Clinical examination of voice

While the beneficial effect of levodopa on traditional motor control tasks have been well documented over the decades, its effect on speech motor control has rarely been objectively examined and the existing literature remains inconclusive. This paper aims to examine the effect of levodopa on speech in patients with Parkinson's disease. It was hypothesized that levodopa would improve preparatory motor set related activity and alleviate hypophonia. Patients fasted and abstained from levodopa overnight. Motor examination and speech testing was performed the following day, pre-levodopa during their "off" state, then at hourly intervals post-medication to obtain the best "on" state. All speech stimuli showed a consistent tendency for increased loudness and faster rate during the "on" state, but this was accompanied by a greater extent of intensity decay. Pitch and articulation remained unchanged. Levodopa effectively upscaled the overall gain setting of vocal amplitude and tempo, similar to its well-known effect on limb movement. However, unlike limb movement, this effect on the final acoustic product of speech may or may not be advantageous, depending on the existing speech profile of individual patients.

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For better or worse: The effect of levodopa on speech in Parkinson's disease

Robust and complex approach of pathological speech signal analysis

Background:

Parkinsonian dysarthria (as typically characterized by hypophonia, monotony of pitch, and rhythm abnormalities) is often accompanied by gait disturbances. The long-term effect of subthalamic nucleus deep brain stimulation (STN DBS) on dysarthria remains unclear.



Methods:

Given STN DBS's known improvement of gait disorders, we analyzed speech intelligibility and aerodynamic and acoustic parameters in 11 advanced PD patients in three double-blind, randomized conditions: “defined Off,” 60 Hz STN DBS and 130 Hz STN DBS.



Results:

An improvement in aerodynamic speech parameters during 60 Hz STN DBS was accompanied by significant clinical benefit.



Conclusions:

Chronic treatment with low-frequency STN DBS may have a beneficial impact on dysarthropneumophonia, even in advanced PD patients. © 2011 Movement Disorder Society

Modulation of dysarthropneumophonia by low-frequency STN DBS in advanced Parkinson's disease.

Although speech disorders represent an early and common manifestation of Parkinson's disease (PD), little is known about their progression and relationship to dopaminergic replacement therapy. The aim of the current study was to examine longitudinal motor speech changes after the initiation of pharmacotherapy in PD. Fifteen newly-diagnosed, untreated PD patients and ten healthy controls of comparable age were investigated. PD patients were tested before the introduction of antiparkinsonian therapy and then twice within the following 6 years. Quantitative acoustic analyses of seven key speech dimensions of hypokinetic dysarthria were performed. At baseline, PD patients showed significantly altered speech including imprecise consonants, monopitch, inappropriate silences, decreased quality of voice, slow alternating motion rates, imprecise vowels and monoloudness. At follow-up assessment, preservation or slight improvement of speech performance was objectively observed in two-thirds of PD patients within the first 3-6 years of dopaminergic treatment, primarily associated with the improvement of stop consonant articulation. The extent of speech improvement correlated with L-dopa equivalent dose (r = 0.66, p = 0.008) as well as with reduction in principal motor manifestations based on the Unified Parkinson's Disease Rating Scale (r = -0.61, p = 0.02), particularly reflecting treatment-related changes in bradykinesia but not in rigidity, tremor, or axial motor manifestations. While speech disorders are frequently present in drug-naive PD patients, they tend to improve or remain relatively stable after the initiation of dopaminergic treatment and appear to be related to the dopaminergic responsiveness of bradykinesia.

Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson's disease: longitudinal follow-up study on previously untreated patients.

https://hal.archives-ouvertes.fr/hal-01317198/document

How to manage sound, physiological and clinical data of 2500 dysphonic and dysarthric speakers?

https://hal.archives-ouvertes.fr/hal-01616010/document

La dysarthrie au cours de la maladie de Parkinson. Histoire naturelle de ses composantes: dysphonie, dysprosodie et dysarthrie

https://hal.archives-ouvertes.fr/hal-01616004/document

Contribution de la mesure de la pression intra-orale pour la compréhension des troubles de la coordination pneumophonique dans la dysarthrie parkinsonienne

Dysprosody represents an essentiel part of speech intelligibility in Parkinson disease. To date the patients' management is based on two therapeutic interventions: the L-DOPA medication and/or the sub-thalamic stimulation. We study the speech production in two groups of ten patients (one group for each treatment), considering the prosodic parameters; pitch, intensity and duration. The results of this study show a clear effect only on the pitch parameter (mean F0 and tonal extent) either with L-DOPA or with STN stimulation. No significant change are obtained with these treatments on intensity and duration.

https://hal.archives-ouvertes.fr/hal-00250275/document

Bernard Teston

Papers

How to manage sound, physiological and clinical data of 2500 dysphonic and dysarthric speakers?

La dysarthrie au cours de la maladie de Parkinson. Histoire naturelle de ses composantes: dysphonie, dysprosodie et dysarthrie

Contribution de la mesure de la pression intra-orale pour la compréhension des troubles de la coordination pneumophonique dans la dysarthrie parkinsonienne

Effects of Pharmacological versus Electrophysiological Treatments on Parkinsonian Dysprosody

Analyse acoustique de la production vocale : contribution à l'évaluation de la dysprosodie parkinsonienne