Showing papers on "Dysarthria published in 2004"

Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome

Abstract: Many diseases involve the cerebellum and produce ataxia, which is characterized by incoordination of balance, gait, extremity and eye movements, and dysarthria. Cerebellar lesions do not always manifest with ataxic motor syndromes, however. The cerebellar cognitive affective syndrome (CCAS) includes impairments in executive, visual-spatial, and linguistic abilities, with affective disturbance ranging from emotional blunting and depression, to disinhibition and psychotic features. The cognitive and psychiatric components of the CCAS, together with the ataxic motor disability of cerebellar disorders, are conceptualized within the dysmetria of thought hypothesis. This concept holds that a universal cerebellar transform facilitates automatic modulation of behavior around a homeostatic baseline, and the behavior being modulated is determined by the specificity of anatomic subcircuits, or loops, within the cerebrocerebellar system. Damage to the cerebellar component of the distributed neural circuit subserving sensorimotor, cognitive, and emotional processing disrupts the universal cerebellar transform, leading to the universal cerebellar impairment affecting the lesioned domain. The universal cerebellar impairment manifests as ataxia when the sensorimotor cerebellum is involved and as the CCAS when pathology is in the lateral hemisphere of the posterior cerebellum (involved in cognitive processing) or in the vermis (limbic cerebellum). Cognitive and emotional disorders may accompany cerebellar diseases or be their principal clinical presentation, and this has significance for the diagnosis and management of patients with cerebellar dysfunction.

Treatments for dysarthria in Parkinson's disease

Abstract: Dysarthria in Parkinson's disease can be characterised by monotony of pitch and loudness, reduced stress, variable rate, imprecise consonants, and a breathy and harsh voice. Use of levodopa to replenish dopamine concentrations in the striatum seems to improve articulation, voice quality, and pitch variation, although some studies show no change in phonatory parameters. Traditional speech therapy can lead to improvement of dysarthria, and intensive programmes have had substantial beneficial effects on vocal loudness. Unilateral surgical lesions of subcortical structures are variably effective for the alleviation of dysarthria, whereas bilateral procedures typically lead to worsening of speech production. Among deep-brain stimulation procedures, only stimulation of the subthalamic nucleus improves some motor components of speech although intelligibility seems to decrease after surgery. Due to the variable treatment effects on parkinsonian speech, management of dysarthria is still challenging for the clinician and should be discussed with the patient.

Subthalamic nucleus stimulation and dysarthria in Parkinson's disease: a PET study.

Abstract: In Parkinson’s disease, functional imaging studies during limb motor tasks reveal cerebral activation abnormalities that can be reversed by subthalamic nucleus (STN) stimulation. The effect of STN stimulation on parkinsonian dysarthria has not, however, been investigated using PET. The aim of the present study was to evaluate the effect of STN stimulation on regional cerebral blood flow (rCBF) during speech production and silent articulation in patients with Parkinson’s disease. Ten Parkinson’s disease patients surgically implanted bilaterally in the STN and with significant improvement of their dysarthria induced by STN stimulation were included. Ten healthy control subjects also participated in this study. Control subjects performed six sessions of [15O]H2O–PET scanning corresponding to three duplicated conditions externally cued by an auditory signal. The conditions were: (i) rest; (ii) production of a short, simple sentence; and (iii) silent articulation of the same sentence. Parkinson’s disease patients carried out the six PET sessions twice, i.e., in the ON and OFF STN stimulation states. PET data analysis was performed using statistical parametric mapping (SPM99). In control subjects, speech production (SP) compared with rest was associated with increased rCBF bilaterally in the primary motor cortex (M1) corresponding to the orofacial somatotopy, the supplementary motor area (SMA), the associative auditory cortex and the cerebellar hemispheres. Silent articulation (SA) compared with rest induced a bilateral rCBF increase restricted to the orofacial M1 and cerebellar hemispheres. In Parkinson’s disease patients in the OFF stimulation condition, during both SP and SA there was a lack of activation in the right orofacial M1 and in the cerebellum, abnormal increased rCBF in the right superior premotor cortex, and overactivation of the SMA. There was also an abnormal, increased rCBF in the dorsolateral prefrontal cortex (DLPFC) only during SP and increased rCBF in the left insula only during SA. In Parkinson’s disease patients ON stimulation, for both SP and SA the activation pattern appeared similar to that in control subjects. In conclusion, our results suggest that parkinsonian dysarthria is associated with altered recruitment of the main motor cerebral regions (orofacial M1, cerebellum), and increased involvement of the premotor and prefrontal cortices (DLPFC, SMA, superior premotor cortex). These abnormal activations are different from those reported during hand motor tasks. They could be a compensatory mechanism, but might also arise directly as part of the pathophysiology of Parkinson’s disease. STN stimulation tends to reverse these abnormal activations, which is consistent with the observed improvement of Parkinson’s disease dysarthria.

