Hospital, Madison
| | - Deanna Britton
- Department of Speech & Hearing Sciences, Portland State University, OR
- Northwest Clinic for Voice and Swallowing, Oregon Health & Science University, Portland
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Portalete CR, Moraes DADO, Pagliarin KC, Keske-Soares M, Cielo CA. Acoustic and Physiological Voice Assessment And Maximum Phonation Time In Patients With Different Types Of Dysarthria. J Voice 2024; 38:540.e1-540.e11. [PMID: 34895782 DOI: 10.1016/j.jvoice.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the maximum phonation time of /a/, acoustic glottal source parameters, and physiological measures in patients with dysarthria. METHOD Thirteen patients were classified according to dysarthria type and divided into functional profiles (hypofunctional, hyperfunctional, and mixed). Assessments of maximum phonation time of /a/, glottal source parameters, electroglottography, and nasometry were performed. Results were compared between groups using ANOVA and Tukey posthoc tests. RESULTS The highest fundamental frequency differed significantly between groups, with the hyperfunctional profile showing higher values than the other participant groups. Reductions in the maximum phonation time of /a/ and alterations in acoustic glottal source parameters and electroglottography measures were observed in all groups, with no significant differences between them. The remaining measures did not differ between groups. CONCLUSION The maximum phonation times for /a/ were reduced in all participant groups, suggesting air escape during phonation. The presence of alterations in several glottal source parameters in all participant groups is indicative of noise, tremor, and vocal instability. Lastly, the high fundamental frequency in patients with a hyperfunctional profile reinforces the presence of vocal instability. These findings suggest that, although the characteristics observed in the assessments were consistent with expectations of patients with dysarthria, it is difficult to perform a differential diagnosis of this condition based on acoustic and physiological parameters alone.
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Mračková M, Mareček R, Mekyska J, Košťálová M, Rektorová I. Levodopa may modulate specific speech impairment in Parkinson's disease: an fMRI study. J Neural Transm (Vienna) 2024; 131:181-187. [PMID: 37943390 DOI: 10.1007/s00702-023-02715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
Hypokinetic dysarthria (HD) is a difficult-to-treat symptom affecting quality of life in patients with Parkinson's disease (PD). Levodopa may partially alleviate some symptoms of HD in PD, but the neural correlates of these effects are not fully understood. The aim of our study was to identify neural mechanisms by which levodopa affects articulation and prosody in patients with PD. Altogether 20 PD patients participated in a task fMRI study (overt sentence reading). Using a single dose of levodopa after an overnight withdrawal of dopaminergic medication, levodopa-induced BOLD signal changes within the articulatory pathway (in regions of interest; ROIs) were studied. We also correlated levodopa-induced BOLD signal changes with the changes in acoustic parameters of speech. We observed no significant changes in acoustic parameters due to acute levodopa administration. After levodopa administration as compared to the OFF dopaminergic condition, patients showed task-induced BOLD signal decreases in the left ventral thalamus (p = 0.0033). The changes in thalamic activation were associated with changes in pitch variation (R = 0.67, p = 0.006), while the changes in caudate nucleus activation were related to changes in the second formant variability which evaluates precise articulation (R = 0.70, p = 0.003). The results are in line with the notion that levodopa does not have a major impact on HD in PD, but it may induce neural changes within the basal ganglia circuitries that are related to changes in speech prosody and articulation.
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Affiliation(s)
- Martina Mračková
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Radek Mareček
- Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Jiří Mekyska
- Department of Telecommunications, Brno University of Technology, Brno, Czech Republic
| | - Milena Košťálová
- Department of Neurology, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Brno, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic.
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Houle N, Feaster T, Mira A, Meeks K, Stepp CE. Sex Differences in the Speech of Persons With and Without Parkinson's Disease. Am J Speech Lang Pathol 2024; 33:96-116. [PMID: 37889201 PMCID: PMC11000784 DOI: 10.1044/2023_ajslp-22-00350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/24/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Sex differences are apparent in the prevalence and the clinical presentation of Parkinson's disease (PD), but their effects on speech have been less studied. METHOD Speech acoustics of persons with (34 females and 34 males) and without (age- and sex-matched) PD were examined, assessing the effects of PD diagnosis and sex on ratings of dysarthria severity and acoustic measures of phonation (fundamental frequency standard deviation, smoothed cepstral peak prominence), speech rate (net syllables per second, percent pause ratio), and articulation (articulatory-acoustic vowel space, release burst precision). RESULTS Most measures were affected by PD (dysarthria severity, fundamental frequency standard deviation) and sex (smoothed cepstral peak prominence, net syllables per second, percent pause ratio, articulatory-acoustic vowel space), but without interactions between them. Release burst precision was differentially affected by sex in PD. Relative to those without PD, persons with PD produced fewer plosives with a single burst: females more frequently produced multiple bursts, whereas males more frequently produced no burst at all. CONCLUSIONS Most metrics did not indicate that speech production is differentially affected by sex in PD. Sex was, however, associated with disparate effects on release burst precision in PD, which deserves further study. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24388666.
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Affiliation(s)
- Nichole Houle
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Taylor Feaster
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Amna Mira
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Kirsten Meeks
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head & Neck Surgery, Boston University School of Medicine, MA
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Zheng WZ, Han JY, Chen CY, Chang YJ, Lai YH. Improving the Efficiency of Dysarthria Voice Conversion System Based on Data Augmentation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4613-4623. [PMID: 37938964 DOI: 10.1109/tnsre.2023.3331524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Dysarthria, a speech disorder often caused by neurological damage, compromises the control of vocal muscles in patients, making their speech unclear and communication troublesome. Recently, voice-driven methods have been proposed to improve the speech intelligibility of patients with dysarthria. However, most methods require a significant representation of both the patient's and target speaker's corpus, which is problematic. This study aims to propose a data augmentation-based voice conversion (VC) system to reduce the recording burden on the speaker. We propose dysarthria voice conversion 3.1 (DVC 3.1) based on a data augmentation approach, including text-to-speech and StarGAN-VC architecture, to synthesize a large target and patient-like corpus to lower the burden of recording. An objective evaluation metric of the Google automatic speech recognition (Google ASR) system and a listening test were used to demonstrate the speech intelligibility benefits of DVC 3.1 under free-talk conditions. The DVC system without data augmentation (DVC 3.0) was used for comparison. Subjective and objective evaluation based on the experimental results indicated that the proposed DVC 3.1 system enhanced the Google ASR of two dysarthria patients by approximately [62.4%, 43.3%] and [55.9%, 57.3%] compared to unprocessed dysarthria speech and the DVC 3.0 system, respectively. Further, the proposed DVC 3.1 increased the speech intelligibility of two dysarthria patients by approximately [54.2%, 22.3%] and [63.4%, 70.1%] compared to unprocessed dysarthria speech and the DVC 3.0 system, respectively. The proposed DVC 3.1 system offers significant potential to improve the speech intelligibility performance of patients with dysarthria and enhance verbal communication quality.
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Kim JA, Jang H, Choi Y, Min YG, Hong YH, Sung JJ, Choi SJ. Subclinical articulatory changes of vowel parameters in Korean amyotrophic lateral sclerosis patients with perceptually normal voices. PLoS One 2023; 18:e0292460. [PMID: 37831677 PMCID: PMC10575489 DOI: 10.1371/journal.pone.0292460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The available quantitative methods for evaluating bulbar dysfunction in patients with amyotrophic lateral sclerosis (ALS) are limited. We aimed to characterize vowel properties in Korean ALS patients, investigate associations between vowel parameters and clinical features of ALS, and analyze subclinical articulatory changes of vowel parameters in those with perceptually normal voices. Forty-three patients with ALS (27 with dysarthria and 16 without dysarthria) and 20 healthy controls were prospectively collected in the study. Dysarthria was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R) speech subscores, with any loss of 4 points indicating the presence of dysarthria. The structured speech samples were recorded and analyzed using Praat software. For three corner vowels (/a/, /i/, and /u/), data on the vowel duration, fundamental frequency, frequencies of the first two formants (F1 and F2), harmonics-to-noise ratio, vowel space area (VSA), and vowel articulation index (VAI) were extracted from the speech samples. Corner vowel durations were significantly longer in ALS patients with dysarthria than in healthy controls. The F1 frequency of /a/, F2 frequencies of /i/ and /u/, the VSA, and the VAI showed significant differences between ALS patients with dysarthria and healthy controls. The area under the curve (AUC) was 0.912. The F1 frequency of /a/ and the VSA were the major determinants for differentiating ALS patients who had not yet developed apparent dysarthria from healthy controls (AUC 0.887). In linear regression analyses, as the ALSFRS-R speech subscore decreased, both the VSA and VAI were reduced. In contrast, vowel durations were found to be rather prolonged. The analyses of vowel parameters provided a useful metric correlated with disease severity for detecting subclinical bulbar dysfunction in ALS patients.
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Affiliation(s)
- Jin-Ah Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Hayeun Jang
- Division of English, Busan University of Foreign Studies, Busan, Republic of Korea
| | - Yoonji Choi
- Department of Korean Language and Literature, Seoul National University, Seoul, Republic of Korea
| | - Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Borrie SA, Hepworth TJ, Wynn CJ, Hustad KC, Barrett TS, Lansford KL. Perceptual Learning of Dysarthria in Adolescence. J Speech Lang Hear Res 2023; 66:3791-3803. [PMID: 37616225 PMCID: PMC10713018 DOI: 10.1044/2023_jslhr-23-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE As evidenced by perceptual learning studies involving adult listeners and speakers with dysarthria, adaptation to dysarthric speech is driven by signal predictability (speaker property) and a flexible speech perception system (listener property). Here, we extend adaptation investigations to adolescent populations and examine whether adult and adolescent listeners can learn to better understand an adolescent speaker with dysarthria. METHOD Classified by developmental stage, adult (n = 42) and adolescent (n = 40) listeners completed a three-phase perceptual learning protocol (pretest, familiarization, and posttest). During pretest and posttest, all listeners transcribed speech produced by a 13-year-old adolescent with spastic dysarthria associated with cerebral palsy. During familiarization, half of the adult and adolescent listeners engaged in structured familiarization (audio and lexical feedback) with the speech of the adolescent speaker with dysarthria; and the other half, with the speech of a neurotypical adolescent speaker (control). RESULTS Intelligibility scores increased from pretest to posttest for all listeners. However, listeners who received dysarthria familiarization achieved greater intelligibility improvements than those who received control familiarization. Furthermore, there was a significant effect of developmental stage, where the adults achieved greater intelligibility improvements relative to the adolescents. CONCLUSIONS This study provides the first tranche of evidence that adolescent dysarthric speech is learnable-a finding that holds even for adolescent listeners whose speech perception systems are not yet fully developed. Given the formative role that social interactions play during adolescence, these findings of improved intelligibility afford important clinical implications.
