Showing papers on "Dysarthria published in 1995"

Motor Speech Disorders: Substrates, Differential Diagnosis, and Management

Abstract: Part 1: Substrates 1. Defining, Understanding, and Categorizing Motor Speech Disorders 2. Neurologic Bases of Motor Speech and its Pathologies 3. Examination of Motor Speech Disorders Part 2: The Disorders and Their Diagnoses 4. Flaccid Dysarthria 5. Spastic Dysarthria 6. Ataxic Dysarthria 7. Hypokinetic Dysarthria 8. Hyperkinetic Dysarthria 9. Unilateral Upper Motor Neuron Dysarthria 10. Mixed Dysarthrias 11. Apraxia of Speech 12. Neurogenic Mutism 13. Other Neurogenic Speech Disturbances 14. Acquired Psychogenic Speech Disturbances 15. Differential Diagnosis Part 3: Management 16. Managing Motor Speech Disorders: General Principles 17. Managing the Dysarthrias 18. Managing Apraxia of Speech 19. Managing Other Neurogenic Speech Disturbances 20. Managing Acquired Psychogenic Speech Disorders

The Influence of Speaking Rate on Vowel Space and Speech Intelligibility for Individuals With Amyotrophic Lateral Sclerosis

Abstract: The relationship between speaking rate, vowel space area, and speech intelligibility was studied in a group of 9 subjects with amyotrophic lateral sclerosis (ALS) and 9 age- and gender-matched cont...

Mutism and Pseudobulbar Symptoms after Resection of Posterior Fossa Tumors in Children: Incidence and Pathophysiology

Abstract: MUTISM AND A variety of other neurobehavioral symptoms have been reported anecdotally after the removal of posterior fossa mass lesions. To determine the incidence and clinical spectrum of this syndrome, a detailed review was performed of patients undergoing resection of infratentorial tumors at our institution during the last 9 years; 12 of 142 patients (8.5%) manifested this syndrome, the largest series of such patients reported to date. Each child had a lesion that involved the vermis; seven had medulloblastomas, three had astrocytomas, and two had ependymomas. The incidence among children with vermian neoplasms was 13%. Ten children underwent division of the inferior vermis during tumor resection, and three had a superior vermian incision; one child underwent both superior and inferior vermian incisions. In 10 children, mutism developed in a delayed fashion postoperatively. The speech disturbance was associated with poor oral intake in 9 children, urinary retention in 5, long-tract signs in 6, and bizarre personality changes, emotional lability, and/or decreased initiation of voluntary movements in all 12. Neuropsychiatric testing, performed in seven children, confirmed impairments not only in speech but also in initiation of other motor activities. Ten children regained normal speech, bladder control, and neurological functioning, other than ataxia and mild dysarthria, within 1 to 16 weeks; two children had significant residual deficits. Characteristically, affect and oral intake returned to their preoperative baseline before the speech difficulties began to resolve. A detailed radiological review of these cases in parallel with 24 cases of vermian tumors without mutism identified only one factor that was significantly associated with the mutism syndrome, bilateral edema within the brachium pontis (P < 0.01). Neither the size of the tumor nor the length of vermian incision was associated with the development of mutism. The clinical features of this syndrome in the context of these imaging findings suggest that the mutism syndrome results from transient impairment of the afferent and/or efferent pathways of the dendate nuclei that are involved in initiating complex volitional movements. The clinical courses of our patients are presented and compared with those of similar cases in the literature in an attempt to evaluate the validity of this hypothesis.

Speech dysfunction in early Parkinson's disease.

Abstract: The purpose of this study is to determine if subjects in the early stages of untreated Parkinson's disease (PD) or PD treated with deprenyl alone suffer from motor speech abnormalities. Speech defects are common in advanced PD, including disturbances of respiration, phonation, and articulation. We studied 12 subjects with early PD (Hoehn and Yahr stage < or = 2, mean duration disease 3.2 years) who were not taking symptomatic therapy and tested them under two conditions: on and off deprenyl. None of the subjects was depressed or demented (Mini Mental Status mean 29.9/30; Hamilton Depression Rating mean 2.7/52). All functioned independently (Schwab and England Activities of Daily Living mean 93.1/100). Acoustic and speech productions were assessed using the DSP Sona-Graph 5500 and an evaluation of dysarthria. All 12 had at least two characteristics of dysarthria on examination, although 8 were not aware of it. Vocal tremor was identified on narrow band spectrogram for four subjects. Deprenyl did not have a consistent effect on speech. Ten subjects had no detectable change in speech on deprenyl, one was worse, and one was improved.

