Showing papers on "Dysarthria published in 2003"

Neuromuscular treatments for speech and swallowing: a tutorial.

Abstract: Despite the proliferation of oral motor therapies, much controversy exists regarding the application and benefit of neuromuscular treatments (NMTs) such as strength training for alleviating dysarth...

Toward an acoustic typology of motor speech disorders

Abstract: Acoustic methods have progressed to the point that an acoustic typology of the motor speech disorders can be constructed from a parametric assessment of the speech subsystems (e.g., phonation, nasal resonance, vowel articulation, consonant articulation, intonation, and rhythm). The results of this analysis can be interpreted in respect to global functions in speech (e.g., voice quality, intelligibility, and prosody). This paper reviews studies showing that specific acoustic analyses have demonstrated or potential value toward the overall goal of constructing acoustic profiles of dysarthria and apraxia of speech. Several different acoustic measures are relevant to the study of the motor speech disorders, and these are increasingly supported by normative data and by guidelines for clinical application. Examples of these applications are discussed for a variety of specific neurologic diseases or perceptual types of disorder. Acoustic studies are useful in the study of motor speech disorders and recent progre...

Corticobasal degeneration as a cognitive disorder.

Abstract: The presence of cognitive impairment in corticobasal degeneration (CBD) is now widely recognised. Our review of the literature reveals that, although the pattern and severity of neuropsychological impairments can be highly variable across patients, several general trends can be identified. The most characteristic impairments are limb apraxia (usually ideomotor), constructional and visuospatial difficulties, acalculia, frontal dysfunction, and nonfluent aphasia. The limb apraxia is associated with deficits in drawing, copying, and handwriting, but there is emerging evidence that the problems with handwriting are not due exclusively to the apraxia. The findings with respect to episodic memory are more variable, but when there is impairment in this area, it tends to be milder than that seen in Alzheimer's disease. Semantic memory functioning appears relatively preserved but has been poorly studied. Problems with speech are common, and may be due to dysarthria or buccofacial apraxia. Aphasia, although initially considered rare, is in fact a common accompaniment of CBD, may be the presenting feature, and is typically nonfluent in type. More systematic investigation of the clinical and neuropathological overlap between progressive nonfluent aphasia (generally considered to be a form of frontotemporal dementia) and CBD is needed.

Cerebellar Speech Representation: Lesion Topography in Dysarthria as Derived From Cerebellar Ischemia and Functional Magnetic Resonance Imaging

Abstract: Background Lesion topography and the pathophysiological background of dysarthria due to focal cerebellar lesions have not yet been fully clarified. Objectives To investigate the lesion topography of dysarthria due to cerebellar ischemia and evaluate brainstem functions. Design Case studies. Patients Eighteen right-handed patients with sudden-onset dysarthria and cerebellar ischemia with and without brainstem involvement and 19 healthy, right-handed, monolingual, German-speaking volunteers. Methods In patients, we used multimodal electrophysiologic techniques to investigate brainstem functions. Functional magnetic resonance imaging (MRI) was performed in the 19 healthy volunteers. Activation tasks consisted of repetitive vertical silent movements of the tongue and lips at a self-paced rhythm. Results Cerebellar lesions and additional signs of brainstem involvement were observed in 11 patients with posterior inferior cerebellar artery, anterior inferior cerebellar artery, and superior cerebellar artery infarctions, respectively. In all other patients with isolated cerebellar infarction (n = 7), only the superior cerebellar artery territory (6 right-sided, 1 left-sided) was affected, and the common lesion site was the rostral paravermal region of the anterior lobe. Functional MRI in healthy volunteers indicated that the cerebellar representation of the tongue and orofacial muscles corresponds to that of the area involved in patients with cerebellar dysarthria. Conclusions The results of this study demonstrate that articulatory movements of the tongue and orofacial muscles are involved in the activation of the rostral paravermal area of the anterior lobe. This location corresponds to the area involved in cerebellar ischemia in patients with dysarthria. Lesions in the upper paravermal area of the right cerebellar hemisphere, the site of coordination of articulatory movements of the tongue and orofacial muscles, may lead to the development of dysarthria that is unrelated to (often concomitant) brainstem infarctions.

Effects of presentation mode and repeated familiarization on intelligibility of dysarthric speech.

Abstract: Clinical measures of speech intelligibility are widely used as one means of characterizing the speech of individuals with dysarthria. Many variables associated with both the speaker and the listene...

Implementing speech supplementation strategies: effects on intelligibility and speech rate of individuals with chronic severe dysarthria.

Abstract: A growing body of experimental research suggests that speech supplementation strategies can markedly increase speech intelligibility for individuals with dysarthria (D. Beukelman & K. Yorkston, 197...

Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study.

Abstract: This study examined the effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT®]) on ataxic dysarthria in a woman with cerebellar dysfunction secondary to thiamine deficiency...

