Showing papers on "Dysarthria published in 2005"
TL;DR: The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.
Abstract: Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.
193 citations
TL;DR: A brief review of terminology associated with AOS, its clinical hallmarks and neuroanatomical correlates, current models of motor programming will also be addressed as they relate to AOS and typical treatment strategies used in rehabilitating the articulation and prosody deficits associatedwith AOS will be summarized.
Abstract: Apraxia of speech (AOS) is a motor speech disorder that can occur in the absence of aphasia or dysarthria. AOS has been the subject of some controversy since the disorder was first named and described by Darley and his Mayo Clinic colleagues in the 1960s. A recent revival of interest in AOS is due in part to the fact that it is often the first symptom of neurodegenerative diseases, such as primary progressive aphasia and corticobasal degeneration. This article will provide a brief review of terminology associated with AOS, its clinical hallmarks and neuroanatomical correlates. Current models of motor programming will also be addressed as they relate to AOS and finally, typical treatment strategies used in rehabilitating the articulation and prosody deficits associated with AOS will be summarized.
176 citations
TL;DR: Results provided initial support for processing deficits in speakers with ataxic and hypokinetic dysarthria that are separable from motor execution impairments.
93 citations
TL;DR: It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation.
Abstract: Levodopa (L-dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L-dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton-motor subsystems.
92 citations
TL;DR: There is no evidence of the quality required by this review to support or refute the effectiveness of Speech and Language Therapy interventions for dysarthria following non-progressive brain damage.
Abstract: Background
Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population.
Objectives
To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain damage.
Search methods
We searched the trials registers of the following Cochrane Groups: Stroke, Injuries, Movement Disorders and Infectious Diseases. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The trials registers were last searched in September 2004. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to September 2004), EMBASE (1980 to September 2004), CINAHL (1983 to September 2004), PsycINFO (1974 to October 2004), and Linguistics and Language Behavior Abstracts (1983 to December 2004) were searched electronically. We handsearched the International Journal of Language and Communication Disorders (1966 to 2005, Issue 1) and selected conference proceedings, and scanned the reference lists of relevant articles. We approached colleagues and speech and language therapy training institutions to identify other possible published and unpublished studies.
Selection criteria
Unconfounded randomised controlled trials (RCTs).
Data collection and analysis
One author assessed trial quality. Two co-authors were available to examine any potential trials for possible inclusion in the review.
Main results
No trials of the required standard were identified.
Authors' conclusions
There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following non-progressive brain damage. Despite the recent commencement of a RCT of optimised speech and language therapy for communication difficulties after stroke, there continues to be an urgent need for good quality research in this area.
78 citations
TL;DR: Regression analyses with intelligibility measures as the criterion variable and linguistic and acoustic measures as predictor variables produced significant functions both within and across speakers, but the solutions were not the same.
Abstract: Purpose: This study was designed to determine whether within-speaker fluctuations in speech intelligibility occurred among speakers with dysarthria who produced a reading passage, and, if they did, whether selected linguistic and acoustic variables predicted the variations in speech intelligibility. Method: Participants with dysarthria included a total of 10 persons with Parkinson's disease and amyotrophic lateral sclerosis; a control group of 10 neurologically normal speakers was also studied. Each participant read a passage that was subsequently separated into consecutive breath groups for estimates of individual breath group intelligibility. Sixty listeners participated in 2 perceptual experiments, generating intelligibility scores across speakers and for each breath group produced by speakers with dysarthria. Results: Individual participants with dysarthria had fluctuations in intelligibility across breath groups. Breath groups of participants with dysarthria had fewer average words and reduced interq...
73 citations
TL;DR: The multiplicity and progressiveness of the disabilities in ALS, highlights the need for a coordinated multidisciplinary rehabilitation program managing symptoms, respiratory care, dysphagia and nutrition, dysarthria and communication, physical and occupational therapy.
