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Seminars in Speech and Language Feb 2018Dysarthria is a common consequence of stroke and can have a detrimental influence on communication and quality of life. Speech-language pathologists (SLPs) play an... (Review)
Review
Dysarthria is a common consequence of stroke and can have a detrimental influence on communication and quality of life. Speech-language pathologists (SLPs) play an important role in the evaluation and rehabilitation of stroke survivors who present with dysarthria. An understanding of the physiologic reason behind the altered speech characteristics, such as weakness or incoordination, can facilitate differential diagnosis, guide evaluation strategies, and influence treatment approaches. An initial comprehensive speech evaluation is comprised of examination of the speech mechanism, screening of speech subsystems, perceptual assessment, and intelligibility measurement. Management strategies focus on optimizing communication through compensatory strategies as well as providing physiologic support. The SLP is also responsible for educating family and staff regarding strategies that can facilitate communication.
Topics: Dysarthria; Female; Humans; Male; Speech; Speech-Language Pathology; Stroke
PubMed: 29359302
DOI: 10.1055/s-0037-1608852 -
Medicine Mar 2020To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke.
DESIGN
Prospective, randomized controlled trial.
SETTING
Tertiary hospital.
PARTICIPANTS
The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups.
INTERVENTION
Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks.
MAIN OUTCOME MEASURES
MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis.
RESULTS
Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups.
CONCLUSIONS
Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.
Topics: Adult; Aged; Aged, 80 and over; Breathing Exercises; Deglutition Disorders; Dysarthria; Female; Humans; Male; Middle Aged; Muscle Weakness; Prospective Studies; Respiratory Muscles; Statistics, Nonparametric; Stroke
PubMed: 32150072
DOI: 10.1097/MD.0000000000019337 -
European Journal of Physical and... Feb 2021Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients.
EVIDENCE ACQUISITION
Literature searches with the keywords: "stroke" and "dysarthria" and "diagnosis" and "stroke" and "dysarthria" and "assessment" were conducted using PubMed, EMBASE, Cochrane Library, and Web of Science databases to perform the systematic review about the methods used to measure the severity of dysarthria in subjects post-stroke. The search was performed by two authors from 15 January to 22 February 2020. The research identified a total of 402 articles for the search using the keywords "stroke" and "dysarthria," and "diagnosis" and 84 references for the search using the keywords "stroke" and "dysarthria" and "assessment." Sixty-nine selected articles were analyzed by the reviewers. Thirty-seven publications met the inclusion criteria and were included in the systematic review. Thirty-two articles were excluded for several reasons: 1) 12 involved individuals with aphasia or other speech problems different from dysarthria; 2) 12 examined different topics from our aim; and 3) eight did not include post-stroke cases.
EVIDENCE SYNTHESIS
The systematic review identified methods for measuring the severity of post-stroke dysarthria. The meta-analysis showed the acoustic parameters affected in dysarthria secondary to stroke and the differences in these parameters after speech therapy.
CONCLUSIONS
The alternating and sequential motion rate (AMR- Pə, AMR-Tə, AMR-Kə, and SMR-PəTəKə) and maximum phonation time were significantly improved after speech rehabilitation.
Topics: Dysarthria; Humans; Speech Therapy; Stroke Rehabilitation
PubMed: 32519528
DOI: 10.23736/S1973-9087.20.06242-5 -
European Journal of Physical and... Oct 2020Speech difficulties such as dysarthria or aphasia are frequently seen, in addition to motor impairments, in subjects after stroke.
INTRODUCTION
Speech difficulties such as dysarthria or aphasia are frequently seen, in addition to motor impairments, in subjects after stroke.
EVIDENCE ACQUISITION
Literature searches with the keywords: "stroke" AND "dysarthria" AND "speech therapy" OR "language therapy" were conducted in PubMed, EMBASE, Cochrane Library and Web of Science to perform the systematic review about the several strategies used to treat dysarthria in subjects after stroke. The search was performed independently by two authors (CR and VM) from December 15 2019 to January 15 2020, using the PICOS criteria: participants were aging adults (>18 years old) affected by stroke; intervention was based on rehabilitation speech therapy; comparator was any comparator (all logopedic and speech rehabilitation tools); outcomes included clinical assessments, diagnostic scales and acoustic analysis of voice; and study design was RCTs, case series and case report, observational studies. The research identified a total of 94 articles for the first search and 56 for the second search. Sixty selected articles were analyzed by the reviewers. Twenty-five publications met the inclusion criteria and were included in the systematic review. Thirty-three articles were excluded for the following reasons: 12 involved individuals with aphasia or other speech problems different from dysarthria, 10 examined the clinical features of dysarthria, 3 treated on the impact of dysarthria on social participation following stroke, 8 did not include cases after stroke.
