Showing papers on "Dysarthria published in 1996"

Comprehensibility of Dysarthric Speech

Abstract: This paper describes the concept of comprehensibility and how it is an important construct in the assessment and treatment of dysarthric speech. Intelligibility and comprehensibility are differenti...

Optimum stimulus parameters for lateralized suppression of speech with magnetic brain stimulation

Abstract: Rapid-rate transcranial magnetic brain stimulation produces lateralized suppression of speech output over the frontal lobe, consistent with cerebral dominance for language. But the sensitivity of magnetic speech localization has been limited, and reports are imprecise concerning the amount of discomfort involved. Using a focal magnetic coil, we evaluated the effectiveness and pain of stimulation at different intensities, orientations, and repetition rates (2 to 32 Hz) in six normal volunteers. We obtained complete and clearly lateralized speech arrest in all subjects. The best ratio of efficacy to pain occurred using slower repetition rates of 4 to 8 Hz with a horizontal alignment of the induced electric field. Lower stimulation frequency also allowed clearer distinction between speech arrest and dysarthria from tonic contraction of cranial muscles. The relative comfort and safety of stimulation at 4 Hz should allow more widespread use of magnetic speech localization in clinical and research applications. NEUROLOGY 1996;47: 1590-1593

The Nemours database of dysarthric speech

Abstract: The Nemours database is a collection of 814 short nonsense sentences; 74 sentences spoken by each of 11 male speakers with varying degrees of dysarthria. Additionally, the database contains two connected-speech paragraphs produced by each of the 11 speakers. The database was designed to test the intelligibility of dysarthric speech before and after enhancement by various signal processing methods, and is available on CD-ROM. It can also be used to investigate general characteristics of dysarthric speech such as production error patterns. The entire database has been marked at the word level and sentences for 10 of the 11 talkers have been marked at the phoneme level as well. The paper describes the database structure and techniques adopted to improve the performance of a Discrete Hidden Markov Model (DHMM) labeler used to assign initial phoneme labels to the elements of the database. These techniques may be useful in the design of automatic recognition systems for persons with speech disorders, especially when limited amounts of training data are available.

Treatment efficacy: dysarthria

Abstract: The dysarthrias form a group of diverse, chronic motor speech disorders. The disorders of Parkinson's disease, stroke, traumatic brain injury, amyotrophic lateral sclerosis, and cerebral palsy are reviewed because they represent important clinical diagnoses in which dysarthria is a frequent and debilitating symptom. The roles played by speech-language pathologists include participation in differential diagnosis, provision of speech treatment, staging of treatment, and timely education so that clients and families can make informed decisions about communication alternatives. Both scientific and clinical evidence is presented that suggests that individuals with dysarthria benefit from the services of speech-language pathologists. Group-treatment studies, single-subject studies, and case reports illustrate the effectiveness of various types of speech treatment. Research into the effectiveness of augmentative and alternative communication systems for individuals with cerebral palsy is also presented.

The integrated use of maximum performance tasks in differential diagnostic evaluations among children with motor speech disorders

Abstract: Maximum performance tasks (MPT) were employed to quantify the speech motor capacities of children with dysarthria and developmental apraxia of speech. Specifically, several MPT (i.e. vowel prolongation, fricative prolongation, maximum syllable repetition rate) were conducted among nine carefully selected children with spastic dysarthria, 11 children with developmental apraxia of speech (DAS), and 11 age–matched normal-speaking children. The results indicated that children with spastic dysarthria can be differentiated from both DAS and normal-speaking subjects on only two of the MPT (i.e. monosyllabic repetition rate and vowel prolongation). Children with developmental apraxia of speech, furthermore, differed from the normal-speaking children on fricative prolongation and trisyllabic repetition rate, as well as on measures of trisyllabic repetitive performances (i.e. number of sequencing errors and number of attempts). The findings underscored the clinical importance of MPT for differential diagnosis, and ...

Influence of verbal and nonverbal contexts on the sentence intelligibility of a speaker with dysarthria.

Abstract: The influence of verbal and nonverbal contextual factors on intelligibility was examined using sentences produced under varying conditions by a speaker with severe flaccid dysarthria. Contextual fa...