Abstract: Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disease. ALS is a progressive neurodegenerative disorder, involving motor neurons in the cerebral cortex, brainstem and spinal cord, presenting with a combination of upper and lower motor neuron signs. Etiology remains undetermined, although a multifactorial origin is widely accepted including genetic factors, auto-immunity, oxidative stress, glutamate excitotoxicity and abnormal neurofilament aggregation. The absence of specific diagnostic testing, and variable clinical presentations make the diagnosis of ALS challenging, relying upon correlation of clinical, electrophysiological and neuroimaging data. The disease is relentlessly progressive, with dysarthria, dysphagia, tetraparesis, and respiratory insufficiency due to ongoing respiratory muscle paresis. There is no specific treatment for ALS. Riluzole, a glutamate antagonist, is the only FDA approved drug for ALS, but has only a modest effect on survival. The multiplicity and progressiveness of the disabilities in ALS, highlights the need for a coordinated multidisciplinary rehabilitation program managing symptoms, respiratory care, dysphagia and nutrition, dysarthria and communication, physical and occupational therapy. The main goals are to prolong independence, prevent complications and improve quality of life.
72 citations
TL;DR: Intelligibility as scored by a panel of speech therapists was significantly improved in the on-condition, and no correlation was found, however, between intelligibility and overall severity of the disease or severity ofThe motor problems.
71 citations
TL;DR: This study demonstrates the multidimensional nature of prosodic deficits in the dysarthria related to TBI and illustrates the ability of acoustic measures to give a picture of the dysprosody associated with TBI-induced Dysarthria.
65 citations
TL;DR: The role the cerebellum plays in motor speech disorders is not limited to (ataxic) dysarthria, but also encompasses mutism and possibly apraxia of speech, and a relationship between visuomotor imagery and cerebellar activation in the absence of real movement has been demonstrated.
Abstract: Background: Traditional neurological tenets posit that the cerebellum coordinates skilled voluntary movements, and controls motor tone, posture, and gait. However, anatomical, clinical, and neuroimaging studies conducted over the past decades have shown that the cerebellum is implicated in diverse higher cognitive functions, such as language, memory, visuospatial skills, executive functions, thought modulation, and emotional regulation of behaviour. Address correspondence to: Prof. Dr Philippe F. Paquier, Service de Neurologie, Hopital Universitaire Erase, 808 route de Lennik, B‐1070 Bruxelles, Belgium. Email: ppaquier@ulb.ac.be Aims: To provide an introductory overview of the recently acknowledged role of the cerebellum in a number of cognitive processes, with special emphasis on its implication in speech and language functions. Main Contribution: The role the cerebellum plays in motor speech disorders is not limited to (ataxic) dysarthria, but also encompasses mutism and possibly apraxia of speech. Cere...
43 citations
TL;DR: Only the results for the PD group support the hypothesis that lax vowel space areas for speakers with dysarthria should be similar to those for neurologically normal talkers, and only limited support is provided for the idea that lax vowels are highly susceptible to speech mode effects.
Abstract: It has been hypothesized that lax vowels may be relatively unaffected by dysarthria, owing to the reduced vocal tract shapes required for these phonetic events (G. S. Turner, K. Tjaden, & G. Weisme...
Journal Article•
TL;DR: The importance of breath group management in TBI-induced dysarthria and the need to use methods such as those used in this study for large-scale investigations that examine cognitive, linguistic and motoric factors that conspire to reduce communicative efficiency are indicated.
Abstract: Prosodic abnormality is a common feature in the dysarthrias associated with traumatic brain injury (TBI), but very few analytic studies have been reported on the nature of the prosodic disturbances. T
TL;DR: The MR-analysis showed that superior paravermal cerebellar areas likely involved in dysarthria in adults (paravermal lobules HVI, Crus I) were not significantly affected.
TL;DR: The fact that speaking condition similarly affected acoustic measures of anticipatory coarticulation for all speaker groups suggests the feasibility of applying theories and models of speech production for neurologically normal talkers to the study of dysarthria.
Abstract: The present study compared patterns of anticipatory coarticulation for utterances produced in habitual, loud, and slow conditions by 17 individuals with multiple sclerosis (MS), 12 individuals with...
01 Jan 2005
TL;DR: For an individual with a severe speech disorder relating to an acquired neurological condition such as Parkinson’s disease, motor neurone disease or multiple sclerosis the ability to produce intelligible speech can become increasingly difficult as the underlying pathology progresses.