Cerebellar mutism--report of four cases.

Abstract: The aim of the present study was to investigate the manifestations of mutism after surgery in children with cerebellar tumors. Speech impairment following cerebellar mutism in children was investigated based on standardized acoustic speech parameters and perceptual criteria. Mutistic and non-mutistic children after cerebellar surgery as well as orthopedic controls were tested pre-and postoperatively. Speech impairment was compared with the localization of cerebellar lesions (i. e. affected lobules and nuclei). Whereas both control groups showed no abnormalities in speech and behavior, the mutistic group could be divided into children with dysarthria in post mutistic phase and children with mainly behavioral disturbances. In the mutistic children involvement of dentate and fastigial nuclei tended to be more frequent and extended than in the nonmutistic cerebellar children. Cerebellar mutism is a complex phenomenon of at least two types. Dysarthric symptoms during resolution of mutism support the anarthria hypothesis, while mainly behavioral changes suggest an explanation independent from speech motor control.

Effects of subthalamic nucleus stimulation on parkinsonian dysarthria and speech intelligibility

Abstract: Subthalamic stimulation is known to improve tremor, akinesia and rigidity in Parkinson's disease. However, other signs such as hypophonia and swallowing disorders can be relatively resistant to this technique. The effect on dysarthria remains unclear. The aim of this study was to investigate the effects of implantation of electrode and stimulation of the subthalamic nucleus (STN) on parkinsonian dysarthria. Seven patients were prospectively included. Electrodes (Medtronic) were implanted in both STN. The electrode contacts and stimulation parameters were adjusted to provide best relief of symptoms with fewest side effects. Assessment used global scales (Unified Parkinson Disease Rating Scale, UPDRS II and III), dyskinesia scale, exhaustive dysarthria assessment (bucco-facial movements, voice, articulation, intelligibility) and the 'dysarthria' item from the UPDRS III. Evaluations were performed in six conditions: before and three months after surgery (pre-op, post-op) stimulation turned off or on (off-stim, onstim), and without or with a suprathreshold levodopa dose (offdrug, on-drug). Performance level on the UPDRS III significantly improved following electrode implantation and stimulation. For dysarthria, modest beneficial effects were observed on several motor parameters, especially lip movements. Voice mildly improved, especially for the modulation in loudness and pitch. Articulation was not affected. Furthermore, intelligibility was slightly reduced in the on-stimulation condition, especially when patients received levodopa. At an individual level, negative effects on intelligibility were observed in two patients, and this was associated with a discrete increase in facial and trunk dyskinesias, but not with the electrode position or stimulation parameters. In conclusion, surgery had weak effects on dysarthria. Intelligibility can be worsened, especially in the on-drug condition. Thus, adaptation of the stimulation parameters can be difficult.

When more yields less: speaking and writing deficits in nonfluent progressive aphasia.