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Affiliation(s)
- Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Taylor J. Hepworth
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Camille J. Wynn
- Department of Communication Science and Disorders, University of Houston
| | - Katherine C. Hustad
- Waisman Center, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | | | - Kaitlin L. Lansford
- Department of Communication Science and Disorders, Florida State University, Tallahassee
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Yoho SE, Barrett TS, Borrie SA. The Influence of Sensorineural Hearing Loss on the Relationship Between the Perception of Speech in Noise and Dysarthric Speech. J Speech Lang Hear Res 2023; 66:4025-4036. [PMID: 37652059 PMCID: PMC10713019 DOI: 10.1044/2023_jslhr-23-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/25/2023] [Accepted: 06/14/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE The ability to understand speech under adverse listening conditions is highly variable across listeners. Despite this, studies have found that listeners with normal hearing display consistency in their ability to perceive speech across different types of degraded speech, suggesting that, for at least these listeners, global skills may be involved in navigating the ambiguity in speech signals. However, there are substantial differences in the perceptual challenges faced by listeners with normal and impaired hearing. This study examines whether listeners with sensorineural hearing loss demonstrate the same type of consistency as normal-hearing listeners when processing neurotypical (i.e., control) speech that has been degraded by external noise and speech that is neurologically degraded such as dysarthria. METHOD Listeners with normal hearing (n = 31) and listeners with sensorineural hearing loss (n = 36) completed an intelligibility task with neurotypical speech in noise and with dysarthric speech in quiet. RESULTS Findings were consistent with previous work demonstrating a relationship between the ability to perceive neurotypical speech in noise and dysarthric speech for listeners with normal hearing, albeit at a higher intelligibility level than previously observed. This relationship was also observed for listeners with hearing loss, although listeners with more severe hearing losses performed better with dysarthric speech than with neurotypical speech in noise. CONCLUSIONS This study demonstrated a high level of consistency in intelligibility performance for listeners across two different types of degraded speech, even when those listeners were further challenged by the presence of sensorineural hearing loss. Clinical implications for both listeners with hearing loss and their communication partners with dysarthria are discussed.
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Affiliation(s)
- Sarah E. Yoho
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | | | - Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
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Lee J, Vishwanath V, Gill N. Dysphagia, Dysarthria, and Diplopia in a 14-year-old Boy. Pediatr Rev 2023; 44:592-594. [PMID: 37777648 DOI: 10.1542/pir.2021-005366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- July Lee
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vijay Vishwanath
- Division of Pediatric Neurology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Natasha Gill
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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14
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Cave R, Bloch S. The use of speech recognition technology by people living with amyotrophic lateral sclerosis: a scoping review. Disabil Rehabil Assist Technol 2023; 18:1043-1055. [PMID: 34511007 DOI: 10.1080/17483107.2021.1974961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 80% of people living with Amyotrophic Lateral Sclerosis (plwALS) develop difficulties with their speech, affecting communication, self-identity and quality of life. Automatic speech recognition technology (ASR) is becoming a common way to interact with a broad range of devices, to find information and control the environment.ASR can be problematic for people with acquired neurogenic motor speech difficulties (dysarthria). Given that the field is rapidly developing, a scoping review is warranted. AIMS This study undertakes a scoping review on the use of ASR technology by plwALS and identifies research gaps in the existing literature. MATERIALS AND METHODS Electronic databases and relevant grey literature were searched from 1990 to 2020. Eleven research papers and articles were identified that included participants living with ALS using ASR technology. Relevant data were extracted from the included sources, and a narrative summary of the findings presented.Outcomes and Results: Eleven publications used recordings of plwALS to assess word recognition rate (WRR) word error rate (WER) or phoneme error rate (PER) and appropriacy of responses by ASR devices. All were found to be linked to severity of dysarthria and the ASR technology used. One article examined how speech modification may improve ASR accuracy. The final article completed thematic analysis of Amazon.com reviews for the Amazon Echo and plwALS were reported to use ASR devices to control the environment and summon assistance. CONCLUSIONS There are gaps in the evidence base: understanding expectations of plwALS and how they use ASR technology; how WER/PER/WRR relates to usability; how ASR use changes as ALS progresses.Implications for rehabilitationDevices that people can interact with using speech are becoming ubiquitous. As movement and mobility are likely to be affected by ALS and progress over time, speech interaction could be very helpful for accessing information and environmental control.However, many people living with ALS (plwALS) also have impaired speech (dysarthria) and experience trouble using voice interaction technology because it may not understand them.Although advances in automated speech recognition (ASR) technology promise better understanding of dysarthric speech, future research needs to investigate how plwALS use ASR, how accurate it needs to be to be functionally useful, and how useful it may be over time as the disease progresses.
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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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15
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Kang K, Nunes AS, Sharma M, Hall AJ, Mishra RK, Casado J, Cole R, Derhammer M, Barchard G, Najafi B, Vaziri A, Wills AM, Pantelyat A. Utilizing speech analysis to differentiate progressive supranuclear palsy from Parkinson's disease. Parkinsonism Relat Disord 2023; 115:105835. [PMID: 37678101 PMCID: PMC10591790 DOI: 10.1016/j.parkreldis.2023.105835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Distinguishing Parkinson's disease (PD) from Progressive supranuclear palsy (PSP) at early disease stages is important for clinical trial enrollment and clinical care/prognostication. METHODS We recruited 21 participants with PSP(n = 11) or PD(n = 10) with reliable caregivers. Standardized passage reading, counting, and sustained phonation were recorded on the BioDigit Home tablet (BioSensics LLC, Newton, MA USA), and speech features from the assessments were analyzed using the BioDigit Speech platform (BioSensics LLC, Newton, MA USA). An independent t-test was performed to compare each speech feature between PSP and PD participants. We also performed Spearman's correlations to evaluate associations between speech measures and clinical scores (e.g., PSP rating scales and MoCA). In addition, the model's performance in classifying PSP and PD was evaluated using Rainbow passage reading analysis. RESULTS During Rainbow passage reading, PSP participants had a significantly slower articulation rate (2.45(0.49) vs 3.60(0.47) words/minute), lower speech-to-pause ratio (2.33(1.08) vs 3.67(1.18)), intelligibility dynamic time warping (DTW, 0.26(0.19) vs 0.53(0.26)), and similarity DTW (0.43(0.27) vs 0.67(0.13)) compared to PD participants. PSP participants also had longer pause times (17.24(5.47) vs 8.45(3.13) sec) and longer total signal times (52.44(6.67) vs (36.67(6.73) sec) when reading the passage. In terms of the phonation 'a', PSP participants showed a significant higher spectral entropy, spectral centroid, and spectral spread compared to PD participants and no differences were found for phonation 'e'. PD participants had more accurate reverse number counts than PSP participants (14.89(3.86) vs 7.36(4.67)). PSP Rating Scale (PSPRS) dysarthria (r = 0.79, p = 0.004) and bulbar item scores (r = 0.803, p = 0.005) were positively correlated with articulation rate in reverse number counts. Correct reverse number counts were positively correlated with total Montreal Cognitive Assessment scores (r = 0.703, p = 0.016). Machine learning models using passage reading-derived measures obtained an AUC of 0.93, and the sensitivity/specificity in correctly classifying PSP and PD participants were 0.95 and 0.90, respectively. CONCLUSION Our study demonstrates the feasibility of differentiating PSP from PD using a digital health technology platform. Further multi-center studies are needed to expand and validate our initial findings.
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Affiliation(s)
- Kyurim Kang
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, 21287, USA
| | | | - Mansi Sharma
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Boston, MA, USA
| | - A J Hall
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, 21287, USA
| | | | | | | | | | | | - Bijan Najafi
- Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | - Anne-Marie Wills
- Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Boston, MA, USA
| | - Alexander Pantelyat
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, 21287, USA.
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He D, Feenaughty L, Wan Q. Global Acoustic Speech Temporal Characteristics for Mandarin Speakers With Parkinson's Disease During Syllable Repetition and Passage Reading. Am J Speech Lang Pathol 2023; 32:2232-2244. [PMID: 37625136 DOI: 10.1044/2023_ajslp-23-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
PURPOSE Previous research has revealed considerable variation in speech rates among English speakers with Parkinson's disease (PD) with slower, faster, or similar rates than controls. The purpose of this study was to characterize speech rates of Mandarin speakers with PD and the corresponding articulation and pause characteristics explaining the speech rates to enhance rate control therapies. METHOD Eighteen Mandarin speakers with PD and 18 controls produced syllable repetitions and passage reading using their typical speech style. Speech rates, articulation rates, mean pause durations (≥ 10 ms), and the number of pauses with duration between 10 ms and 300 ms and greater than 300 ms were measured and compared between groups and tasks as well as across the initial, middle, and final periods of the passage. Two-way, mixed-model analyses of variance were employed for data analysis. RESULTS Compared to controls, individuals with PD spoke with similar speech rates and faster articulation rates during passage reading, whereas during syllable repetitions, they produced slower speech rates and comparable articulation rates. The slower syllable repetitions produced by speakers with PD may be explained by longer pauses and more perceptual pauses, whereas faster articulation rates may explain the trend of faster speech rates during reading. Speech and articulation rates accelerated for both groups during passage reading. CONCLUSIONS Speech rates of Mandarin speakers with PD were characterized by faster articulation, longer pauses, and more perceptual pauses for passage reading. A descriptive model of speech rate suggested that speakers with PD and dysarthria in this study would benefit from rate reduction therapy decreasing articulation rate. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23982282.