Characteristics of the dysarthria of multiple system atrophy

Abstract: Objective: To characterize the dysarthria in patients with multiple system atrophy (MSA). Design: Motor speech examinations, consisting of oral motor, oral agility, and perceptual speech analysis, were performed on 46 patients with MSA. Setting: University department of neurology referral center. Results: All patients had dysarthria with combinations of hypokinesia, ataxia, or spasticity. Thirty-two patients had all 3 components, 13 had 2 components, and 1 had only 1 component. In most patients the hypokinetic components were the most severe. Hypokinetic components predominated in 22 patients (48%), whereas ataxic components predominated in 16 (35%), and spastic components in 5 (11%). In 1 patient (2%) the hypokinetic and spastic components were equal and greater than the ataxic components, and in 1 patient (2%) the hypokinetic and ataxic components were equal and greater than the spastic components. One patient (2%) had only ataxic dysarthria. The predominant type of dysarthria corresponded well to the subtype of MSA. Conclusions: The finding of a mixed dysarthria with combinations of hypokinetic, ataxic, and spastic components is consistent with both the overall clinical and the neuropathologic changes in MSA. Motor speech examination can provide helpful information in evaluating patients who might have MSA.

Dysarthria and lacunar stroke: Pathophysiologic aspects

Abstract: We investigated the supranuclear tracts involved in speech production in 8 patients with dysarthria associated with a single lacunar stroke. Magnetic resonance imaging revealed the lesion site in 7 out of 8 patients. We tested corticobulbar tract function using transcranial magnetic stimulation and demonstrated impairment of the corticolingual projections in all the patients and in 5 patients impairment of the corticofacial projections. Sensory function in the oral cavity was impaired in 1 out of 8 patients. 99mTc hexamethyl-propylene amine oxime-single-photon emission computerized tomography (HMPAO-SPECT) imaging, performed in 5 patients, showed cerebellar diaschisis in 1, suggesting additional cerebropontocerebellar tract impairment. Dysarthria observed in the 2 patients with impaired sensation in the oral cavity or with cerebellar diaschisis did not differ from the dysarthria found in the other patients. We conclude that interruption of the corticolingual pathways to the tongue is crucial in the pathogenesis of dysarthria following extracerebellar lacunar stroke.

Speech, language, and the cerebellum

Abstract: The cerebellum can affect speech and language in a number of ways. The most obvious is dysarthria when motor movements are deprived of the regulatory control, which is one of the main functions of the cerebellum. Less well-known is cerebellar mutism, which most often occurs after the removal of a cerebellar tumour. It is unlikely that this is simply the result of dysarthria. The most controversial aspect of cerebellar function, and the main stress of this paper, is the contribution it may make to language production. A number of studies have suggested that the cerebellum can, indeed, be involved in both cognition and language. A number of these are reviewed, in particular, the results of diffuse and focal lesions of the cerebellum, and how these can affect the function of the cerebrum; and conversely how cerebral lesions can cause changes in the cerebellum. Positron emission tomography (PET) has been essential in the assessment of these patients. During human evolution parts of the cerebellum and their connections have enlarged enormously, and it would be surprising if these parts of the brain had not taken on new roles. To regard the cerebellum as only serving motor function is too narrow a concept.

Dysarthria and Apraxia of Speech Associated With FK-506(Tacrolimus)

Abstract: The immunosuppressive agent FK-506 (tacrolimus) is one of the agents most commonly used to prevent rejection after liver transplantation. Neurologic toxicity related to FK-506 has been reported, including speech disorders; however, a detailed analysis of the speech disorder associated with use of FK-506 has not been presented. Herein we describe a patient who exhibited mutism, then severe apraxia of speech with a concomitant hypokinetic, spastic, and ataxic dysarthria after administration of FK-506. His residual mixed dysarthria, without radiographic evidence of a structural lesion, suggests dysfunction of one or more neurochemical systems. The pathophysiologic mechanisms underlying this intriguing entity remain obscure.

Formoffa: An automated formant, moment, fundamental frequency, amplitude analysis of normal and disordered speech

Abstract: A system for semi-automatic, multi-parameter acoustic analysis is described. The system, called FORMOFFA (For = FORmants, Mo = MOments, FF = Fundamental Frequency, A = Amplitude), operates on a PC microcomputer by adaptations of commercially available software. Data displays include a deterministic time record of instantaneous values, and an ergodic time-compressed distribution. In this report the technique is developed with a one-word example, and some measurement and reliability issues are described. The analysis possibilities are then illustrated with several applications: (1) segmental analysis of normal speech, (2) acoustic assessment of the effects of a progressive neurological disease (amyotrophic lateral sclerosis) on sentence production, (3) acoustic study of palatal lift management of a patient with traumatic brain injury, and (4) phonetic assessment of word production by a subject with dysarthria. Although the current technique is recommended as a research tool, this kind of analysis promises s...

