Showing papers on "Dysarthria published in 1997"

Sensory ataxic neuropathy as the presenting feature of a novel mitochondrial disease

Abstract: Four unrelated patients presented with a severe sensory ataxic neuropathy in association with dysarthria and chronic progressive external ophthalmoplegia. Electrophysiologic and pathologic studies showed severe axonal loss disproportionately affecting sensory nerves. Molecular genetic analysis revealed multiple mitochondrial DNA deletions in muscle and peripheral nerve. Sensory ataxic neuropathy may be the predominant and presenting manifestation of a mitochondrial disorder, and a mitochondrial etiology should be included in its differential diagnosis. The triad of sensory ataxic neuropathy, dysarthria, and opthalmoparesis (SANDO) may represent a novel mitochondrial disease associated with multiple mitochondrial DNA deletions.

A Speaking Task Analysis of the Dysarthria in Cerebellar Disease

Abstract: Cerebellar disease affects a number of skilled movements, including those in speech. Ataxic dysarthria, the speech disorder that typically accompanies cerebellar disease, was studied by acoustic methods. Control subjects and subjects with ataxic dysarthria were recorded while performing a number of speaking tasks, including sustained vowel phonation, syllable repetition, monosyllabic word production (intelligibility test), sentence recitation, and conversation. Acoustic data derived from the speech samples confirmed the hypothesis that temporal dysregulation is a primary component of the speech disorder. The data also show that the nature of the disorder varies with the speaking task. This result agrees with observations on other motor systems in subjects with cerebellar disease and may be evidence of a dissociation of impairments. Suggestions are offered on the selection of measures for a given task and on the role of the cerebellum in the regulation of speaking.

Characterizing swallowing abnormalities in progressive supranuclear palsy.

Abstract: The dysphagia that occurs as an early sign of progressive supranuclear palsy (PSP), and which may predispose patients to aspiration pneumonia, has never been fully characterized. We evaluated 27 patients (mean +/- SEM: age, 64.9 +/- 1 years; symptom duration, 52 +/- 5 months) who met the clinical National Institute of Neurological Disorders and Stroke and Society for PSP (NINDS-SPSP) criteria for possible or probable PSP, with a swallowing questionnaire, an oral motor and speech examination, and either a modified barium swallow or ultrasound studies. Twenty-eight age- and sex-matched healthy controls (age, 65.6 +/- 1.5 years) were also evaluated with the questionnaire, oral examination, and the ultrasound study. We used ANOVA statistics to evaluate differences between groups; nonparametric correlations to assess associations between swallowing and motor and cognitive abnormalities; and logistic regression analysis to determine if the items of the questionnaire or oral examination predicted ultrasound or modified barium swallow abnormalities. While PSP patients had at least one complaint on the swallowing questionnaire (mean, 6.6), healthy controls had fewer and less relevant complaints (0.3). Patients with moderate-to-severe cognitive disabilities had significantly more complaints of dysphagia than those with mild or no impairment. PSP patients' oral motor skills and speech were mildly impaired but significantly different from those of controls. In the ultrasound studies, PSP patients had significantly fewer continuous swallows and required a longer duration to complete their swallows than did healthy controls. They also had mild-to-moderate abnormalities in the modified barium swallow study. The swallowing questionnaire, oral motor examination, and speech production examination accurately predicted the abnormalities detected with the swallowing studies. While 75% of patients had abnormal speech, all but one had abnormal swallowing studies. Thus, although dysphagia is associated with dysarthria, the two conditions are not always paired in the same patient. Our results suggest that the swallowing questionnaire and oral motor examination are an easy and cost-effective method to predict the swallowing disturbances in PSP.

Dysarthric speech: a comparison of computerized speech recognition and listener intelligibility.