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Affiliation(s)
- Deling He
- Department of Rehabilitation Sciences, East China Normal University, Shanghai
| | - Lynda Feenaughty
- School of Communication Sciences and Disorders, The University of Memphis, TN
| | - Qin Wan
- Department of Rehabilitation Sciences, East China Normal University, Shanghai
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17
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Johansson IL, Samuelsson C, Müller N. Consonant articulation acoustics and intelligibility in Swedish speakers with Parkinson's disease: a pilot study. Clin Linguist Phon 2023; 37:845-865. [PMID: 35833475 DOI: 10.1080/02699206.2022.2095926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
Imprecise consonant articulation is common in speakers with Parkinson's disease and can affect intelligibility. The research on the relationship between acoustic speech measures and intelligibility in Parkinson's disease is limited, and most of the research has been conducted on English. This pilot study investigated aspects of consonant articulation acoustics in eleven Swedish speakers with Parkinson's disease and six neurologically healthy persons. The focus of the study was on consonant cluster production, articulatory motion rate and variation, and voice onset time, and how these acoustic features correlate with speech intelligibility. Among the measures in the present study, typicality ratings of heterorganic consonant clusters /spr/ and /skr/ had the strongest correlations with intelligibility. Measures based on syllable repetition, such as repetition rate and voice onset time, showed varying results with weak to moderate correlations with intelligibility. One conclusion is that some acoustic measures may be more sensitive than others to the impact of the underlying sensory-motor impairment and dysarthria on speech production and intelligibility in speakers with Parkinson's disease. Some aspects of articulation appear to be equally demanding in terms of acoustic realisation for elderly healthy speakers and for speakers with Parkinson's disease, such as sequential motion rate measures. Clinically, this would imply that for the purpose of detecting signs of disordered speech motor control, choosing measures with less variation among older speakers without articulation impairment would lead to more robust results.
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Affiliation(s)
- Inga-Lena Johansson
- Department of Biomedical and Clinical Sciences/Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - Christina Samuelsson
- Department of Biomedical and Clinical Sciences/Speech and Language Pathology, Linköping University, Linköping, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Solna, Sweden
| | - Nicole Müller
- Department of Biomedical and Clinical Sciences/Speech and Language Pathology, Linköping University, Linköping, Sweden
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
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18
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Donohue C, Chapin JL, Anderson A, DiBiase L, Gray LT, Wymer JP, Plowman EK. Sensitivity and specificity of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised to detect dysarthria in individuals with amyotrophic lateral sclerosis. Muscle Nerve 2023; 68:296-302. [PMID: 37345346 PMCID: PMC10529444 DOI: 10.1002/mus.27923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION/AIMS Given the widespread use of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) to measure disease progression in ALS and recent reports demonstrating its poor sensitivity, we aimed to determine the sensitivity and specificity of the ALSFRS-R bulbar subscale and speech item to detect validated clinical ratings of dysarthria in individuals with ALS. METHODS Paired ALSFRS-R and validated Speech Intelligibility Test (SIT) data from individuals with ALS were analyzed. Trained raters completed duplicate, independent, and blinded ratings of audio recordings to obtain speech intelligibility (%) and speaking rate (words per minute, WPM). Binary dysarthria profiles were derived (dysarthria ≤96% intelligible and/or <150 WPM). Data were obtained using the Kruskal-Wallis test, receiver-operating characteristic (ROC) curve, area under the curve (AUC), sensitivity and specificity percentages, and positive/negative predictive values (PPV/NPV). RESULTS A total of 250 paired SIT and ALSFRS-R data points were analyzed. Dysarthria was confirmed in 72.4% (n = 181). Dysarthric speakers demonstrated lower ALSFRS-R bulbar subscale (8.9 vs. 11.2) and speech item (2.7 vs. 3.7) scores (P < .0001). The ALSFRS-R bulbar subscale score had an AUC of 0.81 (95% confidence interval [CI] 0.75 to 0.86). A subscale score of ≤11 yielded a sensitivity of 86%, specificity of 57%, PPV of 84%, and NPV of 60% to correctly identify dysarthria status. The ALSFRS-R speech item score demonstrated an AUC of 0.81 to detect dysarthria (95% CI 0.76 to 0.85), with sensitivity of 79%, specificity of 75%, PPV of 89%, and NPV of 58% for a speech item cutpoint of ≤3. DISCUSSION The ALSFRS-R bulbar and speech item subscale scores may be useful, inexpensive, and quick tools for monitoring dysarthria status in ALS.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Jennifer L. Chapin
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Amber Anderson
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Lauren DiBiase
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Lauren Tabor Gray
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA
- Center of Collaborative Research, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Department of Surgery, University of Florida, Gainesville, FL, USA
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19
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Kuo C, Berry J. The Relationship Between Acoustic and Kinematic Vowel Space Areas With and Without Normalization for Speakers With and Without Dysarthria. Am J Speech Lang Pathol 2023; 32:1923-1937. [PMID: 37105919 PMCID: PMC10561967 DOI: 10.1044/2023_ajslp-22-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/09/2022] [Accepted: 01/17/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Few studies have reported on the vowel space area (VSA) in both acoustic and kinematic domains. This study examined acoustic and kinematic VSAs for speakers with and without dysarthria and evaluated effects of normalization on acoustic and kinematic VSAs and the relationship between these measures. METHOD Vowel data from 12 speakers with and without dysarthria, presenting with a range of speech abilities, were examined. The speakers included four speakers with Parkinson's disease (PD), four speakers with brain injury (BI), and four neurotypical (NT) speakers. Speech acoustic and kinematic data were acquired simultaneously using electromagnetic articulography during a passage reading task. Raw and normalized VSAs calculated from corner vowels /i/, /æ/, /ɑ/, and /u/ were evaluated. Normalization was achieved through z score transformations to the acoustic and kinematic data. The effect of normalization on variability within and across groups was evaluated. Regression analysis was used across speakers to assess the association between acoustic and kinematic VSAs for both raw and normalized data. RESULTS When evaluating the speakers as three different groups (i.e., PD, BI, and NT), normalization reduced the standard deviations within each group and changed the relative differences in average magnitude between groups. Regression analysis revealed a significant relationship between normalized, but not raw, acoustic and kinematic VSAs, after the exclusion of an outlier speaker. CONCLUSIONS Normalization reduces the variability across speakers, within groups, and changes average magnitudes affecting speaker group comparisons. Normalization also influences the correlation between acoustic and kinematic measures. Further investigation of the impact of normalization techniques upon acoustic and kinematic measures is warranted. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22669747.
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Affiliation(s)
- Christina Kuo
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Jeffrey Berry
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
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20
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Thompson A, Hirsch ME, Lansford KL, Kim Y. Vowel Acoustics as Predictors of Speech Intelligibility in Dysarthria. J Speech Lang Hear Res 2023; 66:3100-3114. [PMID: 36795536 PMCID: PMC10569402 DOI: 10.1044/2022_jslhr-22-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE This study sought to determine if alternative vowel space area (VSA) measures (i.e., novel trajectory-based measures: vowel space hull area and vowel space density) predicted speech intelligibility to the same extent as two traditional vowel measures (i.e., token-based measures: VSA and corner dispersion) in speakers with dysarthria. Additionally, this study examined if the strength of the relationship between acoustic vowel measures and intelligibility differed based on how intelligibility was measured (i.e., orthographic transcriptions [OTs] and visual analog scale [VAS] ratings). METHOD The Grandfather Passage was read aloud by 40 speakers with dysarthria of varying etiologies, including Parkinson's disease (n = 10), amyotrophic lateral sclerosis (n = 10), Huntington's disease (n = 10), and cerebellar ataxia (n = 10). Token- and trajectory-based acoustic vowel measures were calculated from the passage. Naïve listeners (N = 140) were recruited via crowdsourcing to provide OTs and VAS intelligibility ratings. Hierarchical linear regression models were created to model OTs and VAS intelligibility ratings using the acoustic vowel measures as predictors. RESULTS Traditional VSA was the sole significant predictor of speech intelligibility for both the OTs (R 2 = .259) and VAS (R 2 = .236) models. In contrast, the trajectory-based measures were not significant predictors of intelligibility. Additionally, the OTs and VAS intelligibility ratings conveyed similar information. CONCLUSIONS The findings suggest that traditional token-based vowel measures better predict intelligibility than trajectory-based measures. Additionally, the findings suggest that VAS methods are comparable to OT methods for estimating speech intelligibility for research purposes.
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Affiliation(s)
- Austin Thompson
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Micah E. Hirsch
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Kaitlin L. Lansford
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
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21
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Spencer KA, Amaral J, Lansford K. Investigating Perceptual Subgroups in Speakers With Ataxic Dysarthria: An Auditory Free Classification Approach. Am J Speech Lang Pathol 2023; 32:1901-1911. [PMID: 36417768 DOI: 10.1044/2022_ajslp-22-00159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Ataxic dysarthria has presented with considerable heterogeneity in the presentation of speech characteristics. Converging evidence supports the existence of subgroups, specifically related to the instability and inflexibility of motor patterns as a possible explanation of this variability. METHOD To further examine the alignment of the speech characteristics of ataxic dysarthria with the instability/inflexibility framework, 23 graduate student listeners participated in an auditory free classification task and a guided classification task. Listeners grouped 15 speakers with ataxic dysarthria based on their judgment of the most salient perceptual characteristics during two speaking tasks: alternating motion rates (AMRs) and connected speech (one to two sentences). Listener ratings were then compared with a priori determinations of speakers who fit the instability subgroup profile and the inflexibility subgroup profile. RESULTS Results of both the free classification and guided classification listening paradigms provided supportive evidence of subgroups, particularly for the AMR task, in the context of strong inter- and intrarater reliability. CONCLUSION This study adds to the growing evidence of the existence of instability and inflexibility subgroups in ataxic dysarthria and serves as a proof of concept for use of the auditory free classification paradigm in dysarthria subgroup research.