Isolated dysarthria caused by a right paravermal infarction.

Abstract: enlarged. Brain MRI showed haemorrhagic infarction in both thalami, extending to the internal capsule on the right and in the peripheral posterior left parietal lobe. Carotid angiography showed occlusion of the vein of Galen, inferior sagittal sinus, and straight sinus consistent with thrombosis. Routine biochemical and haematological screens were normal. Lupus anticoagulant and cardiolipin antibodies were not detected. The international normalised ratio was 1-0 (normal range < 1-2) and the activated partial thromboplastin time (APTT) was 30 seconds (normal range 20-34 seconds). Antithrombin III and protein C and S concentrations were normal. The activated protein C resistance ratio (a ratio of the APTT measured in the presence of added activated protein C to the APTT measured in its absence) was 1-27 (normal > 2-5). Genetic testing disclosed homozygosity for the factor V mutation (using the method described by Bertina et al,3 after amplification of the factor V cDNA by the polymerase chain reaction, the cDNA fragment was enzymatically digested and hybridised with the bioatinylated oligonucleotide specific for the allele of interest). Anticoagulation was started with intravenous heparin and dexamethasone was given. Her conscious level deteriorated over the next 24 hours despite continued therapeutic anticoagulation. She developed fixed dilated pupils, impaired reflex ocular movements, and exhibited extensor posturing in response to painful stimuli. Anticoagulation was continued throughout, and two weeks after admission further MRI showed progression of thrombus into the lateral sinus and left jugular bulb. Over the next four weeks her conscious state improved. She began to follow commands appropriately; ocular movements returned to normal, but she remained mute with an asymmetric spastic tetraparesis, left worse than right. Over the subsequent seven months, speech retumed to near normal with corresponding improvement in upper and lower limb function. She is now independent in all daily activities despite bilateral upper motor neuron signs and a mild trunkal ataxia. Progress of the cerebral venous thrombosis will be followed up by MRI and it is intended to continue anticoagulation indefinitely. Activated protein C is a natural inhibitor of blood coagulation which acts by inactivating plasma cofactors Va and VIIIa. Activated protein C resistance is known to occur in up to 50% of people with a personal and family history of deep venous thrombosis4 compared with a prevalence of about 5% in the general population. The genetic defect responsible for most cases of activated protein C resistance is now known to be a single point mutation in the factor V gene on chromosome 1.3 This codes for a defective factor V molecule which is not properly inactivated by activated protein C. Women taking the oral contraceptive pill who also have activated protein C resistance are considered to have a higher risk of venous thrombosis than women with activated protein C resistance alone.' Qestrogens in replacement doses have not been shown to increase the risk of thrombosis but were stopped in the present case. There are no clear guidelines to the duration of anticoagulation after cerebral venous thrombosis, with or without activated protein C resistance. The decision to continue lifelong anticoagulation in this patient was based on the catastrophic nature of the venous thrombosis and on the increased risk of future thrombosis as a result of homozygosity for the factor V mutation. Of the patient's family, her mother and one brother are heterozygous for the factor V mutation and another brother is homozygous. They have been advised that they should receive standard prophylaxis against venous thrombosis for procedures with thrombotic risk but that full anticoagulation would only be indicated for a proved thrombosis. TE KIMBER Departments ofMedicine and Neurology JV LLOYD Haematology Unit BP BROPHY Neurosurgery Unit PD THOMPSON Departments ofMedicine and Neurology, Royal Adelaide Hospital, Adelaide, Australia.

Clinical Correlates of Quantitative Acoustic Analysis in Ataxic Dysarthria

Abstract: The speech of 15 Taiwanese patients with cerebellar dysfunction and ataxic dysarthria was investigated utilizing techniques of acoustic analysis and instrumental measurement. Semiquantitative assessment of cerebellar function (SQACF) was also performed. The results of the acoustic analysis of the cerebellar speech were then correlated with the findings in the SQACF. The overlapping of voice onset time highly correlates with truncal ataxia as well as eye movement abnormality and eye-hand coordination. The prolongation of vowel duration also correlates significantly with tandem walking, dysdiadochokinesia and eye movement abnormality. The correlation of the speech function with other cerebellar motor functions provides further insight into the functional anatomy for cerebellar speech motor control. This study concludes that the midline structures-vermis and fastigial nucleus-seem to be the primary focus for the coordination of motor speech in the cerebellum.