Abstract: The purpose of this study was to identify and compare the recognition of dysarthric speech by a computerized voice recognition (VR) system and non-hearing-impaired adult listeners. Intelligibility "functions" were obtained for six dysarthric speakers who varied in severity and six age- and gender-matched controls. Speakers produced 70-item word lists over 5 sessions. VR using the IBM VoiceType and perceptual judgment scores were obtained and functions plotted by session. Data indicate that computerized recognition of both dysarthric and nonimpaired speech was characterized by initially steep increases in correct recognition with more gradual increases noted during the second through fifth sessions. Perceptual recognition by non-hearing-impaired adults indicates generally stable intelligibility scores over time. Severity of dysarthria did appear to influence recognition of target stimuli. Implications of these data to the application of computerized VR technology are presented.

Kinematic analysis of articulatory movements in central motor disorders

Abstract: The various components of the central motor system are expected to play a similar role in speech production and in upper limb control. Slowed articulatory performance, therefore, must be expected in disorders of the corticobulbar tracts, cerebellum, and basal ganglia. Using an optoelectronic device, the present study recorded lower lip trajectories during production of sentence utterances in patients with Parkinson's disease (PD), Huntington's disease (HD), cerebellar atrophy (CA), and pseudobulbar palsy (PB). The various subject groups showed a similar range of overall motor disability. Patients with CA and PB exhibited slowed movement execution in terms of a reduced ratio of peak velocity to maximum amplitude ("stiffness"). In contrast to upper limb motor control, the lip excursions showed an uncompromised shape of velocity profiles. Two different patterns emerged in HD. A single patient suffering from the akinetic-rigid Westphal variant of this disease had articulatory hypometria, whereas the remaining subjects showed significant bradykinesia under increased temporal demands, concomitant with normal movement amplitudes. The PD patients had unimpaired velocity-displacement relationships. Presumably, biomechanical constraints such as the rather small excursions of articulatory lower lip gestures or the scarce spindle supply of facial muscles account for the observed discrepancies between upper limb and speech motor control in PD.

Augmentative and alternative communication decision making for children with severely unintelligible speech

Abstract: Decision making in augmentative and alternative communication (AAC) is particularly difficult for children who have some functional speech. This is in part because there is no measure of speech intelligibility in children that is sensitive to partner familiarity and semantic context, factors that have been shown to greatly impact the comprehensibility of severely impaired speech. This paper describes the development and clinical use of a measure of functional speech comprehensibility for children. The author presents four case studies of children with severe speech impairments who were referred for AAC evaluation. These case studies demonstrate the role of such a measurement tool in AAC decision making for the following purposes: (1) to resolve team conflicts about speech versus alternative strategies, (2) to demonstrate the benefit of speech supplementation strategies for some children for whom AAC equipment may be inappropriate at this time, and (3) to demonstrate the limitations of speech supplementati...

Effects of speech training on the accuracy of speech recognition for an individual with a speech impairment

Abstract: The ability to train clients to use speech recognition systems more effectively enables a broad range of clients with speech impairments to benefit from this state-of-the-art technology. This study investigated the effects of speech training on the recognition accuracy of the IBM VoiceType (Version 1.00) speech recognition system. Isolated words and words in sentences were produced by a young man with mild dysarthric speech. The participant's recognition accuracy was determined by both VoiceType and 10 listeners. The number of sessions required for VoiceType's recognition accuracy to become stable was identified. The results showed that stability of recognition was reached earlier for words in sentences than for isolated words. Initial consonant-null and final consonant place contrasts were chosen for speech training because these contrasts were most frequently misrecognized by both VoiceType and the listeners. Speech training resulted in up to a 57% reduction in errors by VoiceType, suggesting that train...

Cerebellar mutism with subsequent dysarthria in an adult: case report.

Abstract: An adult case of mutism and subsequent dysarthria after posterior fossa surgery is presented. An EEG performed during the mute phase showed widespread left hemisphere abnormality although the CT findings were normal. The possible mechanisms underlying this syndrome are discussed.

The Effect of Increased Vocal Effort on Estimated Velopharyngeal Orifice Area

Abstract: Velopharyngeal deficits are a common component of dysarthria following neurogenic insults. Compensatory strategies may minimize the impact of velopharyngeal deficits on speech production. Velophary...