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Affiliation(s)
- Kristie A Spencer
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Jessica Amaral
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Kaitlin Lansford
- School of Communication Science & Disorders, Florida State University, Tallahassee
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22
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Allison K, Stoeckel R, Olsen E, Tallman S, Iuzzini-Seigel J. Motor Speech Phenotypes in Children With Epilepsy: Preliminary Findings. Am J Speech Lang Pathol 2023; 32:1912-1922. [PMID: 36827527 DOI: 10.1044/2022_ajslp-22-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE This exploratory study aimed to characterize motor speech impairments in a small sample of children with epilepsy, both with and without a known seizure etiology. A secondary aim was to evaluate the validity of the Profile for Childhood Apraxia of speech and Dysarthria (ProCAD), a newly developed tool for differential diagnosis of childhood apraxia of speech and dysarthria. METHOD Thirteen children with seizure disorders completed a comprehensive speech and language assessment. Three expert speech-language pathologists rated the presence of auditory-perceptual features of motor speech impairment using the ProCAD. Motor speech features, diagnoses, and standardized test scores were compared between children with a known seizure etiology and children with idiopathic epilepsy. RESULTS Nine of the 13 children exhibited motor speech impairment; dysarthria was the most common diagnosis. Most children (11/13) exhibited language impairment. Group comparisons showed that children with a known seizure etiology had more atypical motor speech features and lower language scores than children with idiopathic seizures. CONCLUSION These preliminary findings suggest a high rate of motor speech impairment among children with epilepsy.
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Affiliation(s)
| | - Ruth Stoeckel
- Division of Neurology, Department of Speech Pathology, Mayo Clinic (retired), Rochester, MN
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Dunkerton S, Clarke AJ, Thompson EO, Xie P, Tisch S, Worthington JM, Azadi A, Halmagyi GM. Wilson Disease: A Case Report of Psychosis Preceding Parkinsonism. Am J Case Rep 2023; 24:e940561. [PMID: 37583127 PMCID: PMC10441581 DOI: 10.12659/ajcr.940561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/11/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND A first psychotic episode requires the exclusion of toxic-metabolic, inflammatory, infective, and neoplastic causes. Wilson disease is a rare, autosomal recessive disorder of copper metabolism and can present with neuropsychiatric symptoms secondary to copper accumulation in the brain. CASE REPORT We describe the case of a 48-year-old man with parkinsonism on a background of longstanding schizophrenia and psychotic depression in the setting of previously undiagnosed Wilson disease. The common history of neuropsychiatric disturbance and neuroleptic use complicated the assessment of parkinsonism. However, close attention to the temporal appearance of symptoms and signs differentiated his case from drug-induced parkinsonism, which commonly develops hours to weeks after commencement or uptitration of antipsychotic medication. The early features of sialorrhea and dysarthria were also atypical for idiopathic Parkinson disease. The diagnosis was confirmed by serum copper testing and supported by Kayser-Fleischer rings on bedside ophthalmological examination. Magnetic resonance imaging (MRI) of the brain demonstrated copper accumulation in the basal ganglia and pons, contributing to the characteristic neurological manifestations of an akinetic-rigid syndrome with dysarthria. CONCLUSIONS Serum copper testing is easily obtained and should be considered as part of the first-line investigations for new neuropsychiatric disturbances. Although rare, Wilson disease, if diagnosed early, is a potentially treatable and reversible cause of psychosis. With advanced disease, extrapyramidal findings on examination correlate with MRI brain changes, aiding the clinical assessment in differentiating the disease from drug-induced parkinsonism.
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Affiliation(s)
- Sophie Dunkerton
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Antonia J. Clarke
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Peter Xie
- Department of Psychiatry, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John M. Worthington
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Azadeh Azadi
- Department of Psychiatry, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gabor M. Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Gosztolya G, Svindt V, Bona J, Hoffmann I. Extracting Phonetic Posterior-Based Features for Detecting Multiple Sclerosis From Speech. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3234-3244. [PMID: 37549073 DOI: 10.1109/tnsre.2023.3300532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which, in addition to affecting motor and cognitive functions, may also lead to specific changes in the speech of patients. Speech production, comprehension, repetition and naming tasks, as well as structural and content changes in narratives, might indicate a limitation of executive functions. In this study we present a speech-based machine learning technique to distinguish speakers with relapsing-remitting subtype MS and healthy controls (HC). We exploit the fact that MS might cause a motor speech disorder similar to dysarthria, which, with our hypothesis, might affect the phonetic posterior estimates supplied by a Deep Neural Network acoustic model. From our experimental results, the proposed posterior posteriorgram-based feature extraction approach is useful for detecting MS: depending on the actual speech task, we obtained Equal Error Rate values as low as 13.3%, and AUC scores up to 0.891, indicating a competitive and more consistent classification performance compared to both the x-vector and the openSMILE 'ComParE functionals' attributes. Besides this discrimination performance, the interpretable nature of the phonetic posterior features might also make our method suitable for automatic MS screening or monitoring the progression of the disease. Furthermore, by examining which specific phonetic groups are the most useful for this feature extraction process, the potential utility of the proposed phonetic features could also be utilized in the speech therapy of MS patients.
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Jhawar N, El Sabbagh A. 86-Year-Old Woman With Fever, New-Onset Dysarthria, and Ataxia. Mayo Clin Proc 2023; 98:1235-1240. [PMID: 37536807 DOI: 10.1016/j.mayocp.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 08/05/2023]
Affiliation(s)
- Nikita Jhawar
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Abdallah El Sabbagh
- Advisor to resident and Consultant in Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL.
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Li Y, Yang J, Evans K, Wong JBW, Dissanayaka NN, Vogel AP. Optimising verbal fluency analysis in neurological patients with dysarthria: examples from Parkinson's disease and hereditary ataxia. J Clin Exp Neuropsychol 2023; 45:452-463. [PMID: 37656122 DOI: 10.1080/13803395.2023.2249172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Verbal fluency tests (VFTs) are widely used to assess cognitive-linguistic performance in neurological diseases. However, the influence of dysarthria on performance in tests requiring oral responses is unclear in ataxia and Parkinson's disease. OBJECTIVES To determine the impact of dysarthria on VFT performance and evaluate the validity and reliability of alternative methods for analyzing VFT data. METHOD Trained raters evaluated dysarthria using VFT recordings in people with ataxia (N = 61) or Parkinson's disease (PD; N = 69). Total Correct Items scores and qualitative parameters (intrusions, ambiguous verbalizations, perseverations, and interjections) were compared across semantic, phonemic, and alternating fluency tasks. Disease severity was considered as a covariate in the regression model. RESULTS VFT dysarthria ratings correlated with the benchmark (ground truth) dysarthria scores derived from a monologue. Ambiguous responses resulting from unclear speech impeded the rater's ability to determine if a response was correct. Regression analysis indicated that more severe dysarthria ratings predicted diminished scores in all three tasks (semantic fluency, phonemic fluency and alternating fluency) in the ataxia group. The contribution of disease severity to semantic, phonemic and alternating fluency was reduced substantially in the ataxia group after accounting for dysarthria severity in the model in both groups. CONCLUSIONS Dysarthria severity can be estimated based on speech samples derived from VFT. Dysarthria can lead to lower total correct items and is associated with more ambiguous verbalizations in VFT. Dysarthria severity should be considered when interpreting VFT performance in common movement disorders.
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Affiliation(s)
- Yanjun Li
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
| | - Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Herston QLD, Australia
| | - Kristine Evans
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Herston QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston QLD, Australia
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
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Peters B, Wiedrick J, Baylor C. Effects of Aided Communication on Communicative Participation for People With Amyotrophic Lateral Sclerosis. Am J Speech Lang Pathol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Migliorelli L, Moccia S, Berardini D, Frontoni E, Coccia M, Villani L, Bandini A. A preliminary study on self-care telemonitoring of dysarthria in spinal muscular atrophy. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083694 DOI: 10.1109/embc40787.2023.10340908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Spinal muscular atrophy (SMA) is a rare neuromuscular disease which may cause impairments in oro-facial musculature. Most of the individuals with SMA present bulbar signs such as flaccid dysarthria which mines their abilities to speak and, as consequence, their psychic balance. To support clinicians, recent work has demonstrated the feasibility of video-based techniques for assessing the oro-facial functions in patients with neurological disorders such as amyotrophic lateral sclerosis. However, no work has so far focused on automatic and quantitative monitoring of dysarthria in SMA. To overcome limitations this work's aim is to propose a cloud-based store-and-forward telemonitoring system for automatic and quantitative evaluation of oro-facial muscles in individuals with SMA. The system integrates a convolutional neural network (CNN) aimed at identifying the position of facial landmarks from video recordings acquired via a web application by an SMA patient.Clinical relevance- The proposed work is in the preliminary stage, but it represents the first step towards a better understanding of the bulbar-functions' evolution in patients with SMA.
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Lester-Smith RA, Miller CH, Cherney LR. Behavioral Therapy for Tremor or Dystonia Affecting Voice in Speakers with Hyperkinetic Dysarthria: A Systematic Review. J Voice 2023; 37:561-573. [PMID: 34112549 DOI: 10.1016/j.jvoice.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hyperkinetic dysarthria is characterized by atypical involuntary movements within the speech mechanism that may affect the respiratory, laryngeal, pharyngeal-oral, or velopharyngeal-nasal subsystems and may alter speech production. Although articulatory impairments are commonly considered in hyperkinetic dysarthria, speakers with hyperkinetic dysarthria may also present with changes in voice quality, pitch, and loudness. In approximately 70% of speakers with hyperkinetic dysarthria, these voice alterations are associated with tremor or dystonia. The purpose of this systematic review was to investigate the association between behavioral therapy for tremor or dystonia affecting voice in speakers with hyperkinetic dysarthria and improvement in the functional, perceptual, acoustical, aerodynamic, or endoscopic characteristics of voice. METHOD MEDLINE (PubMed), Embase, PsycINFO, and ClinicalTrials.gov online databases were searched in August 2017, December 2018, and April 2020 for relevant studies. The searches provided 4,921 unique records, and six additional unique records were added from other sources. Twelve studies met the criteria for inclusion in the systematic review. Participants who received concurrent medical treatment were included in this review to ensure that the search was inclusive of all relevant studies and informative for typical clinical scenarios. RESULTS The most commonly administered treatment ingredient was relaxation training, which was investigated in three of the four studies on tremor and three of the eight studies on dystonia. Of these six studies, only one used an experimental design and administered relaxation training as the only behavioral approach. This single-case experiment reported a significant reduction in participant ratings of tremor severity and interference with activities of daily living, although the speaking subscale reportedly did not improve and oral medications were administered concurrently. In two group studies that tested potential behavioral therapy targets, production of a low pitch improved acoustical measures for participants with essential tremor and improved auditory-perceptual judgments for participants with laryngeal dystonia. Behavioral therapy improved functional, acoustical, and aerodynamic outcomes in participants with laryngeal dystonia who were also receiving botulinum toxin injections in a randomized cross-over study and a non-randomized controlled study. Because one study employed easy onset and breathing exercises, while the other employed loud voice exercises, the mechanism of action for improvement in voice associated with behavioral therapy requires further investigation. CONCLUSION This systematic review describes the current evidence for treatment of tremor and dystonia affecting voice in speakers with hyperkinetic dysarthria and highlights the need for future research on behavioral therapy for these disorders.