Dysarthric speakers' intelligibility and speech characteristics in relation to computer speech recognition

Abstract: This research examined the use of the DragonDictate speech recognition system as a writing aid by 10 speakers with spastic dysarthria due to cerebral palsy with the ultimate goal of establishing prescription guidelines. The objectives were to (1) determine how intelligibility relates to recognition success; (2) determine those characteristics of speech, fluency, and voice that affect the accuracy level of the voice recognizer; and (3) investigate individual profiles of recognition over a series of dictations among high- and low-intelligibility dysarthric speakers versus nondisabled controls. Correlations between intelligibility measures and recognition success measures were strong. The total number of voice features correlated moderately with the number of readings needed to reach 80% recognition levels and with variability in recognition. The frequency of pauses showed a strong positive association with the number of readings subjects needed to reach 80% recognition. The frequency of nonspeech sounds was...

The role of listener familiarity in the perception of dysarthric speech

Abstract: The effects of two qualitatively different familiarization procedures on listeners' perceptions of speech produced by a Korean woman with moderate-severe spastic-ataxic dysarthria were investigated. Thirty listeners were randomly assigned to one of three listening conditions. Prior to this task, members of the two experimental listening groups were familiarized with a speech sample produced by the woman with dysarthria. Listeners assigned to the Paragraph group heard the speaker read a paragraph twice as they followed along with a script. Listeners assigned to the Word List group heard the speaker read the same words comprising the paragraph, but the words were presented in a random order. This list was heard twice, as the listeners followed along with a script. The Control group performed the transcription task without receiving prior exposure to the dysarthric speech. The 30 listeners then orthographically transcribed sentences produced by the dysarthric speaker. Results showed that listeners familiariz...

Phonetic variation in dysarthric speech as a function of sampling task

Abstract: Previous studies have demonstrated a number of ways in which normal speakers' phonetic performance varies across reading and spontaneous speech tasks. This study set out to investigate whether similar differences across speech sampling tasks were found in a mixed group of dysarthric subjects. A selection of segmental and prosodic parameters were investigated acoustically in the performance of five mild dysarthric speakers and five matched control subjects. The results demonstrated that breath-pause position, unstressed vowel duration and voice-onset time were subject to variation across sampling task in the speech produced by different types of dysarthric speaker. The results suggest that read material produced by dysarthric speakers may not be wholly representative of those speakers' spontaneous speech. Preliminary implications for clinical practice are discussed. The findings point to the need for further research to investigate the extent of such differences and their implications for dysarthria assess...

Mutism and cerebellar dysarthria after brain stem surgery: case report.

Abstract: TRANSIENT MUTISM RESOLVING to cerebellar speech after posterior fossa surgery is a well-recognized phenomenon, particularly in pediatric patients. The anatomic basis for this postoperative functional change is unclear but may reside in the dominant superior cerebellar hemisphere or the media

Does speech and language therapy work? : a review of the literature

Abstract: Acquired dysphasia children with speech and language disorders cleft palate dysarthria laryngectomy learning disabilities stammering voice disorder.

Impaired tongue strength and endurance in developmental verbal dyspraxia: a physiological analysis.

Abstract: Tongue strength and endurance measures were obtained from six children with developmental verbal dyspraxia (DVD) aged between 5;6 years and 11;5 years and compared to those achieved by six normal speaking controls matched for age and sex. The instrument for measuring tongue strength comprised an air-filled soft rubber bulb connected to a pressure transducer. The results indicated that the DVD group had weaker lingual musculature than the controls. In addition the DVD subjects exhibited significantly reduced tongue strength endurance compared with the controls. Overall the findings support the hypothesis that a motor impairment forms at least part of the basis of DVD and may be indicative of the presence of a concomitant dysarthria in children with DVD, or may reflect an underspecification of the motor programme. The need for revision of contemporary taxonomies relating to childhood motor speech disorders is discussed.