Dysarthria-clumsy hand syndrome due to infarction of the cerebral peduncle.

Abstract: Neurofibrillary tangles of paired helical filaments are well known histopathological hallmarks of Alzheimer's disease and other neurodegenerative disorders. At certain predilection sites, they also occur in the brains of many physically and mentally normal aged people and their prevalence augments sharply with increasing age. Recent studies have suggested that moderate numbers of tangles, often together with amyloid deposits, indicate a pathological form of brain aging that may remain clinically silent.' It is less widely known, however, that neurofibrillary tangles are also found in a number of rare CNS disorders of unrelated aetiologies, some of which occur in young people.2 We have recently examined a 16 month old boy whose mother had measles virus pneumonia during the last days of pregnancy. The child had dermatological manifestations of measles shortly after birth, recovered completely, and was neurologically unremarkable. After four months, he started with intractable seizures, mental retardation, and motor impairment. The EEG showed Radermecker complexes typical of subacute sclerosing panencephalitis. Increasing antimeasles virus IgG in serum and CSF confirmed the diagnosis. The boy died at the age of 16 months.3 The atrophic brain (weight 580 g) showed multiple cortical cysts and typical neuropathological hallmarks of subacute sclerosing panencephalitis. Measles virus

Prevalence of dysarthria in adult myotonic dystrophy (M. Steinert) patients; speech characteristics and intelligibility.

Abstract: Adult patients with myotonic dystrophy (MYD) from one Swedish county were examined with a Swedish dysarthria test and their speech was perceptually evaluated. Nine of the twenty-three patients had ...

A case of adult type adrenoleukodystrophy with an acute onset and repeated episodes of ataxic dysarthria

Abstract: We report a 30-year-old man with adult type adrenoleukodystrophy (ALD) who manifested an acute onset and repeated episodes of ataxic dysarthria. He noticed a moderate dysarthria after a high grade fever in February of 1995; however, two weeks later his symptom disappeared completely. Three months later, he noticed the dysarthria again and he was referred to our hospital for further examination. General physical findings on admission revealed a dark skin color, pigmentation of gingivae and reduced body hair. Neurologically he was normal except for a moderate ataxic dysarthria. Cranial T2-weighted MRI showed multiple high intensity lesions in the subcortical white matter of frontal lobe, bilateral peritrigonal white matter, splenium of the corpus callosum and bilateral cerebellar white matter. Only cerebellar lesions responsible for his symptom were enhanced on MRI after gadolinium administration. Initially we diagnosed him with multiple sclerosis (MS) based upon the clinical course and MRI findings, and then started corticosteroid treatment. His dysarthria was slightly improved after the treatment and bilateral gadolinium-enhanced lesions of cerebellar white matter on MRI disappeared. Multimodality evoked potentials such as short latency somatosensory evoked potentials, brainstem auditory evoked potentials and pattern-reversal visual evoked potentials, disclosed a prolonged central conduction time associated with bilaterally symmetric individual interpeak latencies. These findings, which supported diffuse and bilateral subclinical demyelinating lesions in the central nervous system, were unusual for MS; therefore his plasma very-long-chain fatty acids (VLCFA) were assayed for ALD. Finally, he was diagnosed with adult type ALD because of the high ratio of C26: 0/C22: 0 (0.075; normal 0.033). It is very difficult to clinically distinguish the early stage of adult type ALD especially in patients like this from MS. Therefore it is useful and important to evaluate not only the level of plasma VLCFA, but also to evaluate multimodality evoked potentials.

Transient acquired stuttering in a child

Abstract: We describe a case of a 9-year-old girl who, after removal of a cerebellar tumour and a secondary right temporo-parietal epidural haematoma, developed transient stuttering, with signs of right hemispheric involvement. Her speech behavlour was very similar to stuttering associated with acquired neurological disorder in adults and different from developmental stuttering and dysarthria subsequent to posterior fossa tumour surgery. Acquired stuttering is rarely reported in children and we think that it was the result of combined right hemispheric and cerebellar dysfunction in this case.

[A 63 year-old man with progressive gait disturbance and dysarthria].