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Affiliation(s)
- Rosemary A Lester-Smith
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois.
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leora R Cherney
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois
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Pah ND, Motin MA, Oliveira GC, Kumar DK. The Change of Vocal Tract Length in People with Parkinson's Disease. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082914 DOI: 10.1109/embc40787.2023.10340263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Hypokinetic dysarthria is one of the early symptoms of Parkinson's disease (PD) and has been proposed for early detection and also for monitoring of the progression of the disease. PD reduces the control of vocal tract muscles such as the tongue and lips and, therefore the length of the active vocal tract is altered. However, the change in the vocal tract length due to the disease has not been investigated. The aim of this study was to determine the difference in the apparent vocal tract length (AVTL) between people with PD and age-matched control healthy people. The phoneme, /a/ from the UCI Parkinson's Disease Classification Dataset and the Italian Parkinson's Voice and Speech Dataset were used and AVTL was calculated based on the first four formants of the sustained phoneme (F1-F4). The results show a correlation between Parkinson's disease and an increase in vocal tract length. The most sensitive feature was the AVTL calculated using the first formants of sustained phonemes (F1). The other significant finding reported in this article is that the difference is significant and only appeared in the male participants. However, the size of the database is not sufficiently large to identify the possible confounding factors such as the severity and duration of the disease, medication, age, and comorbidity factors.Clinical relevance-The outcomes of this research have the potential to improve the identification of early Parkinsonian dysarthria and monitor PD progression.
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Mohamadi O, Torabinezhad F, Sanjari MA, Razazian N, Ebadi A. Evaluation of orofacial force-related measures using a novel measuring device: explanation of associations with speech rate in dysarthria. Expert Rev Med Devices 2023; 20:1193-1210. [PMID: 37942748 DOI: 10.1080/17434440.2023.2282178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The aim of this study was to examine the potential associations between orofacial force-related measures and speech rate in matched groups of 23 adults with dysarthria, and 69 healthy adults. RESEARCH DESIGN AND METHODS A novel piezoresistive sensor-based device was utilized to obtain the orofacial maximum forces (OMFs) and rate of force development (RFD) measures. The study computed alternating motion rates (AMRs), sequential motion rates (SMRs), and articulation rate (AR) for all participants. The analysis included between-group comparisons and correlation analyses. The study also examined the reliability of the OMFs and RFD measures. RESULTS Individuals with dysarthria exhibited significantly slower speech rates (approximately 41.89% to 56.53% slower) compared to the control group. Except for a few exceptions in the jaw, the dysarthria group demonstrated significantly lower OMFs and RFD measures. The correlation analysis revealed that OMFs were weakly to moderately correlated (r = .488-.674) and RFD measures were very weak to moderately correlated (r = .047-.578) with speech rate measures. CONCLUSIONS The findings suggest that reduced OMFs and RFD measures may contribute to the slowed speech rate observed in adults with dysarthria. The study also highlights that OMFs are significantly more reliable (day-to-day) than RFD measures.
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Affiliation(s)
- Omid Mohamadi
- Department of Speech-Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Torabinezhad
- Department of Speech-Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab. Rehabilitation Research Center, and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Razazian
- Department of Neurology, Imam Reza hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Borrie SA, Yoho SE, Healy EW, Barrett TS. The Application of Time-Frequency Masking To Improve Intelligibility of Dysarthric Speech in Background Noise. J Speech Lang Hear Res 2023; 66:1853-1866. [PMID: 36944186 PMCID: PMC10457087 DOI: 10.1044/2023_jslhr-22-00558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Background noise reduces speech intelligibility. Time-frequency (T-F) masking is an established signal processing technique that improves intelligibility of neurotypical speech in background noise. Here, we investigated a novel application of T-F masking, assessing its potential to improve intelligibility of neurologically degraded speech in background noise. METHOD Listener participants (N = 422) completed an intelligibility task either in the laboratory or online, listening to and transcribing audio recordings of neurotypical (control) and neurologically degraded (dysarthria) speech under three different processing types: speech in quiet (quiet), speech mixed with cafeteria noise (noise), and speech mixed with cafeteria noise and then subsequently processed by an ideal quantized mask (IQM) to remove the noise. RESULTS We observed significant reductions in intelligibility of dysarthric speech, even at highly favorable signal-to-noise ratios (+11 to +23 dB) that did not impact neurotypical speech. We also observed significant intelligibility improvements from speech in noise to IQM-processed speech for both control and dysarthric speech across a wide range of noise levels. Furthermore, the overall benefit of IQM processing for dysarthric speech was comparable with that of the control speech in background noise, as was the intelligibility data collected in the laboratory versus online. CONCLUSIONS This study demonstrates proof of concept, validating the application of T-F masks to a neurologically degraded speech signal. Given that intelligibility challenges greatly impact communication, and thus the lives of people with dysarthria and their communication partners, the development of clinical tools to enhance intelligibility in this clinical population is critical.
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Affiliation(s)
- Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Sarah E. Yoho
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Eric W. Healy
- Department of Speech and Hearing Science, The Ohio State University, Columbus
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Fletcher AR, Potts MW, Borrie SA. Educational Information Improves Listener Attitudes Toward People With Dysarthria Secondary to Parkinson's Disease. Am J Speech Lang Pathol 2023; 32:1099-1109. [PMID: 36881856 PMCID: PMC10473394 DOI: 10.1044/2022_ajslp-22-00234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/14/2022] [Accepted: 12/19/2022] [Indexed: 05/06/2023]
Abstract
PURPOSE People with dysarthria have been rated as less confident and less likable and are often assumed by listeners to have reduced cognitive abilities relative to neurotypical speakers. This study explores whether educational information about dysarthria can shift these attitudes in a group of speakers with hypokinetic dysarthria secondary to Parkinson's disease. METHOD One hundred seventeen listeners were recruited via Amazon Mechanical Turk to transcribe sentences and rate the confidence, intelligence, and likability of eight speakers with mild hypokinetic dysarthria. Listeners were assigned to one of four conditions. In one condition, listeners were provided with no educational information prior to exposure to speakers with dysarthria (n = 29). In another condition, listeners were given educational statements from the American Speech-Language-Hearing Association website (n = 29). In a third condition, listeners were given additional information stating that dysarthria does not indicate reduced intelligence or understanding (n = 30). Finally, in a fourth condition, listeners only heard samples from neurotypical, age-matched adults (n = 29). RESULTS Results revealed statistically significant effects of educational statements on ratings of speakers' confidence, intelligence, and likability. However, educational statements did not affect listeners' transcription accuracy. CONCLUSIONS This study presents preliminary evidence that educational material can positively influence listener impressions of speakers with hypokinetic dysarthria, especially when it is explicitly stated that the disorder does not affect intelligence or understanding. This initial examination provides preliminary support for educational awareness campaigns and self-disclosure of communicative difficulties in people with mild dysarthria.
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Affiliation(s)
- Annalise R Fletcher
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Madison W Potts
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton
| | - Stephanie A Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
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Exner AH, Francis AL, MacPherson MK, Darling-White M, Huber JE. The Effects of Speech Task on Lexical Stress in Parkinson's Disease. Am J Speech Lang Pathol 2023; 32:506-522. [PMID: 36638359 PMCID: PMC10171851 DOI: 10.1044/2022_ajslp-22-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 10/23/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Hypokinetic dysarthria associated with Parkinson's disease (PD) is characterized by dysprosody, yet the literature is mixed with respect to how dysprosody affects the ability to mark lexical stress, possibly due to differences in speech tasks used to assess lexical stress. The purpose of this study was to compare how people with and without PD modulate acoustic dimensions of lexical stress-fundamental frequency, intensity, and duration-to mark lexical stress across three different speech tasks. METHOD Twelve individuals with mild-to-moderate idiopathic PD and 12 age- and sex-matched older adult controls completed three speech tasks: picture description, word production in isolation, and word production in lists. Outcome measures were the fundamental frequency, intensity, and duration of the vocalic segments of two trochees (initial stress) and two iambs (final stress) spoken in all three tasks. RESULTS There were very few group differences. Both groups marked trochees by modulating intensity and fundamental frequency and iambs by modulating duration. Task had a significant impact on the stress patterns used by both groups. Stress patterns were most differentiated in words produced in isolation and least differentiated in lists of words. CONCLUSIONS People with PD did not demonstrate impairments in the production of lexical stress, suggesting that dysprosody associated with PD does not impact all types of prosody in the same way. However, there were reduced distinctions in stress marking that were more apparent in trochees than iambs. In addition, the task used to assess prosody has a significant effect on all acoustic measures. Future research should focus on the use of connected speech tasks to obtain more generalizable measures of prosody in PD.
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Affiliation(s)
- Andrew H. Exner
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Alexander L. Francis
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Megan K. MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
| | - Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Jessica E. Huber
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
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Kim Y, Sidtis D, Sidtis JJ. Singing and Speaking Ability in Parkinson's Disease and Spinocerebellar Ataxia. J Speech Lang Hear Res 2023; 66:126-153. [PMID: 36608288 PMCID: PMC10023174 DOI: 10.1044/2022_jslhr-22-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings. METHOD Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar. DEPENDENT VARIABLES In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb). RESULTS Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants. CONCLUSIONS The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21809544.