EVIDENCE SYNTHESIS
A systematic review was performed to identify the main used speech rehabilitation treatments for dysarthria after stroke. We defined the several techniques to better guide the physician to delineate a speech rehabilitation protocol adopting the better strategies described in the current literature.
CONCLUSIONS
This systematic review tried to provide to the reader a complete overview of the literature of all possible different speech treatments for dysarthria after stroke. A correct protocol could permit to improve the communication and the quality of life of these subjects.
Topics: Dysarthria; Humans; Speech Therapy; Stroke
PubMed: 32434313
DOI: 10.23736/S1973-9087.20.06185-7 -
The New England Journal of Medicine Jul 2021Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that...
BACKGROUND
Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that decodes words and sentences directly from the cerebral cortical activity of such patients may represent an advancement over existing methods for assisted communication.
METHODS
We implanted a subdural, high-density, multielectrode array over the area of the sensorimotor cortex that controls speech in a person with anarthria (the loss of the ability to articulate speech) and spastic quadriparesis caused by a brain-stem stroke. Over the course of 48 sessions, we recorded 22 hours of cortical activity while the participant attempted to say individual words from a vocabulary set of 50 words. We used deep-learning algorithms to create computational models for the detection and classification of words from patterns in the recorded cortical activity. We applied these computational models, as well as a natural-language model that yielded next-word probabilities given the preceding words in a sequence, to decode full sentences as the participant attempted to say them.
RESULTS
We decoded sentences from the participant's cortical activity in real time at a median rate of 15.2 words per minute, with a median word error rate of 25.6%. In post hoc analyses, we detected 98% of the attempts by the participant to produce individual words, and we classified words with 47.1% accuracy using cortical signals that were stable throughout the 81-week study period.
CONCLUSIONS
In a person with anarthria and spastic quadriparesis caused by a brain-stem stroke, words and sentences were decoded directly from cortical activity during attempted speech with the use of deep-learning models and a natural-language model. (Funded by Facebook and others; ClinicalTrials.gov number, NCT03698149.).
Topics: Adult; Brain Stem Infarctions; Brain-Computer Interfaces; Deep Learning; Dysarthria; Electrocorticography; Electrodes, Implanted; Humans; Male; Natural Language Processing; Neural Prostheses; Quadriplegia; Sensorimotor Cortex; Speech
PubMed: 34260835
DOI: 10.1056/NEJMoa2027540 -
American Journal of Speech-language... Feb 2016This article describes the effects of a new intensive dysarthria treatment program (Be Clear) on speech intelligibility in adults with dysarthria secondary to stroke and... (Comparative Study)
Comparative Study
PURPOSE
This article describes the effects of a new intensive dysarthria treatment program (Be Clear) on speech intelligibility in adults with dysarthria secondary to stroke and traumatic brain injury.
METHOD
A small group-repeated measures research design was used to examine the effects of treatment on the speech of 8 participants with nonprogressive dysarthria. Treatment consisted of a 1-hr prepractice session followed by 1-hr therapy sessions, 4 times per week, for 4 weeks (16 sessions). Paired-comparison ratings of speech intelligibility served as the primary outcome measure for the study. Perceptual data, quality of life, and communication partner opinion were obtained at 3 time intervals: (a) prior to treatment, (b) immediately posttreatment, and (c) 1-3 months posttreatment.
RESULTS
Following treatment, group data demonstrated substantial improvements in speech intelligibility as perceived by naive listeners on a paired-comparison rating task. Word intelligibility was clinically significantly improved posttreatment and sentence intelligibility demonstrated statistically significant improvement. Communication partner ratings of speech intelligibility and overall communicative function were statistically significantly improved posttreatment.
CONCLUSIONS
The results of this study suggest that this new intensive treatment may have potential as an effective intervention for nonprogressive dysarthria. However, controlled studies are required to establish treatment efficacy.
Topics: Adolescent; Adult; Brain Injuries, Traumatic; Dysarthria; Feasibility Studies; Female; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Practice, Psychological; Speech Intelligibility; Speech Production Measurement; Speech Therapy; Stroke; Young Adult
PubMed: 26882004
DOI: 10.1044/2015_AJSLP-14-0113 -
Journal of Speech, Language, and... Oct 2023As evidenced by perceptual learning studies involving adult listeners and speakers with dysarthria, adaptation to dysarthric speech is driven by signal predictability...
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 ( = 42) and adolescent ( = 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.
