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The Cochrane Database of Systematic... 2001Dysarthria is a common manifestation of Parkinson's disease that increases in frequency and intensity with the progress of the disease (Streifler 1984). Up to 20% of... (Comparative Study)
Comparative Study Review
BACKGROUND
Dysarthria is a common manifestation of Parkinson's disease that increases in frequency and intensity with the progress of the disease (Streifler 1984). Up to 20% of Parkinsonian patients are referred for speech and language therapy (S & LT), its aim being to improve the intelligibility of the patient's speech.
OBJECTIVES
To compare the efficacy and effectiveness of novel S & LT techniques versus standard S & LT to treat dysarthria in patients with Parkinson's disease. To compare the efficacy and effectiveness of one S & LT technique versus a second form of S & LT to treat Parkinsonian dysarthria.
SEARCH STRATEGY
Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.
SELECTION CRITERIA
Only randomised controlled trials (RCT) were included.
DATA COLLECTION AND ANALYSIS
Data was abstracted independently by KD and RW and differences settled by discussion.
MAIN RESULTS
Only two trials were identified with only 71 patients. The method of randomisation was good in only one trial and the concealment of allocation was inadequate in both trials. These methodological problems could potentially lead to bias from a number of sources. The methods used in the two studies varied so much that meta-analysis of the results was not possible. Scott 83 compared prosodic exercises with visual cues with prosodic exercises alone (See Glossary: Table 01). The authors examined prosody and intelligibility as outcome measures immediately after therapy. Ramig 95 compared the Lee Silverman Voice Therapy (LSVT) which emphasises increased vocal effort, with respiratory therapy which aimed to increase respiratory muscle activity. Ramig 95 examined a wide range of vocal characteristics, activities of daily living affected by speech, depression and the carer's impressions of the patient's speech quality. Some of these outcomes were measured up to 24 months after the end of the therapy. However, in neither study were changes in outcomes due to 'Therapy A' compared with the changes due to 'Therapy B' statistically. Therefore no comment on the comparative efficacy of these types of speech and language therapy can be made.
REVIEWER'S CONCLUSIONS
Considering the methodological flaws in both of these studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of any given form of S & LT over another to treat dysarthria in Parkinson's disease. Given the lack of evidence from RCTs to support or refute the efficacy of S & LT in Parkinson's disease (see Cochrane review 'Speech and Language therapy for Dysarthria in Patients with Parkinson's Disease'), the consensus as to what is considered 'best-practice' S & LT must be proved first through a large well-designed placebo-controlled randomised trial before examining variations in S & LT methodology. The design of these trials should minimise bias and be reported fully using CONSORT guidelines (CONSORT 1996). Outcome measures with particular relevance to patients, their carers, physicians and speech and language therapists should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.
Topics: Bias; Dysarthria; Humans; Language Therapy; Parkinson Disease; Randomized Controlled Trials as Topic; Speech Therapy
PubMed: 11406045
DOI: 10.1002/14651858.CD002814 -
Journal of Speech and Hearing Research Aug 1993A new, intensity-based method of measuring syllable duration was used to assess syllabic timing in 75 patients with dysarthria of predominantly traumatic and... (Comparative Study)
Comparative Study
A new, intensity-based method of measuring syllable duration was used to assess syllabic timing in 75 patients with dysarthria of predominantly traumatic and cerebro-vascular origin and in 30 normal subjects. The applied speech tasks included repetitions of sentences containing chains of plosive-vowel-syllables. The logarithm of the duration of the syllable carrying sentence accent proved to be particularly highly correlated with perceived speech rate. Among the potential sources of temporal variability, segmental influences and the influence of sentence stress were examined. Further, the between-sentence variation of syllable duration was assessed. The resulting measures of variability were correlated with the severity of dysarthric impairment. A strengthening of normal effects was found in the consonant-related variation, whereas intrinsic vowel effects and the influence of sentence stress were largely reduced. These results are discussed from the viewpoint of timing theories in speech and limb motor control. They are considered to provide a valuable background against which the speech impairments of specific neurologic groups can be tested.
Topics: Adolescent; Adult; Brain; Brain Diseases; Dysarthria; Female; Humans; Language Tests; Male; Middle Aged; Motor Activity; Speech Acoustics; Speech Disorders; Speech Perception; Speech Production Measurement; Time Factors
PubMed: 8377481
DOI: 10.1044/jshr.3604.683 -
Journal of Speech, Language, and... Dec 2018The objectives of this study were to examine different speech profiles among children with dysarthria secondary to cerebral palsy (CP) and to characterize the effect of...
PURPOSE
The objectives of this study were to examine different speech profiles among children with dysarthria secondary to cerebral palsy (CP) and to characterize the effect of different speech profiles on intelligibility.
METHOD
Twenty 5-year-old children with dysarthria secondary to CP and 20 typically developing children were included in this study. Six acoustic and perceptual speech measures were selected to quantify a range of segmental and suprasegmental speech characteristics and were measured from children's sentence productions. Hierarchical cluster analysis was used to identify naturally occurring subgroups of children who had similar profiles of speech features.
