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Movement Disorders : Official Journal... Apr 2021Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech... (Review)
Review
Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech subsystems. There is widespread cross-discipline use of speech recordings for diagnostic and research purposes, despite which there are no specific guidelines for a standardized method. This review aims to combine the specific clinical presentations of patients with movement disorders, existing acoustic assessment protocols, and technological advances in capturing speech to provide a basis for future research in this field and to improve the consistency of clinical assessments. We considered 3 areas: the recording environment (room, seating, background noise), the recording process (instrumentation, vocal tasks, elicitation of speech samples), and the acoustic outcome data. Four vocal tasks, namely, sustained vowel, sequential and alternating motion rates, reading passage, and monologues, are integral aspects of motor speech assessment. Fourteen acoustic vocal speech features, including their hypothesized pathomechanisms with regard to typical occurrences in hypokinetic or hyperkinetic dysarthria, are hereby recommended for quantitative exploratory analysis. Using these acoustic features and experimental speech data, we demonstrated that the hyperkinetic dysarthria group had more affected speech dimensions compared with the healthy controls than had the hypokinetic speakers. Several contrasting speech patterns between both dysarthrias were also found. This article is the first attempt to provide initial recommendations for a standardized way of recording the voice and speech of patients with hypokinetic or hyperkinetic dysarthria; thus allowing clinicians and researchers to reliably collect, acoustically analyze, and compare vocal data across different centers and patient cohorts. © 2020 International Parkinson and Movement Disorder Society.
Topics: Acoustics; Dysarthria; Humans; Parkinson Disease; Speech; Speech Acoustics; Speech Disorders
PubMed: 33373483
DOI: 10.1002/mds.28465 -
Folia Phoniatrica Et Logopaedica :... 2021Communication is affected in most people with amyotrophic lateral sclerosis (ALS); up to 80-95% will reach a point where they are no longer able to meet their...
BACKGROUND
Communication is affected in most people with amyotrophic lateral sclerosis (ALS); up to 80-95% will reach a point where they are no longer able to meet their communicative needs with natural speech. The deterioration of speech and communicative abilities presumably has an impact on communicative participation. However, little is known about how these factors relate to each other in this population of patients.
OBJECTIVE
This study aimed to investigate the association between communicative participation, functional deficits, and severity of dysarthria in individuals with ALS.
METHOD
Thirty people with ALS were rated for (1) communicative participation, using the Communicative Participation Item Bank (CPIB, Swedish); and (2) disability related to the disease, using the Revised ALS Functional Rating Scale (Swedish). An expert listening panel assessed intelligibility and severity of dysarthria based on recorded text readings and sentences from the Swedish Test of Intelligibility.
RESULTS
CPIB scores were significantly lower for participants with moderate/severe dysarthria than for those with no/mild dysarthria and correlated with bulbar function and intelligibility.
CONCLUSION
The study found that the CPIB provides a means to rate and discuss communicative participation with persons with ALS, which could assist in the planning of further efforts/services.
Topics: Amyotrophic Lateral Sclerosis; Communication; Dysarthria; Humans; Speech; Speech Disorders; Speech Intelligibility
PubMed: 31918429
DOI: 10.1159/000505022 -
Clinical Linguistics & Phonetics Nov 2020Dysarthria is commonly understood as a motor speech disorder characterized by symptoms that are framed as physiologically or acoustically measurable. The effects of...