Kinematic analysis of lower lip movements in ataxic dysarthria.

Abstract: The present study investigates the influence of cerebellar disorders on articulatory performance. A linear trend between peak velocity and movement amplitude seems to represent a basic organization...

The Influence of Familiarity on Judgments of Treated Speech

Abstract: Three groups of 10 naive listeners transcribed sentences produced by a dysarthric speaker The first group (Control) transcribed sentences that the speaker read in her customary manner A second gr

Acoustic analysis of dysarthria associated with multiple sclerosis

Abstract: Approximately 40% of all individuals with multiple sclerosis (MS) present some degree of speech impairment. MS speakers with dysarthria are a heterogeneous group and the speech disorder is characterized by disturbances of the temporal patterning of speech as well as articulatory and phonatory symptoms. Previous research also indicates that the neuromotor dysfunction manifests itself in the fundamental frequency of sustained phonation, even in the absence of other speech symptoms. The present study was designed with the specific purpose of exploring the temporal, spectral and phonatory acoustic features of five MS speakers as compared to those of two normal controls. It was found that the dysarthric symptoms of these MS speakers largely mirror their different underlying neuromotor dysfunctions, and that they exhibit temporal and articulatory deviation when compared to the normal speakers. It is also suggested that a Fourier spectrum analysis of the derived pitch of the sustained phonation in MS speakers is...

Loss of speech after orthotopic liver transplantation

Abstract: Alteration of speech is a rare but distressing complication of orthotopic liver transplantation (OLT). We describe a characteristic speech disorder identified in a large series of consecutive patients undergoing OLT. Between 1988 and 1993, 525 adults underwent OLT. For all recipients with neurologic complications, we reviewed clinical findings, imaging and electrophysiologic test results, and perioperative laboratory data. Five patients (ages 23–52; UNOS status 3–4) exhibited a characteristic pattern of stuttering dysarthria, leading to complete loss of speech production, occasionally with elements of aphasia. In four of the five patients, right-sided focal seizures were subsequently noted. All cases presented within the first 10 postoperative days and improved within 1 month of cessation of cyclosporin (CyA), although halting, monotonous speech was evident to some degree in all five for up to 1 year. There was no correlation between onset of symptoms and CyA levels. None of the patients had clinical or radiologic findings suggestive of central pontine myelinolysis or akinetic mutism. EEGs and Spect scan results were consistent with dysfunction in the left frontotemporoparietal regions of the brain. A characteristic speech disorder, which may be described as cortical dysarthria or speech apraxia, occurs in approximately 1% of adults undergoing OLT. Prompt recognition of this syndrome and temporary cessation of CyA therapy may favorably affect the course.

Effects of Supplemental Linguistic Cues on the Intelligibility of Severely Dysarthric Speakers

Abstract: Severely dysarthric speakers who are considering an augmentative form of communication may think this option precludes use of their residual speech Current procedures used to assess speech intelligibility have not addressed how natural speech might be incorporated into a total communication system for an individual with severe dysarthria The purpose of this investigation was to determine if any of three types of linguistic cues (first letter, word class, combined first letter and word class) aided listeners in their ability to understand three speakers with different severity levels of dysarthria Speech intelligibility was judged by four panels of 10 unfamiliar listeners (N = 40) using a word transcription task A two-factor (4 × 3) mixed design was used to determine the effects of cuing conditions and severity of dysarthria on speech intelligibility scores expressed as the number of correctly transcribed single words The two factors were linguistic cue, having four levels (no cue, first-letter cue, w

Variability in the perceptual and physiological features of dysarthria following severe closed head injury: an examination of five cases.