RESULTS
Results revealed 4 naturally occurring speech clusters among children: 1 cluster of children with typical development and 3 clusters of children with dysarthria secondary to CP. Two of the 3 dysarthria clusters had statistically equivalent intelligibility levels but significantly differed in articulation rate and degree of hypernasality.
CONCLUSION
This study provides initial evidence that different speech profiles exist among 5-year-old children with dysarthria secondary to CP, even among children with similar intelligibility levels, suggesting the potential for developing a pediatric dysarthria classification system that could be used to stratify children with dysarthria into meaningful subgroups for studying speech motor development and efficacy of interventions.
Topics: Cerebral Palsy; Child Language; Child, Preschool; Dysarthria; Female; Humans; Longitudinal Studies; Male; Speech Acoustics; Speech Intelligibility; Speech Production Measurement
PubMed: 30481827
DOI: 10.1044/2018_JSLHR-S-17-0356 -
International Journal of Language &... 2011People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such...
BACKGROUND
People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such problems are likely to impact on both the person with dysarthria and those with whom they interact. If this is the case then we may ask questions not just about the nature of these problems but how it is that such problems are dealt with by participants when they occur.
AIMS
To investigate ways through which problems resulting from dysarthria in everyday conversation are resolved by participants. Further, to examine some of the features of repair resolution, particularly where understanding of self-repair attempts themselves prove difficult.
METHODS & PROCEDURES
Video data of natural conversation from two dyads were selected for this paper. One dyad features a 58 year-old man with multiple sclerosis and moderate intelligibility problems, the other a 79 year-old woman with motor neurone disease with mild to moderate intelligibility problems. Both elected to be recorded in conversation with their spouses. The dyads were video-recorded at home with no researcher present. Using the methods of Conversation Analysis (CA) a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the participants resolve problems in the understanding of dysarthric speech.
OUTCOMES & RESULTS
It is shown how some problems resulting from dysarthria in conversation can be resolved relatively quickly, particularly where a specific element of a prior turn is highlighted by the recipient as problematic. In other instances, the recipient's understanding problem may be more global. These result in longer repair sequences in which problematic elements are addressed individually. Such a resolution method is ultimately successful but may also be characterised by additional understanding problems. These findings draw attention to an important distinction between intelligibility and understandability.
CONCLUSIONS & IMPLICATIONS
It is concluded that problems resulting from dysarthria in conversation can require extensive repair work involving both parties. This has implications for the assessment of dysarthria in everyday conversation and also the promotion of intervention strategies that encompass the activities of both participants when dealing with dysarthria in interaction. These findings may be usefully employed in informing both direct clinical work and through training those who work with this client group and their significant others.
Topics: Adaptation, Psychological; Aged; Communication; Dysarthria; Female; Humans; Male; Middle Aged; Motor Neuron Disease; Multiple Sclerosis; Phonation; Social Behavior; Speech Intelligibility
PubMed: 21899669
DOI: 10.1111/j.1460-6984.2011.00076.x -
American Journal of Speech-language... May 2023People 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...
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 ( = 29). In another condition, listeners were given educational statements from the American Speech-Language-Hearing Association website ( = 29). In a third condition, listeners were given additional information stating that dysarthria does not indicate reduced intelligence or understanding ( = 30). Finally, in a fourth condition, listeners only heard samples from neurotypical, age-matched adults ( = 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.
Topics: Adult; Humans; Speech Intelligibility; Dysarthria; Parkinson Disease; Attitude; Cognition; Speech Perception
PubMed: 36881856
DOI: 10.1044/2022_AJSLP-22-00234 -
PM & R : the Journal of Injury,... Mar 2021To define methods to measure dysarthria due to stroke and guide physicians in delineating a diagnostic protocol using the best current strategies.
OBJECTIVE
To define methods to measure dysarthria due to stroke and guide physicians in delineating a diagnostic protocol using the best current strategies.
DESIGN
Systematic review.
LITERATURE SURVEY
A search was conducted on PubMed, EMBASE, the Cochrane Library, and Web of Science to identify measurement methods for dysarthria severity in adults after stroke.
METHODS
Two reviewers independently reviewed articles and came to a consensus about which ones to include. The authors excluded all duplicates, articles involving individuals with aphasia or other speech problems other than dysarthria, and articles unrelated to stroke. Articles were included if diagnostic measures were used to examine the effectiveness of speech rehabilitation in stroke patients.
SYNTHESIS
The search identified 1154 articles with the keywords "stroke" OR "ictus" OR "cerebral vascular accident" AND "dysarthria" OR "Speech and Language Disorders" AND "diagnosis" OR "assessment." The reviewers analyzed 86 full texts. There were 37 publications that met the criteria and were included in the systematic review. These articles were used to describe the main methods used for measuring the severity of stroke-related dysarthria before and after speech rehabilitation.
CONCLUSION
Despite the range of diagnostic tools available, robust trials are lacking, and the diagnostic approaches are always different. More research is needed to find the best diagnostic methodologies and delineate a definitive diagnostic protocol.