Abstract: Fourteen patients with nonfluent progressive aphasia (NFPA) performed a picture description task in both spoken- and written-output conditions, as well as tests of confrontation naming, spelling to dictation and reading aloud of single words and text. Relative to controls, the patients' spoken and written picture descriptions were reduced in length, speed and amount of information. Of particular interest, and accounting for the first part of the article's title, was a pervasive pattern of poorer spoken and written output associated with the requirement to produce more; this was true when 'more' meant either (a) longer vs. shorter single words or (b) connected language vs. single words. Deficits in spoken and written naming were largely parallel and modality-specific output impairments (such as dysarthria in speech or letter-formation problems in writing) seemed to account for the minority of cases who exhibited a discrepancy. Most patients showed no evidence of agrammatism or reduced verb production in their speech, which typically had normal proportions of content and function words as well as nouns and verbs. By contrast, some degree of telegraphic output was observed in the written narratives of a number of patients. Our results argue against several candidates for the main functional locus of impairment in NFPA, but it is likely that deficits in grammatical processing, working memory, planning/executive skills, speech motor abilities and phonological processing all play a role.

Alternating motion rate as an index of speech motor disorder in traumatic brain injury

Abstract: The task of syllable alternating motion rate (AMR) (also called diadochokinesis) is suitable for examining speech disorders of varying degrees of severity and in individuals with varying levels of linguistic and cognitive ability. However, very limited information on this task has been published for subjects with traumatic brain injury (TBI). This study is a quantitative and qualitative acoustic analysis of AMR in seven subjects with TBI. The primary goal was to use acoustic analyses to assess speech motor control disturbances for the group as a whole and for individual patients. Quantitative analyses included measures of syllable rate, syllable and intersyllable gap durations, energy maxima, and voice onset time (VOT). Qualitative analyses included classification of features evident in spectrograms and waveforms to provide a more detailed description. The TBI group had (1) a slowed syllable rate due mostly to lengthened syllables and, to a lesser degree, lengthened intersyllable gaps, (2) highly correlated syllable rates between AMR and conversation, (3) temporal and energy maxima irregularities within repetition sequences, (4) normal median VOT values but with large variation, and (5) a number of speech production abnormalities revealed by qualitative analysis, including explosive speech quality, breathy voice quality, phonatory instability, multiple or missing stop bursts, continuous voicing, and spirantization. The relationships between these findings and TBI speakers' neurological status and dysarthria types are also discussed. It was concluded that acoustic analyses of the AMR task provides specific information on motor speech limitations in individuals with TBI.

The understandability of AAC: A conversation analysis study of acquired dysarthria

Abstract: In this paper, an analysis of augmentative and alternative communication (AAC) system use by two adults with acquired dysarthria in conversation with their partners at home is presented. The qualitative methodology of Conversation Analysis (CA) is used to describe a particular type of AAC activity that was utilized during conversations by speakers with dysarthria for whom natural speech was still the primary modality. The two main findings were (a) that AAC was regularly used by speakers with dysarthria to attempt self-repairs of communication problems identified by their non-dysarthric partners; and (b) that AAC turns during self-repair activities were typically treated as intelligible but not fully understandable. It is suggested that CA can serve as a useful tool in dysarthria/AAC assessment and for the tailoring of AAC interventions to everyday conversational practices between people with dysarthria and their conversation partners.

A UK multi-centre pilot study of speech and swallowing outcomes following head and neck cancer.

Abstract: Speech and swallowing are important components of health-related quality of life following head and neck cancer treatment. The aim of this study was to demonstrate the value of prospective multi-centre evaluation by Speech and Language Therapists and to compare health-related quality of life with speech and swallowing impairments. The University of Washington Head and Neck questionnaire version 4 (UW-QOL) and Therapy Outcome Measures (TOM) were rated before and 6 months after cancer treatment in 95 patients from 12 centres. There was deterioration in TOM scores at 6 months. Pretreatment UW-QOL swallowing was ranked equal first, with speech fourth. At 6 months speech was first and swallowing second. There were positive correlations between UW-QOL swallowing and TOM dysphagia and between UW-QOL speech and TOM laryngectomy, voice, phonology and dysarthria disorders. Both outcome measures are suitable for routine practice. Adaptation of TOM scales for use with head and neck cancer patients may improve sensitivity, validity and therapist compliance.