Dysarthria is commonly understood as a motor speech disorder characterized by symptoms that are framed as physiologically or acoustically measurable. The effects of dysarthria on social interaction through conversation have been reported but, in comparison with physical measures, remain relatively unexplored. Other-initiated repair sequences are particularly common in dysarthria-in-interaction, drawing attention to the actions of both participants in managing (un)intelligibility, rather than the behavior(s) of the person with dysarthric speech in isolation. These sequences merit detailed and ongoing investigation as they enable us to understand how dysarthria impacts on conversation and, critically, how participants attempt to manage difficulties when they arise. This study explores the organization of other-initiated repair sequences in a dyad where one participant has severe dysarthria arising from amyotrophic lateral sclerosis (ALS) also known as MND. Two hours of recordings were collected on four dates over a 12-month period with the data presented here from recording two. The evidence shows that the participants were able to resolve their troubles, but it required extensive work to both identify the trouble sources and to unravel the problems to reach a satisfactory understanding. The interactions presented in this paper reveal an important limitation of other initiation of repair. Physical restrictions were seen to play an important part in the dysarthric speaker's ability to position his talk in sequential context and successfully accomplish self-repair; particularly, third-turn repair. The present study has offered a depiction of layered conversational problems that other-initiation of repair may not completely resolve or, in some cases, multiply.
Topics: Amyotrophic Lateral Sclerosis; Dysarthria; Humans; Speech Intelligibility
PubMed: 31899971
DOI: 10.1080/02699206.2019.1705915 -
BMJ Case Reports Feb 2021A 73-year-old man who presented with fever and abdominal discomfort was diagnosed to have a liver abscess. He was treated with antimicrobials which included...
A 73-year-old man who presented with fever and abdominal discomfort was diagnosed to have a liver abscess. He was treated with antimicrobials which included metronidazole. One month into treatment, he developed neurological symptoms and signs that were suggestive of cerebellar pathology. MRI of the brain showed T2/fluid attenuated inversion recovery hyperintensities involving bilateral dentate, fastigial and interpositus nuclei. After excluding common aetiologies, the possibility of metronidazole-induced neurotoxicity was considered. After stopping metronidazole, his symptoms and signs resolved. A subsequent MRI scan of the brain showed reversal of changes. Neurotoxicity caused by metronidazole is an uncommon adverse effect of a commonly used antimicrobial drug and should be considered in the appropriate clinical scenario.
Topics: Aged; Anti-Bacterial Agents; Ataxia; Cerebellar Diseases; Cerebellar Nuclei; Duration of Therapy; Dysarthria; Humans; Liver Abscess; Magnetic Resonance Imaging; Male; Metronidazole; Neurotoxicity Syndromes
PubMed: 33526534
DOI: 10.1136/bcr-2020-239227 -
Journal of Speech, Language, and... Aug 2023The purpose of this study was to describe, compare, and understand speech modulation capabilities of patients with varying motor speech disorders (MSDs) in a paradigm in...
PURPOSE
The purpose of this study was to describe, compare, and understand speech modulation capabilities of patients with varying motor speech disorders (MSDs) in a paradigm in which patients made highly cued attempts to speak faster or slower.
METHOD
Twenty-nine patients, 12 with apraxia of speech (AOS; four phonetic and eight prosodic subtype), eight with dysarthria (six hypokinetic and two spastic subtype), and nine patients without any neurogenic MSD completed a standard motor speech evaluation where they were asked to repeat words and sentences, which served as their "natural" speaking rate. They were then asked to repeat lower complexity (counting 1-5; repeating "cat" and "catnip" 3 times each) and higher complexity stimuli (repeating "catastrophe" and "stethoscope" 3 times each and "My physician wrote out a prescription" once) as fast/slow as possible. Word durations and interword intervals were measured. Linear mixed-effects models were used to assess differences related to MSD subtype and stimuli complexity on bidirectional rate modulation capacity as indexed by word duration and interword interval. Articulatory accuracy was also judged and compared.
RESULTS
Patients with prosodic AOS demonstrated a reduced ability to go faster; while they performed similarly to patients with spastic dysarthria when counting, patients with spastic dysarthria were able to increase rate similar to controls during sentence repetition; patients with prosodic AOS could not and made increased articulatory errors attempting to increase rate. AOS patients made more articulatory errors relative to other groups, regardless of condition; however, their percentage of errors reduced with an intentionally slowed speaking rate.
CONCLUSIONS
The findings suggest comparative rate modulation abilities in conjunction with their impact on articulatory accuracy may support differential diagnosis between healthy and abnormal speech and among subtypes of MSDs (i.e., type of dysarthria or AOS). Findings need to be validated in a larger, more representative cohort encompassing several types of MSDs.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.22044632.