Abstract: The perceptual and physiological features of the dysarthric speech of five severely closed-head-injured (CHI) subjects were examined in a case-by-case analysis. The five male CHI subjects included in the study were selected to reflect the range of severity and types of dysarthria evident in the CHI population. The perceptual profiles of each subject consisted of the findings of a perceptual speech analysis, the Frenchay Dysarthria Assessment (FDA) and the Assessment of the Intelligibility of Dysarthric Speakers (ASSIDS). The subjects' physiological profiles included the results of instrumental assessments of the respiratory, laryngeal, velopharyngeal and articulatory subsystems of the speech-production mechanism. The case studies highlighted the variability among the individual subjects with respect to the location, physiological nature, and severity of the impairment in their speech-production mechanisms. In addition, the interdependence of the various speech subsystems in determining speech outcome, the...

The relationship between dysarthria and verbal dyspraxia in children: A comparative study using profiling and instrumental analyses

Abstract: This paper discusses the relationship between the dysarthrias and verbal dyspraxia in school-aged children. Using perceptual profiling and instrumental (electropalatographic) techniques, the speech of a small subject group was analysed in depth, in order to compare the two neurological conditions. The aim of the study was to provide distinguishing characteristics between the conditions. The rationale for the conclusion from the study is examined in relation to clinical implications.

Traumatic bilateral hypoglossal nerve palsy

Abstract: A case of bilateral hypoglossal nerve palsy following a road traffic accident is reported. The possible aetiology is discussed.

The Relationship of Selected Perceptual Measures of Diadochokinesis to Speech Intelligibility in Dysarthric Speakers With Amyotrophic Lateral Sclerosis

Abstract: The current experiment explored the relationship of two perceptual measures of diadochokinetic (DDK) performance to speech intelligibility in 15 men with amyotrophic lateral sclerosis (ALS). The pe...

Pronunciation errors in acquired speech disorders: the errors of our ways

Abstract: There are conflicting arguments over whether perceptual analysis of speech errors can be used for a differential diagnosis of acquired motor speech disorders. This study addressed the issue using a narrow phonetic transcription of single-word naming and repetition responses, and a comprehensive taxonomy of error types. Speaker groups were selected according to criteria which were not variables to be investigated later. The listener-perceived segmentai errors of 30 post-stroke speech-impaired speakers (six spastic dysarthric; 12 speech dyspraxic and phonemic paraphasic without dysphasia; 12 speech dyspraxic and phonemic paraphasic with dysphasia) were analysed and subjected to statistical analysis. A variety of analyses failed to establish any consistently reliable differential diagnostic pointers. It is concluded that reasons for the inconclusiveness of perceptual assessment go beyond investigatory methodological problems and embrace issues of underlying theory as well.Personne ne sait encore au juste s'i...

A comparative study of the relationship between dysarthria and verbal dyspraxia in adults and children

Abstract: This paper discusses the relationship between the dysarthrias and verbal dyspraxia in adults and children, and examines these conditions with reference to current theories and a model. The empirical basis for the study described here was the examination in depth of the speech of six subjects, each of whom presented with neurological disorders of different origins: two adults, chosen to exemplify the acquired conditions of dysarthria and dyspraxia, and four children. The speech analyses used profiling techniques of segmental phonological and prosodic assessment, and electropalatographic (EPG) examination, and the profiles thus obtained were compared between subjects and across client groups. The hypothesis was that in-depth analyses would provide distinguishing characteristics between the two neurological conditions, such that the children with suspected developmental verbal dyspraxia would demonstrate differences from those with developmental dysarthria, and clear similarities to the dyspraxic adult. The ...

Aphasia, Apraxia of Speech, and Dysarthria

Abstract: For the astute clinician, a speech abnormality, no less so than a gait disturbance, is a road map to neuroanatomic localization and clinical diagnosis. However, it is difficult for neurologists to appreciate nuances of speech and language without the opportunity to listen critically to patients so affected. When restricted to textbook descriptions, the clinician who encounters speech- and languageimpaired patients on the ward or in the clinic will be unable to develop a critical and discerning ear. Thus, didactic clinical material presented in an audio format would be a logical and welcome means of educating neurologists and other specialists who assess these patients. Aphasia, Apraxia of Speech, and Dysarthria consists of a pamphlet, an audiocassette, and laminated test stimuli, which are to be used with a screening examination described in the pamphlet. The slim manual introduces and characterizes the speech samples contained on the tape. I chose to disregard the