Revisiting dysarthria assessment intelligibility metrics.

Abstract: This study reports on the development of an automated isolated-word intelligibility metric system designed to improve the scoring consistency and reliability of the Frenchay Dysarthria Assessment Test (FDA).The proposed intelligibility measurements are based on the probabilistic likelihood scores derived from the forced alignment of the dysarthric speech to whole-word hidden Markov models (HMMs) trained on data from a variety of normal speakers. The hypothesis is that these probability scores are correlated to the decoding effort made by naive listeners when trying to comprehend dysarthric utterances. Initial results indicate that the scores returned from these composite measurements provide a more fine-grained assessment of a given dysarthric individual’s oral communicative competence when compared with traditional ‘right-or-wrong’ scoring of expert listeners’ transcriptions of dysarthric speech samples.

Effect of high-frequency spectral components in computer recognition of dysarthric speech based on a Mel-cepstral stochastic model.

Abstract: Computer speech recognition of individuals with dysarthria, such as cerebral palsy patients, requires a robust technique that can handle conditions of very high variability and limited training data. In this study, a hidden Markov model (HMM) was constructed and conditions investigated that would provide improved performance for a dysarthric speech (isolated word) recognition system intended to act as an assistive/control tool. In particular, we investigated the effect of high-frequency spectral components on the recognition rate of the system to determine if they contributed useful additional information to the system. A small-size vocabulary spoken by three cerebral palsy subjects was chosen. Mel-frequency cepstral coefficients extracted with the use of 15 ms frames served as training input to an ergodic HMM setup. Subsequent results demonstrated that no significant useful information was available to the system for enhancing its ability to discriminate dysarthric speech above 5.5 kHz in the current set of dysarthric data. The level of vari- ability in input dysarthric speech patterns limits the reliability of the system. However, its application as a rehabilitation/control tool to assist dysarthric motor-impaired individuals such as cere- bral palsy subjects holds sufficient promise.

An evaluation of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury: a report of 3 cases.

Abstract: Objective: To evaluate the effectiveness of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury (17111). Design: An A-B-A experimental research design. Assessments were conducted prior to commencement of the program, midway, immediately posttreatment, and 1 month after completion of the CPAP therapy program. Participants: Three adults with dysarthria and moderate to severe hypernasality subsequent to TBI. Outcome Measures: Perceptual evaluation using the Frenchay Dysarthria Assessment, the Assessment of Intelligibility of Dysarthric Speech, and a speech sample analysis, and instrumental evaluation using the Nasometer. Results: Between assessment periods, varying degrees of improvement in hypernasality and sentence intelligibility were noted. At the 1-month post-CPAP assessment, all 3 participants demonstrated reduced nasalance values, and 2 exhibited increased sentence intelligibility. Conclusions: CPAP may be a valuable treatment of impaired velopharyngeal function in the TBI population.

Acoustic analysis of speech tasks performed by three individuals with spinocerebellar ataxia.

Abstract: A number of speech tasks produced by three female subjects with different types of genetically diagnosed spinocerebellar ataxia and with mild dysarthria were investigated using acoustic instrumentation. All subjects showed a number of signs of decreased speech rate, increased pause duration, increased and more variable durations of alternating motion rate, sequential motion rate syllables and inter-stress intervals in addition to vocal instability. These signs were consistent with the perceptual judgment of ataxic dysarthria. Furthermore, the severity of impairment found using these speech analysis methods seemed to correspond to the general severity of the disease and the duration of the illness in these few subjects. The tasks studied appeared to be relevant and suitable for acoustic analyses as they did reveal deviations in the speech of the subjects compared with controls.

Listener attitudes toward individuals with cerebral palsy who use speech supplementation strategies.