Characteristics of diadochokinesis in multiple sclerosis and Parkinson's disease.

Abstract: Diadochokinesis (DDK) for speakers with dysarthria has been described using a variety of acoustic measures. A clinical protocol for the objective assessment of DDK requires a unified approach, however, to facilitate implementation across clinics and laboratories. A protocol for the acoustic analysis of DDK that incorporates temporal and energy measures has been used to describe DDK characteristics for dysarthria secondary to stroke as well as ataxic dysarthria. The current study sought to validate and extend the protocol to a new set of etiological groups, including dysarthria secondary to multiple sclerosis (MS) and Parkinson's disease (PD). The results suggest that temporal measures are more useful than energy measures for distinguishing among dysarthria secondary to MS, dysarthria secondary to PD, and healthy controls. The results also highlight the value of including both alternating and sequential motion rate tasks in the assessment of DDK and of supplementing quantitative measures with qualitative spectrographic observations.

Bilateral subthalamic stimulation effects on oral force control in Parkinson's disease

Abstract: Dysarthria in Parkinson's disease (PD) consists of articulatory, phonatory and respiratory impairment. Bilateral subthalamic nucleus (STN) stimulation greatly improves motor disability, but its long-term effect on speech within a large group of patients has not been precisely evaluated. The aim of this study was to determine the effect of bilateral STN stimulation on oral force control in PD. We measured forces of the upper lip, lower lip and tongue in twenty-six PD patients treated with bilateral STN stimulation. Measurements of the articulatory organ force, as well as a motor evaluation using the Unified Parkinson's Disease Rating Scale (UPDRS), were made with and without STN stimulation. Maximal voluntary force (MVF), reaction time (RT), movement time (MT), imprecision of the peak force (PF) and the hold phase (HP) were all improved with STN stimulation during the articulatory force task, as well as the motor examination scores of the UPDRS. It seems that the beneficial STN stimulation-induced effect on articulatory forces persisted whatever the duration of post-surgical follow-up. However, dysarthria evaluated by the UPDRS was worse in two subgroups of patients with a one to two year and three to five year post-surgical follow-up, in comparison with a subgroup of patients with a three month follow-up. STN stimulation has a beneficial long-term effect on the articulatory organs involved in speech production, and this indicates that parkinsonian dysarthria is associated, at least in part, with an alteration in STN neuronal activity. Nevertheless, to confirm the persistence of the beneficial effect of STN stimulation on parkinsonian dysarthria, a longitudinal evaluation is still needed.

The effect of pacing strategies on the variability of speech movement sequences in dysarthria.

Abstract: There are many potential sources of variability in speech production, particularly in individuals with dysarthria The degree and time course of stabilization of the speech production system during recovery from a neurological insult is not constant across individuals Another source of variability in speech production is speaking rate Although individuals with no neurological impairments typically show increased variability at reduced speaking rates, this phenomenon has not been explored extensively in individuals with dysarthria Because rate control strategies are commonly used in dysarthria treatment, it is of clinical importance to know if individuals with dysarthria produce less variable speech with rate reduction Six individuals with mild dysarthria, 6 with moderate-to-severe dysarthria, and 6 matched normal controls repeated an utterance in four speaking rate conditions: habitual, fast, breaks between words, and stretched Data were analyzed using the spatiotemporal index (STI), a composite measure of spatial and temporal variability across token repetitions The normal controls consistently demonstrated the least variability, regardless of rate condition Both groups with dysarthria were the least variable in the stretched condition and the most variable in the fast condition The STI values of the group with moderate-to-severe dysarthria were significantly different from both the individuals with mild dysarthria and the normal controls There were no significant differences between the group with mild dysarthria and the normal controls In general, slowing the speaking rate in individuals with dysarthria reduces spatiotemporal variability; however, the effect of reduced spatiotemporal variability on intelligibility requires further investigation

Acoustic characteristics of the question-statement contrast in severe dysarthria due to cerebral palsy.

Abstract: Studies of prosodic control in severe dysarthria (DYS) have focused on differences between impaired and nonimpaired speech in terms of the range and variation of fundamental frequency (F0), intensi...

Acoustic correlates of hypernasality.

Abstract: The aim of this study was to apply one-third-octave analysis for measuring an acoustic correlate of hypernasality in the speech of adults with a range of aetiologies (dysarthria, maxillectomy and cleft palate). Subjects included 12 speakers with hypernasality and 12 normal controls. The speech material was the vowel /i/ segmented from two Cantonese single words produced by each speaker. The results showed that speakers with hypernasality had significantly higher energy level for the one-third-octave bands centred at 630, 800 and 1000 Hz, and significantly lower amplitude for the band centred at 2500 Hz than speakers with normal resonance. These results are in general agreement with past findings about nasalization of vowels. This study showed that one-third-octave analysis has high intrajudge reliability and is applicable to the speech of adults with hypernasality due to different etiologies.