Resolution of Dysarthria in Multiple Sclerosis by Treatment with Weak Electromagnetic Fields

Abstract: It has been reported that 50% or more of patients diagnosed with multiple sclerosis (MS) exhibit speech impairment (dysarthria) which in some cases can be exceedingly disabling. Currently there is no effective medical treatment for the dysarthria of MS which occurs as a result of lesions to the cerebellum and its outflow tracts. It was reported recently that extracranial application of brief AC pulsed electromagnetic fields (EMFs) in the picotesla (pT) range intensity produced in patients with MS sustained improvement in motor functions including cerebellar symptomatology. This communication concerns two MS patients with a chronic progressive course who exhibited severe dysarthria which improved already during the initial treatment with pulsed EMFs and which resolved completely 3-4 weeks later. Since application of EMFs has been shown to alter: (a) the resting membrane potential and synaptic neurotransmitter release through an effect involving changes in transmembrane calcium flux; and (b) the secretion of pineal melatonin which in turn influences the synthesis and release of serotonin (5-HT) and gamma-amino butyric acid (GABA) in the cerebellum, it is suggested that the immediate improvement of the dysarthria occurred as a result of changes in cerebellar neurotransmitter functions particularly 5-HT and GABA rather than from remyelination.

Features of Spontaneous Language in Speakers with Amyotrophic Lateral Sclerosis and Dysarthria

Abstract: Language samples (picture description) produced by moderately dysarthric speakers with ALS were compared with those of gender- and age-matched controls. Results indicated that dysarthric speakers p...

Respiratory support for speech in multiple sclerosis

Abstract: The dysarthria of multiple sclerosis (MS) is known to worsen as the disease progresses (Darley, Brown & Goldstein, 1972). Thus, as an MS sufferer's activities of daily life and opportunities for activity are curtailed by increasing disability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter & Bailey, 1988). It may be that disuse creates a discrepancy between the functional ability that is neurologically available and that which is characteristically used. It is this functional overlay that may be the target of speech therapy (Farmakides & Boone, 1969). Five patients with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improving functional speech performance. Intervention effects were demonstrated by introducing the therapy to different patients at successive points in time. Speech therapy exercises targeted the respiratory system alone with no phonatory or articulatory components. Intelligibility was chosen as a global and objective repeat measure of functional speech performance and was established for each patient by use of the Yorkston-Beukelman Assessment of the Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981). Findings cautiously suggest that with certain patients respiratory exercises can improve speech performance as measured by intellligibility. Thus, a component of the dysarthria of MS may not be neuromotor dysfunction, but atrophy based on fatigue and disuse — and may be reversible. Conclusions on appropriate subject selection are made. The experience of the study with objective measures of intelligibility and the use of the multiple baseline across subject experimental format are also presented. A wider distribution in intelligibility scores generated by multiple listeners than that reported by Yorkston and Beukelman (1981) generated the necessity of a single listener for all tests. Wide variation in subjects' baseline speech performance despite stringent controls on factors known to affect intelligibility demonstrates the futility of single ‘before and after’ treatment measures with MS sufferers. Also, the limitations of the research format, especially the long basline phase for later subjects, are discussed.

Interpreting the Physiological Bases of Dysarthria from Perceptual Analyses: An Examination of Subjects with UMN Type Dysarthria

Abstract: The perceptual speech characteristics of a group of 20 subjects with persistent dysarthria following Upper motor neurone (UMN) damage resulting from cerebrovascular accident (CVA) were compared with those of a normal non-neurologically impaired control group matched for age and sex. The perceptual assessments included an inventory of 32 perceptual speech dimensions, the Frenchay Dysarthria Assessment (FDA), and the Assessment of the Intelligibility of Dysarthric Speech (ASSIDS). The results revealed that the CVA subjects presented with features consistent with spastic dysarthria; however, the incidence of the dimensions identified was lower and the severity less than previously reported in the literature. Comparison between the CVA and the control groups revealed reduced speech intelligibility in the CVA group and deficits in all aspects of speech production including respiration, phonation, resonance, and prosody. The perceptual profile obtained from the assessments is interpreted with reference to the i...