Abstract: This study examined listener attitudes toward 7 speakers with dysarthria who implemented 3 speech supplementation strategies (topic cues, alphabet cues, and combined topic and alphabet cues) and a ...

The Effect of Three Practice Conditions on the Consistency of Chronic Dysarthric Speech

Abstract: This study investigated whether it is possible for people with chronic dysarthria to adjust their articulation in three practice conditions. A speaker dependent, speech recognition system was used to compare participants' practice attempts with a model of a word made from previous recordings to give a recognition score. This score was used to indicate changes in production of practice words with different conditions. The three conditions were reading of written target words, visual feedback, and an auditory model followed by visual feedback. For eight participants with dysarthria, the ability to alter speech production was shown, together with a differential effect of the three conditions. Copying an auditory target gave significantly better recognition scores than just repeating the word. Visual feedback was no more effective than repetition alone. For four control participants, visual feedback did produce significantly better recognition scores than just repetition of written words, and the presence of an auditory model was Significantly more effective than visual feedback. Possible reasons for differences between conditions are discussed.

Assessment of tongue weakness and fatigue

Abstract: Assessment of nonspeech tongue function is common in speech-language pathology. This paper reviews techniques used to determine tongue strength and endurance, and describes a constant-effort task. These techniques are intended to reveal and quantify the presence of weakness or fatigue of the tongue. The consequences of performing these tasks with and without a bite block, used to fix jaw position, are considered. Whether nonspeech tongue impairment is associated with speech dysfunction in Parkinson's disease is another topic of interest. Past studies indicated reduced tongue strength and endurance in Parkinson's disease, but these measures did not correlate with speech measures. It was hypothesized that weakness and fatigue need to be impaired to a "critical" level before speech is perceptibly affected. To examine whether experimentally induced tongue fatigue affects speech, normal speakers performed prolonged strenuous tongue exercise. Speech deteriorated following these exercises. A new investigation examines whether 1 hour of speech-like tongue exercise (rapid syllable repetitions) affects dysarthric speech. Preliminary data from 6 participants with Parkinson's disease, 1 person with bulbar ALS, and 6 neurologically normal control subjects indicate that sentences sound more precise but less natural after the exercises. Surprisingly, results did not differ significantly between the groups. Continued collection of data and refinement of tasks will contribute to our understanding of the potential relationships between weakness, fatigue, and speech.

Speech and Language Disorders in Multiple Sclerosis

Abstract: Neuropatholophysiological Basis of Communication Disorders in multiple Sclerosis. Perceptual Features of Dysarthria in Multiple Sclerosis. Acoustic Features of Dysarthria in Multiple Sclerosis. Articulatory and velopharyngeal Dysfunction in Multiple Sclerosis. Laryngeal and Respiratory dysfunction in Multiple Sclerosis. Treatment of Motor Speech Disorders in multiple Sclerosis. Language Disorders in Multiple Sclerosis. High-level language. Naming and Discourse Abilities in Multiple Sclerosis. Subgroups of multiple Sclerosis Patients Based on Language Dysfunction. Treatment of language Disorders in Multiple Sclerosis.

Telephone Communication: Synthetic and Dysarthric Speech Intelligibility and Listener Preferences

Abstract: For many individuals with severe speech intelligibility challenges, deciding whether to use one's own oral dysarthric speech or synthesized speech when communicating on the telephone is a difficult process. In the present study, we investigated the intelligibility of dysarthric speech and two types of synthesized speech over the telephone and in quiet conditions, and listeners' preferences for these speech types. Participants heard short sentences in one of three types of speech: dysarthric female speech, DECTalk® Beautiful Betty, and MacinTalk™ Victoria, high quality. They were asked to transcribe sentences for a measure of intelligibility, and to answer questions to indicate their preferences for speech type and their preferences for synthesizer. The overall intelligibility of DECTalk® and MacinTalk™ were significantly higher than the intelligibility of the dysarthric speech. Additionally, the intelligibility of the speaker with dysarthria decreased significantly when listeners were presented with the m...