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Affiliation(s)
- Yoonji Kim
- Department of Speech, Language and Hearing Science, Temple University, Philadelphia, PA
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
| | - Diana Sidtis
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
- Department of Communicative Sciences and Disorders, New York University, NY
| | - John J. Sidtis
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
- Department of Psychiatry, New York University Langone School of Medicine, NY
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Korkalainen J, McCabe P, Smidt A, Morgan C. Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. J Speech Lang Hear Res 2023; 66:110-125. [PMID: 36623233 DOI: 10.1044/2022_jslhr-22-00375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Dysarthria is common among children with cerebral palsy (CP) and results in poor speech intelligibility and subsequently low communicative participation. Neuroplasticity evidence suggests that adherence to principles of motor learning (PML) improves motor speech intervention outcomes. Motor speech interventions aim to improve speech intelligibility and ultimately facilitate participation, but the effectiveness of these interventions and their inclusion of PML are not clear. Aims are as follows: (a) evaluate the effectiveness motor speech interventions in improving speech intelligibility; (b) summarize the aims, outcome measures, and outcomes relating to the International Classification of Functioning and Disability Child and Youth; and (c) summarize the principles of motor learning used in the intervention. METHOD Eight databases were searched, complemented by a hand search. Studies of any level of evidence were included if they used a motor speech intervention and measured speech in children with CP aged 0-18 years. Studies before 2000 or not in English were excluded. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was rated using the Single Case Experimental Design Scale and Physiotherapy Evidence Database-P rating scales. The strength of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Of 1,036 initial articles, 21 were included. Eight interventions were identified including 131 participants aged 3-18 years. All studies aimed to improve speech intelligibility or articulation and reported improvement at sound, word, or sentence level. One study reported improvements in communicative participation. The strength of evidence ranged from very low to moderate for one intervention. Adherence to PML was inconsistent. CONCLUSIONS The quality of evidence is very low to moderate. More research on motor speech interventions that adhere to PML is required. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817959.
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Affiliation(s)
| | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Andy Smidt
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Donohue C, Gray LT, Anderson A, DiBiase L, Wymer JP, Plowman EK. Profiles of Dysarthria and Dysphagia in Individuals With Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2023; 66:154-162. [PMID: 36525626 PMCID: PMC10023186 DOI: 10.1044/2022_jslhr-22-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/22/2022] [Accepted: 09/21/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE While dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and whether these bulbar symptoms emerge at the same time point or progress at similar rates is not yet clear. We, therefore, sought to determine the relative prevalence of speech and swallowing impairments in a cohort of individuals with ALS and to determine the impact of disease duration, severity, and onset type on bulbar impairments. METHOD Eighty-eight individuals with a confirmed diagnosis of ALS completed the ALS Functional Rating Scale-Revised (ALSFRS-R), underwent videofluoroscopy (VF), and completed the Sentence Intelligibility Test (SIT) during a single visit. Demographic variables including disease duration and onset type were also obtained from participants. Duplicate, independent, and blinded ratings were completed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale and SIT to index dysphagia (DIGEST ≥ 1) and dysarthria (< 96% intelligible and/or < 150 words per minute) status. Descriptive statistics, Pearson chi-squared tests, independent-samples t tests, and odds ratios were performed. RESULTS Dysphagia and dysarthria were instrumentally confirmed in 68% and 78% of individuals with ALS, respectively. Dysarthria and dysphagia were associated (p = .01), and bulbar impairment profile distributions in rank order included (a) dysphagia - dysarthria (59%, n = 52), (b) no dysphagia - dysarthria (19%, n = 17), (c) no dysphagia - no dysarthria (13%, n = 11), and (d) dysphagia - no dysarthria (9%, n = 8). Participants with dysphagia or dysarthria demonstrated 4.2 higher odds of exhibiting a bulbar impairment in the other domain than participants with normal speech and swallowing (95% CI [1.5, 12.2]). There were no differences in ALSFRS-R total scores or disease duration across bulbar impairment profiles (p > .05). ALSFRS-R bulbar subscale scores were significantly lower in individuals with dysphagia versus no dysphagia (8.4 vs. 10.4, p < .0001) and dysarthria versus no dysarthria (8.5 vs. 10.9, p < .0001). Dysphagia and onset type (p = .003) and dysarthria and onset type were associated (p < .0001). CONCLUSIONS Over half of the individuals with ALS in this study demonstrated both dysphagia and dysarthria. Of those with only one bulbar impairment, speech was twice as likely to be the first bulbar symptom to degrade. Future studies are needed to confirm these findings and determine the longitudinal progression of bulbar impairments in this patient population.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
| | - Lauren Tabor Gray
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Center of Collaborative Research, NOVA Southeastern University, Fort Lauderdale, FL
| | - Amber Anderson
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Lauren DiBiase
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville
| | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville
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Lee D, Jeon H, Ahn Y, Kim HJ, Shin HE, Koh JH. Case 6: A 27-Year-Old Woman With Dysarthria. J Korean Med Sci 2023; 38:e5. [PMID: 36625170 PMCID: PMC9829511 DOI: 10.3346/jkms.2023.38.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Donghan Lee
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Howook Jeon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yuran Ahn
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hwa Jung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae-Eun Shin
- Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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Svihlik J, Novotny M, Tykalova T, Polakova K, Brozova H, Kryze P, Sousa M, Krack P, Tripoliti E, Ruzicka E, Jech R, Rusz J. Long-Term Averaged Spectrum Descriptors of Dysarthria in Patients With Parkinson's Disease Treated With Subthalamic Nucleus Deep Brain Stimulation. J Speech Lang Hear Res 2022; 65:4690-4699. [PMID: 36472939 DOI: 10.1044/2022_jslhr-22-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson's disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech. METHOD Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age- and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions. RESULTS All LTAS spectral moments including mean, standard deviation, skewness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups. CONCLUSIONS Our findings confirmed that LTAS is a suitable approach to objectively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21644798.
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Affiliation(s)
- Jan Svihlik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
- Department of Computing and Control Engineering, Faculty of Chemical Engineering, University of Chemistry and Technology, Prague, Czech Republic
| | - Michal Novotny
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Tereza Tykalova
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Kamila Polakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Hana Brozova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Petr Kryze
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Mario Sousa
- Movement Disorders Center, Department of Neurology, University Hospital of Bern, Switzerland
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital of Bern, Switzerland
| | - Elina Tripoliti
- UCL Queen Square Institute of Neurology, Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
- Movement Disorders Center, Department of Neurology, University Hospital of Bern, Switzerland
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Stipancic KL, van Brenk F, Kain A, Wilding G, Tjaden K. Clear Speech Variants: An Investigation of Intelligibility and Speaker Effort in Speakers With Parkinson's Disease. Am J Speech Lang Pathol 2022; 31:2789-2805. [PMID: 36327495 PMCID: PMC9911091 DOI: 10.1044/2022_ajslp-22-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE This study investigated the effects of three clear speech variants on sentence intelligibility and speaking effort for speakers with Parkinson's disease (PD) and age- and sex-matched neurologically healthy controls. METHOD Fourteen speakers with PD and 14 neurologically healthy speakers participated. Each speaker was recorded reading 18 sentences from the Speech Intelligibility Test in their habitual speaking style and for three clear speech variants: clear (SC; given instructions to speak clearly), hearing impaired (HI; given instructions to speak with someone with a hearing impairment), and overenunciate (OE; given instructions to overenunciate each word). Speakers rated the amount of physical and mental effort exerted during each speaking condition using visual analog scales (averaged to yield a metric of overall speaking effort). Sentence productions were orthographically transcribed by 50 naive listeners. Linear mixed-effects models were used to compare intelligibility and speaking effort across the clear speech variants. RESULTS Intelligibility was reduced for the PD group in comparison to the control group only in the habitual condition. All clear speech variants significantly improved intelligibility above habitual levels for the PD group, with OE maximizing intelligibility, followed by the SC and HI conditions. Both groups rated speaking effort to be significantly higher for both the OE and HI conditions versus the SC and habitual conditions. DISCUSSION For speakers with PD, all clear speech variants increased intelligibility to a level comparable to that of healthy controls. All clear speech variants were also associated with higher levels of speaking effort than habitual speech for the speakers with PD. Clinically, findings suggest that clear speech training programs consider using the instruction "overenunciate" for maximizing intelligibility. Future research is needed to identify if high levels of speaking effort elicited by the clear speech variants affect long-term sustainability of the intelligibility benefit.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Frits van Brenk
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | - Alexander Kain
- Department of Pediatrics, Oregon Health & Science University, Portland
| | | | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Pernon M, Assal F, Kodrasi I, Laganaro M. Perceptual Classification of Motor Speech Disorders: The Role of Severity, Speech Task, and Listener's Expertise. J Speech Lang Hear Res 2022; 65:2727-2747. [PMID: 35878401 DOI: 10.1044/2022_jslhr-21-00519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The clinical diagnosis of motor speech disorders (MSDs) is mainly based on perceptual approaches. However, studies on perceptual classification of MSDs often indicate low classification accuracy. The aim of this study was to determine in a forced-choice dichotomous decision-making task (a) how accuracy of speech-language pathologists (SLPs) in perceptually classifying apraxia of speech (AoS) and dysarthria is impacted by speech task, severity of MSD, and listener's expertise and (b) which perceptual features they use to classify. METHOD Speech samples from 29 neurotypical speakers, 14 with hypokinetic dysarthria associated with Parkinson's disease (HD), 10 with poststroke AoS, and six with mixed dysarthria associated with amyotrophic lateral sclerosis (MD-FlSp [combining flaccid and spastic dysarthria]), were classified by 20 expert SLPs and 20 student SLPs. Speech samples were elicited in spontaneous speech, text reading, oral diadochokinetic (DDK) tasks, and a sample concatenating text reading and DDK. For each recorded speech sample, SLPs answered three dichotomic questions following a diagnostic approach, (a) neurotypical versus pathological speaker, (b) AoS versus dysarthria, and (c) MD-FlSp versus HD, and a multiple-choice question on the features their decision was based on. RESULTS Overall classification accuracy was 72% with good interrater reliability, varying with SLP expertise, speech task, and MSD severity. Correct classification of speech samples was higher for speakers with dysarthria than for AoS and higher for HD than for MD-FlSp. Samples elicited with continuous speech reached the best classification rates. An average number of three perceptual features were used for correct classifications, and their type and combination differed between the three MSDs. CONCLUSIONS The auditory-perceptual classification of MSDs in a diagnostic approach reaches substantial performance only in expert SLPs with continuous speech samples, albeit with lower accuracy for AoS. Specific training associated with objective classification tools seems necessary to improve recognition of neurotypical speech and distinction between AoS and dysarthria.