Topics: Humans; Dysarthria; Speech; Apraxias; Phonetics; Speech Production Measurement; Speech Disorders
PubMed: 36780318
DOI: 10.1044/2022_JSLHR-22-00286 -
CoDAS 2021To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS).
PURPOSE
To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS).
METHODS
Quantitative-descriptive study approved by REC under No. CAAE 62912416.4.0000.5404, comprised of 19 individuals with sporadic or familiar ALS. Data were collected using the Dysarthria Protocol and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-Re). We used visual analogue scale (VAS) to assess speech intelligibility and summary measures; and Spearman's coefficients of correlation for the instruments with significance level of 5%.
RESULTS
Speech intelligibility is compromised (41.37±39.73) in varied degrees with positive correlation with the general degree of dysarthria (p=<.0001), and with all the analyzed speech parameters, indicating impact on the speech deterioration of the studied group. There is negative correlation between speech intelligibility and the results of the bulbar sections - speech and deglutition (p=0.0166), arm - activities with the upper limb (p=0.0064) and leg - activities with the lower limb (p=0.0391). Breathing (p=0.0178), phonation (p=0.0334) and resonance (p=0.0053) parameters showed a negative correlation with the item "speech" of the ALSFRS-Re.
CONCLUSION
Results show impaired speech intelligibility and dysarthria, and evidence breathing, phonation and resonance as important markers of the disease progression. A thorough and early evaluation of the oral motor production allows for a better management of alterations in ALS.
Topics: Amyotrophic Lateral Sclerosis; Dysarthria; Humans; Speech; Speech Disorders; Speech Intelligibility; Speech Production Measurement
PubMed: 33533830
DOI: 10.1590/2317-1782/20202019214 -
PloS One 2022Dysarthria may present during the natural course of many degenerative neurological conditions. Hypokinetic and ataxic dysarthria are common in movement disorders and...
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.
Topics: Artificial Intelligence; Ataxia; Cerebellar Ataxia; Dysarthria; Humans; Hypokinesia; Neural Networks, Computer; Parkinsonian Disorders
PubMed: 35658000
DOI: 10.1371/journal.pone.0268337 -
Brain : a Journal of Neurology Feb 2024The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS)...
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS) and/or expressive agrammatism. In addition, many patients exhibit dysarthria and/or receptive agrammatism. This leads to substantial phenotypic variation within the speech-language domain across individuals and time, in terms of both the specific combination of symptoms as well as their severity. How to resolve such phenotypic heterogeneity in nfvPPA is a matter of debate. 'Splitting' views propose separate clinical entities: 'primary progressive apraxia of speech' when AoS occurs in the absence of expressive agrammatism, 'progressive agrammatic aphasia' (PAA) in the opposite case, and 'AOS + PAA' when mixed motor speech and language symptoms are clearly present. While therapeutic interventions typically vary depending on the predominant symptom (e.g. AoS versus expressive agrammatism), the existence of behavioural, anatomical and pathological overlap across these phenotypes argues against drawing such clear-cut boundaries. In the current study, we contribute to this debate by mapping behaviour to brain in a large, prospective cohort of well characterized patients with nfvPPA (n = 104). We sought to advance scientific understanding of nfvPPA and the neural basis of speech-language by uncovering where in the brain the degree of MRI-based atrophy is associated with inter-patient variability in the presence and severity of AoS, dysarthria, expressive agrammatism or receptive agrammatism. Our cross-sectional examination of brain-behaviour relationships revealed three main observations. First, we found that the neural correlates of AoS and expressive agrammatism in nfvPPA lie side by side in the left posterior inferior frontal lobe, explaining their behavioural dissociation/association in previous reports. Second, we identified a 'left-right' and 'ventral-dorsal' neuroanatomical distinction between AoS versus dysarthria, highlighting (i) that dysarthria, but not AoS, is significantly influenced by tissue loss in right-hemisphere motor-speech regions; and (ii) that, within the left hemisphere, dysarthria and AoS map onto dorsally versus ventrally located motor-speech regions, respectively. Third, we confirmed that, within the large-scale grammar network, left frontal tissue loss is preferentially involved in expressive agrammatism and left temporal tissue loss in receptive agrammatism. Our findings thus contribute to define the function and location of the epicentres within the large-scale neural networks vulnerable to neurodegenerative changes in nfvPPA. We propose that nfvPPA be redefined as an umbrella term subsuming a spectrum of speech and/or language phenotypes that are closely linked by the underlying neuroanatomy and neuropathology.