Topics: Adult; Aphasia; Dysarthria; Humans; Speech Disorders; Speech Therapy; Stroke
PubMed: 32818305
DOI: 10.1002/pmrj.12469 -
Journal of Speech, Language, and... Jun 2015In this study, a new algorithm for automated determination of speech rate (SR) in dysarthric speech is evaluated. We investigated how reliably the algorithm calculates...
PURPOSE
In this study, a new algorithm for automated determination of speech rate (SR) in dysarthric speech is evaluated. We investigated how reliably the algorithm calculates the SR of dysarthric speech samples when compared with calculation performed by speech-language pathologists.
METHOD
The new algorithm was trained and tested using Dutch speech samples of 36 speakers with no history of speech impairment and 40 speakers with mild to moderate dysarthria. We tested the algorithm under various conditions: according to speech task type (sentence reading, passage reading, and storytelling) and algorithm optimization method (speaker group optimization and individual speaker optimization). Correlations between automated and human SR determination were calculated for each condition.
RESULTS
High correlations between automated and human SR determination were found in the various testing conditions.
CONCLUSIONS
The new algorithm measures SR in a sufficiently reliable manner. It is currently being integrated in a clinical software tool for assessing and managing prosody in dysarthric speech. Further research is needed to fine-tune the algorithm to severely dysarthric speech, to make the algorithm less sensitive to background noise, and to evaluate how the algorithm deals with syllabic consonants.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Dysarthria; Female; Humans; Male; Middle Aged; Narration; Pattern Recognition, Automated; Reading; Speech; Speech Production Measurement
PubMed: 25860856
DOI: 10.1044/2015_JSLHR-S-14-0242 -
Annual International Conference of the... Jul 2023Spinal muscular atrophy (SMA) is a rare neuromuscular disease which may cause impairments in oro-facial musculature. Most of the individuals with SMA present bulbar...
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.
Topics: Humans; Dysarthria; Self Care; Muscular Atrophy, Spinal; Amyotrophic Lateral Sclerosis; Rare Diseases
PubMed: 38083694
DOI: 10.1109/EMBC40787.2023.10340908 -
International Journal of Language &... May 2020Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility...
BACKGROUND
Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French-speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment.
AIMS
To examine acoustic and perceptual changes in the speech of French-speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible.
METHODS & PROCEDURES
Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11-17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre-recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian-French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels.
OUTCOMES & RESULTS
Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound-pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first-formant vowel frequencies and listeners' greater ease-of-understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease-of-understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed.
CONCLUSIONS & IMPLICATIONS
Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French-speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter-speaker variability are generally consistent with studies on English-speaking children with dysarthria, although changes appear more constrained in these French-speaking children. What this paper adds What is already known on the subject According to the only study comparing effects of speech-cueing strategies on English-speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French-speaking children with dysarthria and no published research has explored effects of cueing strategies in this population. What this paper adds to existing knowledge This paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French-speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level. What are the potential or actual clinical implications of this work? For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand.
Topics: Adolescent; Cerebral Palsy; Child; Cues; Dysarthria; Female; Humans; Male; Speech; Speech Acoustics; Speech Intelligibility
PubMed: 32077196
DOI: 10.1111/1460-6984.12526 -
Disability and Rehabilitation Feb 2020The purpose of this study is to conduct a systematic review of interventions for the treatment of non-progressive dysarthria in adults. Five electronic databases...
The purpose of this study is to conduct a systematic review of interventions for the treatment of non-progressive dysarthria in adults. Five electronic databases (PubMed, Embase, CINAHL, PSYCINFO, Cochrane Collaboration) were searched for all studies that described and evaluated treatment used for non-progressive dysarthria in adults. Studies were included if (1) participants were adults (18+ years) with a confirmed diagnosis of non-progressive dysarthria, (2) participants received intervention with pre-post outcome data, and (3) the article was published between 2006 and 2017 (including early online publications). Data extracted included the number of participants; etiology; dysarthria type and severity; age; gender; presence of a control group; intervention tasks, frequency and duration; outcome measures; and conclusions. Data extraction was completed by a member of the research team independently and crosschecked by another team member. Of the 6728 articles identified, 21 met the inclusion criteria. The predominant study design was a case study or case series. The methodological quality of the studies varied. Typically, the interventions included impairment-based and activity level tasks targeting conversation. Approximately half of the interventions adhered to a treatment manual. The evidence base to guide treatment for non-progressive dysarthria is increasing, with interventions showing promise in results, participant numbers, and positive participant feedback.Implications for rehabilitationThe evidence base to guide treatment for non-progressive dysarthria is increasing, but remains limited.The majority of evidence is of moderate methodological quality.The emergence of new research indicates that health professionals need to be continuously aware and critically appraise new literature in the area.
Topics: Disease Management; Dysarthria; Humans; Speech-Language Pathology
PubMed: 30286661
DOI: 10.1080/09638288.2018.1497714