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Affiliation(s)
- Michaela Pernon
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
- Laboratoire de Phonétique et Phonologie, UMR 7018, CNRS-Université Sorbonne Nouvelle, Paris, France
- CRMR Wilson & Parkinson Unit, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Ina Kodrasi
- Signal Processing for Communication Group, Idiap Research Institute, Martigny, Switzerland
| | - Marina Laganaro
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
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Haas E, Ziegler W, Schölderle T. Intelligibility, Speech Rate, and Communication Efficiency in Children With Neurological Conditions: A Longitudinal Study of Childhood Dysarthria. Am J Speech Lang Pathol 2022; 31:1817-1835. [PMID: 35763411 DOI: 10.1044/2022_ajslp-21-00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to describe communication-related parameters (i.e., intelligibility, speech rate, and communication efficiency) and their developmental courses in children with neurological conditions against the background of typical development. In addition, interrelations between the developmental courses of communication-related parameters and auditory-perceptual ratings related to speech subsystems were investigated. METHOD Fourteen children with neurological conditions (CNC) and 14 typically developing children (CTD), matched for age and gender (four girls; 5;1-8;4 [years;months] at first examination), were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria. To assess intelligibility, naïve listeners transcribed audio samples of sentence repetitions of the children. Speech rate was measured by acoustic analyses, and communication efficiency was determined by multiplying the proportion of correctly transcribed syllables with speech rate. Age normalization was performed following a recently published approach. RESULTS On the group level, CNC had conspicuous raw and normalized scores for the three communication-related parameters and were more variable than the CTD group regarding their developmental courses. These differences were more pronounced for intelligibility than for speech rate. A strong relationship between communication-related and speech subsystems-related auditory-perceptual characteristics was apparent only between intelligibility and articulation/resonance. CONCLUSIONS For the first time, age-normalized scores for communication-related parameters were reported in children with neurological disorders and put into a developmental context within the framework of a longitudinal study. Age-normalized intelligibility was more vulnerable to large developmental changes than speech rate and was best predicted by changes in articulation and resonance. Overall, this study may contribute to a more comprehensive and valid clinical assessment of childhood dysarthria and to a better understanding of its developmental dynamics.
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Affiliation(s)
- Elisabet Haas
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Theresa Schölderle
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
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Ganzeboom M, Bakker M, Beijer L, Strik H, Rietveld T. A serious game for speech training in dysarthric speakers with Parkinson's disease: Exploring therapeutic efficacy and patient satisfaction. Int J Lang Commun Disord 2022; 57:808-821. [PMID: 35338751 PMCID: PMC9543756 DOI: 10.1111/1460-6984.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources. To meet this demand, innovative delivery of speech training is required. eHealth applications may provide a solution, as intensified and prolonged training is only possible and affordable in patients' home environment. AIMS This study explores the effects on speech intelligibility of game-based speech training that provides automatic feedback on loudness, pitch and pronunciation. Additionally, we investigate how satisfied patients are with the game-based speech training and how they experience the automatic feedback. Furthermore, patients' preferences for game-based speech training compared with face-to-face training are explored. METHODS AND PROCEDURES Eight adult dysarthric speakers with Parkinson's disease (PD) completed a 4-week game-based speech training in their home environment. For each speaker, 24 speech utterances were audio recorded 4 weeks before (T1), immediately before (T2) and immediately after (T3) the training. All speech samples were rated on speech intelligibility by 10 untrained listeners, by comparing them with the corresponding utterances realized by a healthy speaker. Changes over time were analysed using a linear mixed-effects analysis. Patient satisfaction with the game and the automatic feedback was assessed using a questionnaire. The preferences of patients were collected using a paired comparisons procedure in which the patients were asked whether they would prefer game-based or face-to-face speech training in four hypothetical scenarios with different hypothesized levels of speech improvement. OUTCOMES AND RESULTS While there was no significant difference in speech intelligibility ratings between T1 and T2, we did find one between T2 and T3. At T3, speech intelligibility was rated higher than at T2, indicating positive effects of the game-based speech training. Patients generally seemed satisfied with the game as average ratings were above 7 on a 10-point rating scale. Generally, patients agreed with the automatic feedback and could use it to positively change the way they spoke. Patients prefer the training that provides the highest hypothetical improvement, and thus do not prefer face-to-face above game-based therapy. CONCLUSIONS AND IMPLICATIONS The results of this study suggest that dysarthric speakers due to PD see game-based speech therapy as a valid alternative for face-to-face therapy and that it leads to an average improvement in speech intelligibility. For an optimal effect and user satisfaction it should preferably not be used in isolation but in combination with face-to-face training. In this manner, the strengths of both therapeutic deliveries can be harnessed. WHAT THIS PAPER ADDS What is already known on this subject Dysarthric speech in patients with PD is known to benefit from intensified and long-term speech therapy. The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources making highly frequent and long-term therapy difficult. eHealth provides the opportunity to intensify and prolong speech training in patients' home environment. A drill-and-practice method was employed and investigated in a web-based speech application, indicating positive effects on speech intelligibility. However, participants indicated a lack of variation in exercises making the training less enjoyable. Other research showed that serious games can increase enjoyment during training. What this paper adds to existing knowledge The results of this study show that it is possible to develop a serious game that can be successfully used for speech training by patients with dysarthria due to PD. Comparing speech intelligibility ratings before and after training, we observed significant improvements in speech intelligibility ratings. Patients generally agree with the automatic feedback and can use it to positively change the way they speak. Average ratings were above 7 on a 10-point scale, indicating that patients are satisfied with the game. Patients prefer the type of training (game based or face to face) that provides the highest hypothetical improvement. What are the potential or actual clinical implications of this work? The results of this study suggest that game-based speech training can improve speech intelligibility in patients. This indicates that it can be considered a suitable approach in the treatment of patients with dysarthria due to PD. Patients do not prefer game-based training above face-to-face training in all scenarios. For that reason, for every patient one should carefully consider how to optimally combine game-based and face-to-face training.
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Affiliation(s)
- Mario Ganzeboom
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
| | - Marjoke Bakker
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
- iXperium/Centre of Expertise Learning and Teaching with ICTHAN University of Applied SciencesNijmegenthe Netherlands
| | - Lilian Beijer
- Research DepartmentSint MaartenskliniekNijmegenthe Netherlands
- Chair Key Factors in Physiotherapy and Allied HealthcareHAN University of Applied SciencesNijmegenthe Netherlands
| | - Helmer Strik
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud University NijmegenNijmegenthe Netherlands
| | - Toni Rietveld
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
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Moya-Galé G, Walsh SJ, Goudarzi A. Automatic Assessment of Intelligibility in Noise in Parkinson’s Disease: A Validation Method (Preprint). J Med Internet Res 2022; 24:e40567. [PMID: 36264608 PMCID: PMC9634525 DOI: 10.2196/40567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Most individuals with Parkinson disease (PD) experience a degradation in their speech intelligibility. Research on the use of automatic speech recognition (ASR) to assess intelligibility is still sparse, especially when trying to replicate communication challenges in real-life conditions (ie, noisy backgrounds). Developing technologies to automatically measure intelligibility in noise can ultimately assist patients in self-managing their voice changes due to the disease. Objective The goal of this study was to pilot-test and validate the use of a customized web-based app to assess speech intelligibility in noise in individuals with dysarthria associated with PD. Methods In total, 20 individuals with dysarthria associated with PD and 20 healthy controls (HCs) recorded a set of sentences using their phones. The Google Cloud ASR API was used to automatically transcribe the speakers’ sentences. An algorithm was created to embed speakers’ sentences in +6-dB signal-to-noise multitalker babble. Results from ASR performance were compared to those from 30 listeners who orthographically transcribed the same set of sentences. Data were reduced into a single event, defined as a success if the artificial intelligence (AI) system transcribed a random speaker or sentence as well or better than the average of 3 randomly chosen human listeners. These data were further analyzed by logistic regression to assess whether AI success differed by speaker group (HCs or speakers with dysarthria) or was affected by sentence length. A discriminant analysis was conducted on the human listener data and AI transcriber data independently to compare the ability of each data set to discriminate between HCs and speakers with dysarthria. Results The data analysis indicated a 0.8 probability (95% CI 0.65-0.91) that AI performance would be as good or better than the average human listener. AI transcriber success probability was not found to be dependent on speaker group. AI transcriber success was found to decrease with sentence length, losing an estimated 0.03 probability of transcribing as well as the average human listener for each word increase in sentence length. The AI transcriber data were found to offer the same discrimination of speakers into categories (HCs and speakers with dysarthria) as the human listener data. Conclusions ASR has the potential to assess intelligibility in noise in speakers with dysarthria associated with PD. Our results hold promise for the use of AI with this clinical population, although a full range of speech severity needs to be evaluated in future work, as well as the effect of different speaking tasks on ASR.