The Effect of Aging and Synthetic Topic Cues on the Intelligibility of Dysarthric Speech

Abstract: For speakers with severe dysarthria, particularly those with progressive diseases, behavioral modifications to improve intelligibility are often unrealistic. This study examined the impact of cues produced by an augmentative and alternative communication (AAC) device on the intelligibility of dysarthric speech. Young and old adults listened to sentences preceded by cues that were either general (“I have a question”) or topic specific (“I have a question about [topic]”). The analyses revealed significant age- and cue-type effects: Younger listeners were more accurate than older listeners were, and topic cues resulted in greater accuracy than general cues. There was also a word class effect that interacted with cue type. The results show that providing topic cues enhances the intelligibility of dysarthric speech.

Relationship between Speech and Swallowing Disorders in Patients with Neuromuscular Disease

Abstract: The intelligibility of monosyllabic speech, word speech, and conversational speech was evaluated in 113 dysarthric speakers, and the presence and severity of swallowing disorders were evaluated using videofluoroscopic and bedside examinations. The results revealed a high correlation between swallowing function and all levels of speech intelligibility. Furthermore, the prevalence of concomitant dysphagia in dysarthric patients was quite high regardless of the primary etiology and time elapsed since the onset. However, the relationship between the two functions is more complex than is initially apparent. The prevalence and severity of dysphagia vary markedly according to the type of dysarthria. Patients in the flaccid, spastic, and mixed categories encompass a broad range of severity levels with many individuals being severely impaired, while patients in the ataxic, hypokinetic, and unilateral upper motor neuron categories seldom have severe concomitant swallowing problems. Furthermore, the correlation coefficient between conversational intelligibility and swallowing function varies considerably according to the type of dysarthria. The correlation was not significant in the flaccid, hypokinetic, and UUMN dysarthria groups. Based on these findings, we discuss herein the clinical management of dysarthric patients with dysphagia.

Myotonia and flaccid dysarthria in patients with adult onset myotonic dystrophy

Abstract: Background: Myotonia and weakness are the most important components of dysarthric speech in myotonic dystrophy. Objective: To specify and quantify possible defects in speech execution in patients with adult onset myotonic dystrophy. Methods: Studies on speech production were done on 30 mildly affected patients with myotonic dystrophy. Special attention was paid to myotonia. Because muscle activity can result in a decrease of myotonia, speech characteristics were measured before and after warm up. The possibility that warming up causes increased weakness was also assessed. Results: As with other motor skills, a warm up effect was found in speech production, resulting in an increase in repetition rate and a decrease in variability of repetition rate. Signs of fatigue did not occur. Conclusions: Warming up is valuable for patients with myotonic dystrophy in reducing the influence of myotonia on speech production.

How Does Fatigue Affect Communication?The Influence of Fatigue on Cognitive, Physical, Psychosocial and Communicative Ability in Individuals With Multiple Sclerosis

Abstract: Fatigue and problems related to communication are common symptoms of multiple sclerosis (MS). However, no research has been conducted on how fatigue affects the communication of individuals with MS. For this study, the Fatigue Impact Scale (FIS) was supplemented with 20 statements concerning communication. Forty-four people with MS and 44 healthy controls completed the questionnaire. Results showed that individuals with MS experienced significantly greater problems caused by fatigue within all sub-areas (cognitive, physical, psychosocial and communicative) compared to the control group. No significant differences were observed in fatigue with regard to MS sub-type, gender, age, neurological disability, or medication. The major influence of fatigue was reported to be in the physical area, with less impact related to communication. Respondents who experienced communicative problems caused by fatigue also had problems with language comprehension and speech (dysarthria). Fifteen subjects with MS were randomly...