Abstract: We report a 63-year-old man with progressive gait disturbance and dysarthria. The patient was apparently well until the age of 62 (February, 1990) when he noted unsteadiness of gait. Two months later, dysarthria appeared. He was admitted to Juntendo Izunagaoka Hospital on April 23, 1990. Neurologic examination revealed a mentally sound man with normal higher cerebral functions. Cranial nerves were unremarkable except for scanning speech. His gait was ataxic with positive Romberg sign. No motor weakness was noted, however, he had hypotonia and cerebellar ataxia. Deep tendon reflexes were retained and the plantar response was flexor. Pain, touch and vibration senses were diminished in the distal parts of the lower extremities. Laboratory examination revealed a 2.5 cm mass in the left lung field. Cranial MRI revealed a small T1-low and T2-high signal intensity lesion in the left temporal lobe. Abdominal CT scan revealed multiple low density lesions in the liver. His subsequent course was complicated by progressive deterioration in his gait and loss of deep tendon reflexes. He expired on November 24, 1990. The patient was discussed in the neurological CPC and the chief discussant arrived at the conclusion that the patient had anti-Hu associated paraneoplastic encephalomyelitis and sensory neuropathy. Some other participants thought that the patient had carcinomatous cerebellar degeneration. Postmortem examination revealed a 4x4 cm mass lesion involving the left S4-S5 segments. Histologic examination of the tumor was small cell carcinoma. Many metastatic foci were found in the liver. The cerebral hemispheres were unremarkable except for a small wedge-shaped tissue defect in the left temporal lobe which appeared to have been caused by old head trauma which the patient had received. The cerebellar vermis showed slight enlargement of cortical sulci, however, the cerebellar hemispheres appeared unremarkable. Upon histologic examination, marked loss of Purkinje cells was noted, particularly in the cerebellar anterior lobe. The dentate nucleus showed slight cell loss with increase in fat granule cells. The inferior olive was normal. The histologic characteristics were consistent with the pathologic diagnosis of carcinomatous cerebellar degeneration. No evidence of limbic encephalitis was seen. The peripheral nerve was not examined.

Treatment efficacy : Dysarthria : Supplement on treatment efficacity: Part I

Abstract: The dysarthrias form a group of diverse, chronic motor speech disorders. The disorders of Parkinson's disease, stroke, traumatic brain injury, amyotrophic lateral sclerosis, and cerebral palsy are reviewed because they represent important clinical diagnoses in which dysarthria is a frequent and debilitating symptom. The roles played by speech-language pathologists include participation in differential diagnosis, provision of speech treatment, staging of treatment, and timely education so that clients and families can make informed decisions about communication alternatives. Both scientific and clinical evidence is presented that suggests that individuals with dysarthria benefit from the services of speech-language pathologists. Group-treatment studies, single-subject studies, and case reports illustrate the effectiveness of various types of speech treatment. Research into the effectiveness of augmentative and alternative communication systems for individuals with cerebral palsy is also presented.

Eight-year Observation of Speech Disorders in a Child with Severe Dysarthria

Abstract: 4歳2ヵ月時のモヤモヤ病による脳梗塞後に, 重篤な麻痺性構音障害を呈した女児1例に8年間継続して言語訓練を行い, その発達・回復経過について報告した.MRIでは両側前頭葉を中心に広範な梗塞像を認めた.口唇・頬の随意運動は稚拙であり, 舌は突出のみ歯列まで可能であったが, その他の随意運動は困難であった.発症後約2ヵ月間は音声を発せず, その後徐々に発声・発語がみられるようになった.現在までの経過において改善がほとんどみられない点は, (1) 発語器官の麻痺, (2) 麻痺性構音障害などがあげられる.改善が明らかにみられた点は (1) 上下肢の不全麻痺の軽減, (2) 声量・発話量の増加, (3) 開鼻声の改善, (4) 抑揚の改善・発話速度の上昇がみられプロソディが改善したことなどがあげられる.本例のように長期にわたり持続的な重度構音障害が生じても, 小児では構音以外の側面が発達する可能性があり, 長期的な経過観察指導が重要である.

Dysarthria -verbal apraxia and TEDYVA: a systematic integrated textbook and assesslDent instrument in Indonesian and Dutch

Abstract: This article describes the combined textbook and assessment method entitled 'Dysarthria - Verbal Apraxia and TED YV A'. Originally written in Dutch and subsequently .translated into Indonesian, it is an integration of theoretical knowledge dealing with dysarthria syndromes and verbal apraxia, the assessment (through the aid of a specially developed assessment instrument) and the management of persons with dysarthria and verbal apraxia. Implications for use in different cultures are discussed.