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Affiliation(s)
- Gemma Moya-Galé
- Department of Communication Sciences & Disorders, Long Island University, Brooklyn, NY, United States
| | - Stephen J Walsh
- Department of Mathematics and Statistics, Utah State University, Logan, UT, United States
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Gutz SE, Stipancic KL, Yunusova Y, Berry JD, Green JR. Validity of Off-the-Shelf Automatic Speech Recognition for Assessing Speech Intelligibility and Speech Severity in Speakers With Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2022; 65:2128-2143. [PMID: 35623334 PMCID: PMC9567308 DOI: 10.1044/2022_jslhr-21-00589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE There is increasing interest in using automatic speech recognition (ASR) systems to evaluate impairment severity or speech intelligibility in speakers with dysarthria. We assessed the clinical validity of one currently available off-the-shelf (OTS) ASR system (i.e., a Google Cloud ASR API) for indexing sentence-level speech intelligibility and impairment severity in individuals with amyotrophic lateral sclerosis (ALS), and we provided guidance for potential users of such systems in research and clinic. METHOD Using speech samples collected from 52 individuals with ALS and 20 healthy control speakers, we compared word recognition rate (WRR) from the commercially available Google Cloud ASR API (Machine WRR) to clinician-provided judgments of impairment severity, as well as sentence intelligibility (Human WRR). We assessed the internal reliability of Machine and Human WRR by comparing the standard deviation of WRR across sentences to the minimally detectable change (MDC), a clinical benchmark that indicates whether results are within measurement error. We also evaluated Machine and Human WRR diagnostic accuracy for classifying speakers into clinically established categories. RESULTS Human WRR achieved better accuracy than Machine WRR when indexing speech severity, and, although related, Human and Machine WRR were not strongly correlated. When the speech signal was mixed with noise (noise-augmented ASR) to reduce a ceiling effect, Machine WRR performance improved. Internal reliability metrics were worse for Machine than Human WRR, particularly for typical and mildly impaired severity groups, although sentence length significantly impacted both Machine and Human WRRs. CONCLUSIONS Results indicated that the OTS ASR system was inadequate for early detection of speech impairment and grading overall speech severity. While Machine and Human WRR were correlated, ASR should not be used as a one-to-one proxy for transcription speech intelligibility or clinician severity ratings. Overall, findings suggested that the tested OTS ASR system, Google Cloud ASR, has limited utility for grading clinical speech impairment in speakers with ALS.
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Affiliation(s)
- Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston
| | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Viana T, Cavaco S. The BioVisualSpeech Serious Game with Voice Exercises for People with Parkinson's Disease with Hypokinetic Dysarthria. Stud Health Technol Inform 2022; 290:919-923. [PMID: 35673153 DOI: 10.3233/shti220214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with Parkinson's disease (PD) can have dysarthria, a voice disorder that affects speech intelligibility. To fight this disorder people may resort to speech and language therapy. Unfortunately, weekly speech therapy sessions may not be enough, because to achieve and maintain good voice quality, intensive training is required. Additionally, the COVID-19 pandemic brought attention to the need for alternative speech therapy treatments that complement face-to-face appointments. Here, we propose a serious therapy game to improve voice loudness that can be used for intensive therapy or when face-to-face appointments are not possible. The game integrates three voice exercises used in speech therapy sessions for people with PD and aims to provide motivation for patients to perform the exercises on a daily basis. This application evaluates the vocal intensity, vocal frequency and maximum phonation time, offering real-time visual feedback. It also allows pathologists to customize the exercises difficulty to the needs of each patient.
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Affiliation(s)
- Tiago Viana
- NOVA LINCS, Department of Computer Science, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Sofia Cavaco
- NOVA LINCS, Department of Computer Science, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
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Song J, Lee JH, Choi J, Suh MK, Chung MJ, Kim YH, Park J, Choo SH, Son JH, Lee DY, Ahn JH, Youn J, Kim KS, Cho JW. Detection and differentiation of ataxic and hypokinetic dysarthria in cerebellar ataxia and parkinsonian disorders via wave splitting and integrating neural networks. PLoS One 2022; 17:e0268337. [PMID: 35658000 PMCID: PMC9165837 DOI: 10.1371/journal.pone.0268337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Dysarthria may present during the natural course of many degenerative neurological conditions. Hypokinetic and ataxic dysarthria are common in movement disorders and represent the underlying neuropathology. We developed an artificial intelligence (AI) model to distinguish ataxic dysarthria and hypokinetic dysarthria from normal speech and differentiate ataxic and hypokinetic speech in parkinsonian diseases and cerebellar ataxia. We screened 804 perceptual speech analyses performed in the Samsung Medical Center Neurology Department between January 2017 and December 2020. The data of patients diagnosed with parkinsonian disorders or cerebellar ataxia were included. Two speech tasks (numbering from 1 to 50 and reading nine sentences) were analyzed. We adopted convolutional neural networks and developed a patch-wise wave splitting and integrating AI system for audio classification (PWSI-AI-AC) to differentiate between ataxic and hypokinetic speech. Of the 395 speech recordings for the reading task, 76, 112, and 207 were from normal, ataxic dysarthria, and hypokinetic dysarthria subjects, respectively. Of the 409 recordings of the numbering task, 82, 111, and 216 were from normal, ataxic dysarthria, and hypokinetic dysarthria subjects, respectively. The reading and numbering task recordings were classified with 5-fold cross-validation using PWSI-AI-AC as follows: hypokinetic dysarthria vs. others (area under the curve: 0.92 ± 0.01 and 0.92 ± 0.02), ataxia vs. others (0.93 ± 0.04 and 0.89 ± 0.02), hypokinetic dysarthria vs. ataxia (0.96 ± 0.02 and 0.95 ± 0.01), hypokinetic dysarthria vs. none (0.86 ± 0.03 and 0.87 ± 0.05), and ataxia vs. none (0.87 ± 0.07 and 0.87 ± 0.09), respectively. PWSI-AI-AC showed reliable performance in differentiating ataxic and hypokinetic dysarthria and effectively augmented data to classify the types even with limited training samples. The proposed fully automatic AI system outperforms neurology residents. Our model can provide effective guidelines for screening related diseases and differential diagnosis of neurodegenerative diseases.
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Affiliation(s)
- Joomee Song
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Hwan Lee
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jungeun Choi
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Mee Kyung Suh
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hun Kim
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeongho Park
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Ho Choo
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Son
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Yeong Lee
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hyeon Ahn
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Su Kim
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (KSK); (JWC)
| | - Jin Whan Cho
- Department of Neurology and Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (KSK); (JWC)
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Stipancic KL, Tjaden K. Minimally Detectable Change of Speech Intelligibility in Speakers With Multiple Sclerosis and Parkinson's Disease. J Speech Lang Hear Res 2022; 65:1858-1866. [PMID: 35442761 PMCID: PMC9559772 DOI: 10.1044/2022_jslhr-21-00648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 05/19/2023]
Abstract
PURPOSE This study sought to determine the minimally detectable change (MDC) of sentence intelligibility for speakers with multiple sclerosis (MS) and Parkinson's disease (PD). METHOD Speakers included 78 participants consisting of 32 neurologically healthy control speakers, 30 speakers with MS, and 16 speakers with PD. All speakers were recorded reading 11 sentences comprising the Speech Intelligibility Test (SIT), which were subsequently transcribed by inexperienced listeners. Percent correct scores were calculated for each sentence. An average percent correct score was also calculated for each speaker. The MDC at the 95% confidence interval was calculated using the following formula: MDC95 = 1.96 × √2 × standard error of measurement. Speakers were divided into operationally defined categories of severity, and MDCs were calculated for each category to permit comparison to MDCs reported for speakers with amyotrophic lateral sclerosis (ALS). Kruskal-Wallis tests were conducted to compare MDCs between groups and severity categories. RESULTS The average MDC95 for control speakers was 5.53% (range = 3.21%-7.47%) and was statistically smaller than MDCs for speakers with MS (average = 10.08%, range = 5.30%-15.62%) and those for speakers with PD (average = 10.98%, range = 8.60%-13.98%). Statistical analyses further revealed significant differences between MDCs across severity categories. CONCLUSIONS In agreement with previous work in ALS conducted under similar conditions (i.e., orthographic transcription of SIT sentences in a quiet listening environment), the MDC95 of speech intelligibility ranged from 3% to 10% for speakers with MS and PD who have mildly impaired speech. These estimates are a step toward the development of a universal language with which to evaluate speech changes in a variety of patient populations.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York
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Hsu SC, Jiao Y, Berisha V, McAuliffe MJ, Lin P, Wu RM, Cheng SJ, Levy ES. The Effects of Intensive Voice Treatment in Mandarin Speakers With Parkinson's Disease: Acoustic and Perceptual Findings. Am J Speech Lang Pathol 2022; 31:1354-1367. [PMID: 35394803 DOI: 10.1044/2022_ajslp-21-00195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study investigated the effects of intensive voice treatment on subjective and objective measures of speech production in Mandarin speakers with hypokinetic dysarthria. METHOD Nine Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease received 4 weeks of intensive voice treatment (4 × 60 min per week). The speakers were recorded reading a passage before treatment (PRE), immediately after treatment (POST), and at 6-month follow-up (FU). Listeners (n = 15) rated relative ease of understanding (EOU) of paired speech samples on a visual analogue scale. Acoustic analyses were performed. Changes in EOU, vocal intensity, global and local fundamental frequency (f o) variation, speech rate, and acoustic vowel space area (VSA) were examined. RESULTS Increases were found in EOU and vocal intensity from PRE to POST and from PRE to FU, with no change found from POST to FU. Speech rate increased from PRE to POST, with limited evidence of an increase from PRE to FU and no change from POST to FU. No changes in global or local f o variation or in VSA were found. CONCLUSIONS Intensive voice treatment shows promise for improving speech production in Mandarin speakers with hypokinetic dysarthria. Vocal intensity, speech rate, and, crucially, intelligibility, may improve for up to 6 months posttreatment. In contrast, f o variation and VSA may not increase following the treatment. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19529017.
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Affiliation(s)
- Sih-Chiao Hsu
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Yishan Jiao
- College of Health Solutions, Arizona State University, Tempe
| | - Visar Berisha
- College of Health Solutions, Arizona State University, Tempe
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe
| | - Megan J McAuliffe
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- New Zealand Institute of Language, Brain & Behaviour, University of Canterbury, Christchurch
| | - Peiyi Lin
- Institute for Learning Technologies, Teachers College, Columbia University, New York, NY
| | - Ruey-Meei Wu
- Centre of Parkinson and Movement Disorders, National Taiwan University Hospital, Taipei
- College of Medicine, National Taiwan University, Taipei
| | - Shih-Jung Cheng
- MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Erika S Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Carl M, Levy ES, Icht M. Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk. Int J Lang Commun Disord 2022; 57:660-679. [PMID: 35363414 DOI: 10.1111/1460-6984.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. AIMS To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. METHODS & PROCEDURES Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. OUTCOMES & RESULTS Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. CONCLUSIONS & IMPLICATIONS Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. WHAT THIS PAPER ADDS What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.
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Affiliation(s)
- Micalle Carl
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Erika S Levy
- Teachers College, Columbia University, New York, NY, USA
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
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