Optimization of dysarthric speech recognition

Abstract: Explores the residual vocal ability of people who have severe motor impairments accompanied with severe dysarthria, and develops methods for improving the performance of automatic speech recognition (ASR) of dysarthric speech. The target applications for this technology are in the development of communication and control devices for these people. In our speech recognition system, we developed an adaptive word detection algorithm to detect words in highly irregular dysarthric speech. We also implemented perceptually-based mel frequency cepstrum coefficients (MFCC) for the parametric representation of the speech signal, and we adopted the left-to-right discrete hidden Markov model (DHMM) for speech pattern recognition. The system was tested with one person who has cerebral palsy and dysarthria, reducing the intelligibility of her speech to less than 15%. Our initial results on a word set consisting of ten digits demonstrated that recognition rates above 90% can be achieved if more than ten repetitions are used for training.

From the brain to the mouth : acquired dysarthria and dysfluency in adults

Abstract: Preface. Introduction:- Acquired Dysarthria and Dysfluency in Adults Y. Lebrun. Dysarthria:- Acoustic Analysis of Durational Speech Parameters in Neurological Dysarthrias I. Hertrich, H. Ackermann. The Importance of Dysarthria in Differential Diagnosis: A Case Study P. Coppens, R.R. Robey. Repair Strategies and Consonantal Cluster Production in Broca's Aphasia J.-L. Nespoulous, N. Moreau. Acute Neurogenic Speechlessness M. Ventura, et al. Slowly Progressive Dysarthria H. van Dongen, et al. Dysfluency:- Adult-Onset Stuttering Y. Lebrun. Idiopathic Stuttering Onset in Adults M.M. Leahy, T. Stewart. The Differential Diagnosis of Late-Onset Stuttering J. van Borsel, et al. A Case of Acquired Stuttering Following Brain Damage H. Bijleveld, A.-M. Simon. Aggravation or Recurrence of Pre-Existing Stuttering Following Brain Damage Suffered in Adulthood J. van Borsel, V. Cappaert. Index.

Variability in upper motor neurone-type dysarthria: an examination of five cases with dysarthria following cerebrovascular accident

Abstract: The degree of diversity in the nature and extent of the physiological deficits which occur in subjects with dysarthria with similar neurological damage is demonstrated through the individual assessment profiles of five subjects with dysarthria following upper motor neurone (UMN) damage. The perceptual profiles of each subject were compiled using perceptual ratings of deviant speech parameters, intelligibility ratings from the Assessment of Intelligibility of Dysarthric Speech (ASSIDS), and perceptual judgements of subsystem function determined from the Frenchay Dysarthria Assessment (FDA). For each individual, the perceptual profile of their speech impairments was compared and contrasted with the objective results of spirometric and kinematic assessments of respiratory function, aerodynamic and electroglottographic evaluations of laryngeal function, pressure and strain gauge evaluations of articulatory function, and nasal accelerometric assessments of nasality. The outcomes of the individual perceptual and physiological profiles are discussed with respect to the presence of differential subsystem impairments both within each subject and between subjects with similar underlying pathophysiological deficits. The importance of interpreting the instrumental findings with respect to the interdependency of each of the motor speech subsystems, the limitations of perceptual assessments, and the advantages of utilising both perceptual and physiological analyses in the process of identifying treatment goals is discussed.

The vowel lengthening exaggeration effect in speakers with apraxia of speech: Compensation, artifact, or primary deficit?

Abstract: Vowel duration functions contrastively in English to signal the voicing feature of syllable-final stop consonants. This study examines three hypotheses posited to explain why speakers with apraxia of speech and a concomitant aphasia exhibit an exaggerated vowel lengthening effect relative to speakers with dysarthria, aphasia without apraxia and controls. The investigation addresses the hypotheses that the vowel lengthening exaggeration effect is attributable to: (1) a compensatory strategy, (2) an artifact of slow speaking rate, (3) the concomitant language impairment, or (4) a primary deficit reflecting the underlying nature of the apraxia disorder. The results do not support the first three of these hypotheses. It is hypothesized that the temporal measures most likely to reveal abnormalities which are uniquely characteristic of speakers with apraxia of speech are those which are relational in nature, either with respect to inter- articulator timing or contrastive durations.