Intelligibility of modifications to dysarthric speech

Abstract: Dysarthria is a motor speech impairment affecting millions of people. Dysarthric speech can be far less intelligible than that of non-dysarthric speakers, causing significant communication difficulties. The goal of our work is to understand the effect that certain modifications have on the intelligibility of dysarthric speech. These modifications are designed to identify aspects of the speech signal or signal processing that may be especially relevant to the effectiveness of a system that transforms dysarthric speech to improve its intelligibility. A result of this study is that dysarthric speech can, in the best case, be modified only at the short-term spectral level to improve intelligibility from 68% to 87%. A baseline transformation system using standard technology, however, does not show improvement in intelligibility. Prosody also has a significant (p<0.05) effect on intelligibility.

Assessment of motor speech disorders online: a pilot study.

Abstract: We have conducted a preliminary validation of an Internet-based telehealth application for assessing motor speech disorders in adults with acquired neurological impairment. The videoconferencing module used NetMeeting software to provide realtime videoconferencing through a 128 kbit/s Internet link, as well as the transfer of store-and-forward video and audio data from the participant to the clinician. Ten participants with dysarthria following acquired brain injury were included in the study. An assessment of the overall severity of the speech disturbance was made for each participant face to face (FTF) and in the online environment; in addition, a 23-item version of the Frenchay Dysarthria Assessment (FDA) (which measures motor speech function) and the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) (which gives the percentage word and sentence intelligibility, words per minute and a rating of communication efficiency) were administered in both environments. There was a 90% level of agreement between the two assessment environments for the rating of overall severity of dysarthria. A 70-100% level of agreement was achieved for 17 (74%) of the 23 FDA variables. On the ASSIDS there was a significant difference between the FTF and online assessments only for percentage word intelligibility. These findings suggest that Internet-based assessment has potential as a reliable method for assessing motor speech disorders.

Interarticulator coordination in dysarthria: an X-ray microbeam study.

Abstract: Articulatory discoordination is often said to be an important feature of the speech production disorder in dysarthria, but little experimental work has been done to identify and specify the coordin...

Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.

Abstract: The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.

A modern approach to dysarthria classification

Abstract: This work deals with the assessment of neurological diseases known as dysarthrias, using a novel approach based on objective and perceptual features extracted from pathological speech signals. A methodology for the classification of dysarthria is developed in which digital signal processing algorithms are used to appraise the severity of those features less reliably judged by the clinicians, while the others are taken directly from perceptual judgments or medical records. The assessment process evaluates the performance of two different classifiers and compares them with the traditional assessment system. The first approach is based on the lineal discriminant analysis and the second is a non-lineal technique based on self-organizing maps. The non-lineal classifier provided the highest percent of correct classification and the most accurate information on the relevance of the features in the classifier decision. It also provided a bi-dimensional representation of de data that allows a better understanding of the correspondence between the speech deviations and the location of the damage in the peripheral or central nervous system.

Comparability of perceptual analysis of speech characteristics in Australian and Swedish speakers with multiple sclerosis.

Abstract: The aims of the present study were to compare the perceptual assessments of deviant speech signs (dysarthria) exhibited by Australian and Swedish speakers with multiple sclerosis (MS) and to explore w

Lip and tongue function differently affected in individuals with multiple sclerosis.

Abstract: Clinical dysarthria test scores on lip function and tongue function were compared for 77 dysarthric as well as non-dysarthric subjects with multiple sclerosis (MS) and 15 control subjects. Results show that tongue function was significantly more severely affected than lip function in individuals with MS. Furthermore, tongue function, but not lip function, was significantly more severely affected in the MS individuals with no dysarthria compared to the control group. Test items requiring increased rate of movement (oral and verbal diadochokinesis) were significantly more severely affected than the items requiring range and force of movement, but only in the dysarthric MS subgroup. Moderate correlations were found between tongue and lip function and neurological deficit scores, number of years in disease progression, and perceptually perceived consonant and vowel precision. Consequently, tongue dysfunction can be detected clinically and subclinically using a dysarthria test procedure, and as an early sign of articulatory dysfunction it should be an early target in therapeutic interventions.

Stroke symptom recognition devices and methods

Abstract: Devices and methods for detecting one or more symptoms of stroke, such as motor function deficits and cognitive function deficits. By way of example, not limitation, the present invention provides devices and methods for detecting various forms of hemiparesis, ataxia, aphasia, and/or dysarthria, which may be measured alone or in any combination.