Topics: Humans; Aphasia, Broca; Prospective Studies; Dysarthria; Speech; Cross-Sectional Studies; Apraxias; Aphasia, Primary Progressive; Primary Progressive Nonfluent Aphasia
PubMed: 37769652
DOI: 10.1093/brain/awad327 -
Journal of Speech, Language, and... Oct 2022While the involvement of attention in utterance planning is well established at the conceptual and lexical levels, the attentional demands of postlexical processes are...
PURPOSE
While the involvement of attention in utterance planning is well established at the conceptual and lexical levels, the attentional demands of postlexical processes are still debated. This study investigates the involvement of attentional resources on motor speech encoding during utterance production in the context of Parkinson's disease (PD), a population allowing to assess if the attentional demands observed in a dual-task paradigm (the dual-task costs [DTCs]) are explained by postlexical difficulties and not solely by executive impairment.
METHOD
Speech production was analyzed in a dual-task paradigm with 30 participants presenting with motor speech disorders due to hypokinetic dysarthria in the context of PD. The dual-task comprised an automatic speech task in which participants recited the days of the week and two nonverbal tasks evaluating processing speed and inhibition. The severity of dysarthria and performance in several executive tests (inhibition, verbal fluency, and cognitive shifting) were used as potential predictors of the DTCs.
RESULTS
Individuals with PD exhibited a DTC on the nonverbal tasks and on the speech task when the secondary task was inhibition (the most difficult one). Additionally, the severity of dysarthria and a poorer performance in cognitive shifting predicted a more severe DTC on speech rate. Finally, modulation of the magnitude of the DTCs was observed, depending on the difficulty of the nonverbal secondary task.
CONCLUSION
The results suggest that, in PD, postlexical processes require attentional resources and cognitive shifting is related to dual-task performance in speech.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.21265893.
Topics: Attention; Dysarthria; Humans; Parkinson Disease; Psychomotor Performance; Speech
PubMed: 36201164
DOI: 10.1044/2022_JSLHR-22-00096 -
Case Reports in Neurology 2022We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical...
We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical nuance to its presentation with a particularly clear imaging correlation. A 78-year-old, right-handed man with a past medical history of aortic stenosis presented after a transcatheter aortic valve replacement. Immediately postoperatively, no neurological deficits were noted. That evening, he described his speech as "drunken." He was later noted to have a right lower facial droop in addition to the speech change. His speech exhibited labial, lingual, and (to a lesser degree) guttural dysarthria. At the patient's request due to claustrophobia, he received 2 mg of oral lorazepam prior to cranial imaging. Afterwards, he was sleepy but arousable, yet was unable to put pen to paper when asked to write. Right lower facial paresis persisted, but he now demonstrated a right pronator drift, which resolved after 14 h without other evolution to his clinical examination. Brainstem lesions above the level of the pontine facial nucleus may present with central facial paresis contralateral to the lesion. An associated dysarthria may have both labial and lingual features in the absence of tongue or pharyngeal weakness. Our review of reported cases of dysarthria in isolation, dysarthria in combination with facial paresis, and facial paresis finds that all presentations may result from cortical, subcortical, or brainstem involvement. Stroke mechanisms are most commonly thromboembolic or small-vessel-ischemic in either the anterior or posterior circulations.
PubMed: 35431875
DOI: 10.1159/000522283