Motor speech impairment in a case of childhood basilar artery stroke: Treatment directions derived from physiological and perceptual assessment

Abstract: The perceptual and physiological characteristics of the speech of a nine year old child who suffered a basilar artery stroke at the age of five years were investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included the Frenchay Dysarthria Assessment, a perceptual analysis of a speech sample based on a reading of the Grandfather Passage and a phonetic intelligibility test. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic evaluation of laryngeal function, nasometric assessment of velopharyngeal function and evaluation of lip and tongue function using pressure transducers. Physiological assessment indicated the most severe deficits to be in the respiratory and velopharyngeal sub-systems with significant deficits in the articulatory sub-system, all of which resulted in severely reduced intelligibility. These results were compared and contrasted with the subject's performance on the perceptual assessment battery. In a number of instances the physiological assessments were able to identify deficits in the functioning of components of the speech production apparatus either not evidenced by the perceptual assessments or where the findings of the various perceptual assessments were contradictory. The resulting comprehensive profile of the child's dysarthria demonstrated the value of using an assessment battery comprised of both physiological and perceptual methods. In particular, the need to include instrumental analysis of the functioning of the various subcomponents of the speech production apparatus in the assessment battery when defining the treatment priorities for children with acquired dysarthria is highlighted. Treatment priorities determined on the basis of both the perceptual and physiological assessments for the present CVA case are discussed.

Biofeedback rehabilitation of speech breathing for an individual with dysarthria

Abstract: This study was designed to examine the use of respiratory kinematic instrumentation as a biofeedback tool to effect change in the disordered speech breathing of a subject with dysarthria. Two types of biofeedback therapy were used for chest wall excursions and breath control, respectively. The improvements observed in the target behaviors during both therapy phases are discussed with respect to the value of these biofeedback techniques as therapy tools for disorders of speech breathing and the clinical application of the respiratory kinematic technique as a biofeedback tool.

Physiological and perceptual features of dysarthria in Moebius syndrome: directions for treatment.

Abstract: The functioning of the major subsystems of the speech production apparatus of a 12 year old female with Moebius syndrome was investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included: The Assessment of Intelligibility of Dysarthric Speech; the Frenchay Dysarthria Assessment; and a perceptual analysis of a speech sample based on a reading of the Grandfather Passage. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic and aerodynamic evaluation of laryngeal function; nasometric assessment of velopharyngeal function; and evaluation of lip and tongue function using a variety of strain-gauge and pressure transducers. Consistent with the pathophysiological basis of Moebius syndrome, the major dysfunctions of the speech production mechanism were found at the level of the articulatory valve. Somewhat unexpectedly, however, impaired function was also identified at the level of the velopharyngeal and laryngeal valves by both the perceptual and instrumental assessments and at the level of the respiratory system by the physiological analysis alone. The results are discussed with reference to the neurological basis and clinical features of Moebius syndrome. The implications of the findings for the treatment of congenital dysarthria associated with Moebius syndrome are also discussed. The advantage of instrumental analysis over perceptual assessments in defining treatment goals for children with congenital dysarthria is highlighted.

Sprachstörungen in der HNO-Praxis

Abstract: The most frequent speech and language disorders which ENT doctors are confronted with are generally known to be and presented as: delayed speech and language development, dystalia, dysglossia, rhinolalia, dysarthria, and verbal fluency disorders (stuttering, cluttering). The diagnostic portion in comparison to the therapeutic part is always greater and quite different. The close cooperation with representatives of phoniatrics and pedaudiology, as well as logopedics and other specialities such as neurology, and internal medicine is highly necessary.