Dysarthria in early Parkinson's disease

Abstract: The aim of the present study was threefold. First, to examine the incidence of dysarthria in patients in the beginning of Parkinson's disease by using a standardised test (Frenchay Dysarthria Assessment/FDA) and an intelligibility assessment tool. Second, to identify differences in speech and in measures of phonation between the Parkinsonian group and a matched control geriatric group using the FDA and electrolaryngography. Finally, to identify the effect of medication on speech and phonation in the dysarthric Parkinsonian group. The results showed that 8 out of 12 (66%) Parkinsonian subjects exhibited lower scores in the FDA compared to controls. Qualitative differences between the two groups were found in the isolated movements of the articulators but not in running speech and speech intelligibility. An improvement in the FDA scoring was found 3-3.5 months after medication. This improvement focused on the areas of tongue and lips and was accompanied with significant increases in intelligibility. No differences in measures of phonation were found either between the two groups or in the same group after medication. The above results suggest that in the beginning of Parkinson's disease, dysarthria is expressed as slowness and may be related to the primary diagnostic symptom of bradykinesia. Due to the small sample and the lack of dosage control, the significance of these findings appears to be inconclusive and warrants further investigation. Future research should employ instrumental quantitative measures on isolated movements of the articulators that may correlate with running speech and will aim to find clinical markers of speech in the diagnosis of Parkinson's disease.

Speech-Breathing Treatment and LSVT for a Patient With Hypokinetic-Spastic Dysarthria After TBI.

Abstract: The Lee Silverman Voice Treatment® (LSVT) program was developed to improve speech in persons with hypokinetic dysarthria associated with Parkinson disease (PD) (Ramig, 1995). It has been tested in a relatively large number of people with PD, and available evidence supports its effectiveness for up to 2 years (Ramig et al., 2001). Less often, LSVT has been used with patients who have other etiologies, including Parkinson-plus syndromes (Countryman, Ramig, & Pawlas, 1994) and multiple sclerosis (Sapir et al., 2001). Results from these cases are guarded by the apparent need to supplement or extend the standard 4-week program and evidence of decreased effectiveness over subsequent months. Previously, we published a case study of a young man who presented with mixed hypokinetic-spastic dysarthria 20 months post-TBI (Solomon et al., 2001). He participated in LSVT followed by 6 weeks of Combination Treatment that included speech-breathing training, physical therapy, and LSVT-type tasks. The additional treatment was deemed necessary because of minimal improvement in speech breathing and speech intelligibility following LSVT alone. Marked improvements resulted after the full 10-week program, and these gains were maintained for several months. To further examine the viability of LSVT as a treatment strategy for patients with mixed hypokinetic-spastic dysarthria, we replicated the study in a similar patient. In contrast to the previous study, we simplified the Combination Treatment to focus only on nonspeech and speech breathing, conducted treatments in reverse order, and included multiple baseline assessments. Data also were collected after 6 weeks of Breathing-for-Speech Treatment (BST), after the 4-week LSVT program, and 1- and 4-months posttreatment.

Acoustic investigation of vocal quality following treatment for childhood cerebellar tumour.

Abstract: The aim of the study was firstly to document the acoustic parameters of voice using the Multidimensional Voice Program (MDVP, Kay Elemetrics) in a group of children with dysarthria subsequent to treatment for cerebellar tumour (CT). Then, secondly, compare the acoustic findings to perceptual voice characteristics as described by the GIRBAS (grade, instability, roughness, breathiness, asthenicity, strain). The assessments were performed on 29 voice samples; 9 cerebellar tumour participants with dysarthria, and 20 control participants. None of the control voices were rated as exhibiting any of the six parameters described by the GIRBAS, while 7 of the CT participants were noted to have at least a mild voice disorder. Roughness, instability, breathiness and asthenicity were all identified as voice characteristics in the CT voice samples. Acoustically, the CT voice samples differed significantly from the controls' voices on frequency and amplitude perturbation measures. Our findings confirmed voice dysfunction as a component of dysarthria in children treated for cerebellar tumour, and discussed the links between acoustic and perceptual descriptions.