Topics: Adult; Humans; Adolescent; Speech Intelligibility; Dysarthria; Learning; Cognition; Speech Perception
PubMed: 37616225
DOI: 10.1044/2023_JSLHR-23-00231 -
International Review of Neurobiology 2017Communication changes are an important feature of Parkinson's and include both motor and nonmotor features. This chapter will cover briefly the motor features affecting... (Review)
Review
Communication changes are an important feature of Parkinson's and include both motor and nonmotor features. This chapter will cover briefly the motor features affecting speech production and voice function before focusing on the nonmotor aspects. A description of the difficulties experienced by people with Parkinson's when trying to communicate effectively is presented along with some of the assessment tools and therapists' treatment options. The idea of clinical heterogeneity of PD and subtyping patients with different communication problems is explored and suggestions are made on how this may influence clinicians' treatment methods and choices so as to provide personalized therapy programmes. The importance of encouraging and supporting people to maintain social networks, employment, and leisure activities is stated as the key to achieving sustainability. Finally looking into the future, the emergence of new technologies is seen as providing further possibilities to support therapists in the goal of helping people with Parkinson's to maintain good communication skills throughout the course of the disease.
Topics: Communication; Dysarthria; Humans; Parkinson Disease; Speech; Speech Disorders; Speech Recognition Software; Speech Therapy; Voice
PubMed: 28805569
DOI: 10.1016/bs.irn.2017.04.014 -
Multiple Sclerosis and Related Disorders Aug 2021Although extant dual-task studies suggest cognitive-motor interference may magnify existing non-speech motor impairments in multiple sclerosis (MS), cognitive-speech...
BACKGROUND
Although extant dual-task studies suggest cognitive-motor interference may magnify existing non-speech motor impairments in multiple sclerosis (MS), cognitive-speech motor interference in MS has not been studied. This study evaluated the presence of cognitive-speech motor interference in MS and explored within subject differences in speech measures from the single-to dual-task condition for individuals with MS with co-occurring dysarthria and impaired cognition.
METHODS
In this dual-task study, 21 individuals with MS and 21 controls read aloud a sentence (single-task) and completed a cognitive-linguistic task while simultaneously reading aloud a sentence (dual-task). Speech measures included speech and articulation rate, silent pause frequency and duration, and total sentence duration.
RESULTS
Both groups had significantly slower speech in the dual-task condition. Relative to participants with dysarthria, speech rate and sentence duration difference scores approached significance or were significantly greater for participants with MS with dysarthria and cognitive impairment. These difference scores were associated with executive function and processing speed deficits and fewer years of education.
CONCLUSION
Significant negative compounding effects for speech rate and sentence duration suggest that the dual-task paradigm shows promise for identifying individuals with MS with cognitive impairment and dysarthria at increased risk of problems with effective communication. Further research is warranted to replicate this work and evaluate the consequences of these speech aberrancies on communication effectiveness that ultimately may affect employment, social relationships, and quality of life.
Topics: Cognition; Dysarthria; Humans; Multiple Sclerosis; Quality of Life; Speech
PubMed: 34157630
DOI: 10.1016/j.msard.2021.103077 -
Ear, Nose, & Throat Journal Mar 2018There is a high prevalence of dysphagia among patients with neuromuscular diseases and cerebrovascular diseases, and its consequences can be profound. However, the... (Review)
Review
There is a high prevalence of dysphagia among patients with neuromuscular diseases and cerebrovascular diseases, and its consequences can be profound. However, the correlation between dysarthria and oral-oropharyngeal dysphagia remains unclear. We conducted a literature review to define the clinical presentation of both dysarthria and dysphagia in patients with neuromuscular and cerebrovascular diseases. We performed a systematic PubMed search of the English-language literature since 1995. Objective and subjective outcomes instruments were identified for both dysarthria and dysphagia. Studies that included the incidence of concomitant presentations were included. Inclusion and exclusion criteria were applied according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1,056 articles we reviewed, we selected 24 for analysis. We found that dysarthria and dysphagia were common among patients with neuromuscular and cerebrovascular diseases. Overall, there was a higher prevalence of dysarthria than dysphagia. Of those patients with dysphagia, some reports found that 76 to 90% of patients with neuromuscular disease also had dysarthria. Dysarthria is a strong clinical clue to the presence of dysphagia. Existing subjective questionnaires may not reveal the presence of oropharyngeal dysphagia; objective measures are obviously more revealing. Further studies to correlate the degree of dysarthria and the severity of oral-oropharyngeal dysphagia are warranted.
Topics: Cerebrovascular Disorders; Deglutition Disorders; Dysarthria; Humans; Incidence; Neuromuscular Diseases
PubMed: 29554404
DOI: No ID Found