Improving Intelligibility of Speakers with Profound Dysarthria and Cerebral Palsy

Abstract: Many individuals with cerebral palsy use natural speech as one mode of communication. Recent research suggests that, for these individuals, speech supplementation strategies, such as topic cues, alphabet cues, and combined cues, can have a significant impact on intelligibility; however, the impact of these strategies when speakers actually implement them while producing connected speech is largely unknown. In the present study, the effects of speaker-implemented topic cues, alphabet cues, and combined cues (compared with a no cues control condition) were studied for three individuals with profound dysarthria secondary to cerebral palsy. Also of interest were listener rankings of each strategy, which were based on speakers' perceived effectiveness. Group results showed that combined cues yielded higher intelligibility scores than no cues, topic cues, and alphabet cues. Conversely, no cues resulted in lower intelligibility scores than alphabet cues and topic cues; and alphabet cues resulted in higher intell...

Speech recognition and dysarthria: a single subject study of two individuals with profound impairment of speech and motor control.

Abstract: This study investigated the use of the speech recognition system Dragon Dictate as an augmentative method of computer access for two individuals with cerebral palsy, including severe motor dysfunction and dysarthria. Single subject design was used and measures of computer access system effectiveness and speech production were used before, during and after intervention. The users' original switch access system was compared to a combination of their switch access system and speech recognition, by counting the number of correct entries. Adding speech recognition increased the number of correct entries by 40% for one of the participants. The other participant did not complete the intervention protocol. An independent judge rated speech production. No changes in speech were observed. Dragon Dictate is time-consuming to learn and demands a high level of motivation, but can be beneficial to a person who has profound dysarthria and great difficulties in accessing the computer.

Perceptual characteristics of Cantonese hypokinetic dysarthria

Abstract: The aims of this study were to provide a perceptual speech 'profile' for Cantonese speakers with hypokinetic dysarthria, to examine the reliability of non-expert listeners in perceptual judgements of dysarthric speech, and to investigate cross-language differences in profiles of hypokinetic dysarthria. Participants included 19 speakers with Parkinson's disease and 10 speech-language pathologists who served as listeners. Listeners rated 21 speech dimensions, using seven-point interval scales. Mean intralistener agreement was 94.52% and mean interlistener reliability was 0.88 (Cronbach's alpha). Mean scale values (MSV) for each dimension ranged from 3.37 to 1.36. The perceptual profile of Cantonese hypokinetic dysarthria was largely similar to profiles for English and Japanese speakers; notable differences are discussed. Possible reasons for the relatively high reliability obtained are presented.

Electropalatographic Assessment of Tongue-to-Palate Contacts Exhibited in Dysarthria Following Traumatic Brain Injury: Spatial Characteristics

Abstract: Consonant imprecision has been reported to be a common feature of the dysarthric speech disturbances exhibited by individuals who have sustained a traumatic brain injury (TBI). Inaccurate tongue placements against the hard palate during consonant articulation may be one factor underlying the imprecision. To investigate this hypothesis, electropalatography (EPG) was used to assess the spatial characteristics of the tongue-to-palate contacts exhibited by three males (aged 23-29 years) with dysarthria following severe TBI. Five nonneurologically impaired adults served as control subjects. Twelve single-syllable words of CV or CVC construction (where initial C = /t, d, S, z, k, g/, V=/i, a/) were read aloud three times by each subject while wearing an EPG palate. Spatial characteristics were analyzed in terms of the location, pattern, and amount of tongue-to-palate contact at the frame of maximum contact during production of each consonant. The results revealed that for the majority of consonants, the patterns and locations of contacts exhibited by the TBI subjects were consistent with the contacts generated by the group of control subjects. One notable exception was one subject's production of the alveolar fricatives in which complete closure across the palate was demonstrated, rather than the characteristic groove configuration. Major discrepancies were also noted in relation to the amount of tongue-to-palate contact exhibited, with two TBI subjects consistently demonstrating increased contacts compared to the control subjects. The implications of these findings for the development of treatment programs for dysarthric speech disorders subsequent to TBI are highlighted.

Progressive dysarthria: definition and clinical follow-up.

Abstract: Progressive dysarthria is a common sign of several degenerative disorders of the central nervous system; it may also be a distinct nosographic entity. We identified nine patients in which progressive dysarthria remained the sole neurological sign for at least 2 years after onset. At least a year after hospital admission, the following diagnoses were made: two cases of corticobasal degeneration, one of frontotemporal dementia, one of primary progressive aphasia, one of motor neuron disease (MND)-dementia, one of ALS, and one of ALS-aphasia. In the remaining two patients progressive dysarthria remained the only neurological sign at latest examination. We conclude that in most cases progressive dysarthria is the presenting sign of an established neurodegenerative disease (generally degenerative dementia or motor neuron disease), although the possibility that progressive dysarthria is a distinct entity cannot be excluded. To clarify this issue, studies (probably multicenter) on more patients with longer clinical follow-up and pathological confirmation are required.