An exploratory study of an undefined acquired neuromotor speech disorder within the context of the four level framework for speech sensorimotor control.

Abstract: In this study, the speech of a 28-year-old male with acquired brain injury and who presents with an undefined neuromotor speech disorder which cannot be categorised as either apraxia of speech or dysarthria, is described. Voice onset time, vowel duration, utterance duration and vowel formant analyses were done acoustically. A perceptual analysis and intelligibility rating were also executed. The subject was found to present with unique perceptual symptoms, intelligible speech, prolonged sound duration and distorted vowel quality. The results are interpreted within the context of the Four Level Framework of Speech Sensorimotor Control (Van der Merwe, 1997).

Acquired Dysarthria and Dysfluency in Adults

Abstract: In comparison with aphasia, which has been extensively studied during the last 130 years, dysarthria has attracted relatively little attention Many more publications have been devoted to disorders of language than to disorders of motor speech Indeed, dysarthria has often been treated as a Cinderella by language pathologists Hecaen and Dubois (1971), for instance, excluded motor speech impairments from the field of neurolinguistic research

Dysarthria: lonely symptom of tardive dystonia.

Abstract: My perception, however, is that TCAs are now rarely prescribed even for hospitalized patients or for patients who have not responded to repeated courses of SSRIs. This is particularly alarming when it occurs in an academic centre, where I have heard some residents state that they now seldom have an opportunity to manage patients on TCAs. The situation is reminiscent of the decline in the use of monoamine oxidase inhibitors in the 1970s and 1980s despite a body of literature attesting to their effectiveness (5).

From the classification of dysarthria to therapeutic concepts

Abstract: The wide definition of dysarthria includes not only involvement of speech and language, but also of the voice. The authors put forward a classification which is based more logically on the mechanisms of the disorders as they present, and which can at the same time serve as a guide to treatment.

Clinical application of speech science instrumentation in the determination of treatment priorities in acquired and congenital childhood dysarthria

Abstract: Comprehensive studies of the physiological functioning of the speech production apparatus in children with either acquired or congenital dysarthria have not been previously reported. In this paper, profiles of the functioning of the major components of the speech production mechanisms of 3 children with acquired dysarthria of varying etiologies (including closed head injury, cerebrovascular accident and intracerebral tumour) and 1 child with congenital dysarthria associated with Moebius syndrome are presented. Each subject was administered a battery of physiological assessments which included: spirometric and kinematic assessments of respiratory function; aerodynamic and electroglottographic evaluations of laryngeal function; pressure and strain gauge transducer evaluations of articulatory function; and nasal accelerometric assessments of nasality. In addition, perceptual profiles of each subject were compiled using perceptual ratings of deviant speech parameters, intelligibility ratings from the Assessment of Intelligibility of Dysarthric Speech and perceptual judgements of subsystem function determined from the Frenchay Dysarthria Assessment. The clinical implications of the findings of the physiological and perceptual analyses are discussed with regard to determination of specific treatment priorities for each of the 4 cases. It was therefore concluded that physiological instrumentation has the potential to play an important role in the clinical assessment and treatment of dysarthria in children.

Unusual cause of dysarthria in a patient with cerebrovascular disease.

Abstract: Motor difficulty in speech with impaired articulation and pronunciation has been termed dysarthria . Although the list of neurological causes of dysarthria is long, an elderly patient with acute dysarthria associated with myocardial infarction would often be presumed to have had a stroke. We were asked to evaluate a patient with stroke who had an unexpected mechanical cause for dysarthria. A 67-year-old woman with diabetes awoke with jaw pain, right arm pain and numbness, and difficulty speaking and swallowing. She wrote a barely legible note saying "take me to the hospital." Five days earlier she had a brief episode of headache and right arm numbness associated with difficulty finding the right word and speaking intelligibly. Electrocardiogram showed acute myocardial infarction and she was treated with tissue-type plasminogen activator. The pain in the right arm and in the jaw, as well as the right arm numbness, resolved, but her speech and swallowing