Abstract: For an individual with a severe speech disorder (dysarthria) relating to an acquired neurological condition such as Parkinson’s disease, motor neurone disease or multiple sclerosis the ability to produce intelligible speech can become increasingly difficult as the underlying pathology progresses (Duffy 1995; Yorkston et al. 2002). This unintelligibility may then lead to troubles in interaction. Robillard (1994, 1999) for example reports specific problems relating to the timing of turns and the context of prior talk as well as difficulties in initiating repair. Additional work highlighting socially consensual ‘real time’ in talk, states that problems in temporal co-ordination may be seen as contributing to the perception of communicative (in)competence among people with speech disorders (Higginbotham and Wilkins 1999).
TL;DR: Results illustrate that individual differences play an important role in the value of supplemental augmentative and alternative communication strategies and that aided and unaided strategies can have similar positive effects on the communication of speakers with global motor impairment.
Abstract: Purpose: This study compared the influence of speaker-implemented iconic hand gestures and alphabet cues on speech intelligibility scores and strategy helpfulness ratings for 3 adults with cerebral...
TL;DR: The collaborative efforts of the dentist and SLP in the rehabilitation of post-stroke patients with velopharyngeal incompetence should be encouraged.
Abstract: Objective: To elucidate the effectiveness of the collaboration of a dentist and speech-language pathologist (SLP) in the rehabilitation of a stroke patient with dysarthria.
Design: A clinical case report treated in the rehabilitation hospital and dental surgery.
Subject: A 71-year-old Japanese man who was admitted to the rehabilitation hospital for speech rehabilitation 2 years and 5 months after a stroke.
Methods: Provision of prosthesis (palatal lift prosthesis + palatal augmentation prosthesis) for improving velopharyngeal incompetence (VPI) and articulation by dentist, and speech behavioural management by SLP including self-monitoring and bio-feedback training using the See-Scape.
Results: Speech behavioural management proved useful for promoting improvement in speech intelligibility to a functionally sufficient level after improving VPI by prosthesis.
Conclusion: The collaborative efforts of the dentist and SLP in the rehabilitation of post-stroke patients with velopharyngeal incompetence should be encouraged.
TL;DR: The results of the instrumental assessment of lip and tongue function support the finding of substantial articulatory dysfunction in this group of children following TBI, and remediation of articulatory function should be a therapeutic priority in these children.
Abstract: Primary objective: To investigate the articulatory function of a group of children with traumatic brain injury (TBI), using both perceptual and instrumental techniques.Research design: The performance of 24 children with TBI was assessed on a battery of perceptual (Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech and speech sample analysis) and instrumental (lip and tongue pressure transduction systems) assessments and compared with that of 24 non-neurologically impaired children matched for age and sex.Main outcomes: Perceptual assessment identified consonant and vowel imprecision, increased length of phonemes and overall reduction in speech intelligibility, while instrumental assessment revealed significant impairment in lip and tongue function in the TBI group, with rate and pressure in repetitive lip and tongue tasks particularly impaired. Significant negative correlations were identified between the degree of deviance of perceptual articulatory features and decreased...
04 Sep 2005
TL;DR: Applications of speech technology to e-inclusion are reviewed and described in the areas of access, control, communication and rehabilitation/therapy, with particular reference to speech technology developments for people with disordered speech.
Abstract: Speech technology is potentially of enormous benefit to people with physical disabilities. Applications of speech technology to e-inclusion are reviewed and described in the areas of access, control, communication and rehabilitation/therapy, with particular reference to speech technology developments for people with disordered speech. To be successful, applications should effectively take into account the needs of user groups and have the ability to adapt to the needs of individuals. This is a challenging area but effective progress can be made through multi-disciplinary research and development. 1. Introduction People with physical disabilities take advantage of a variety of methods to gain access to information technology and to electronic assistive technology for communication, mobility and daily living tasks. Many of these access methods are slow and can lead to frustration, a prime example being the use of switch-activated menu scanning (hereafter referred to as switch-scanning). Automatic Speech Recognition is potentially of enormous benefit to people with severe physical disabilities. The tremendous richness of human speech communication gives the user many degrees of freedom for control and input. The speed of speech recognition also gives it a potential advantage over other input methods commonly employed by physically disabled people. People with neurological conditions causing disability often have associated dysarthria, which is the most common acquired speech disorder affecting 170 per 100,000 population [1]. This may be developmental dysarthria such as that associated with cerebral palsy or acquired dysarthria associated with progressive neurological disease (e.g. Parkinson's disease, motor neurone disease, and multiple sclerosis) or sudden onset conditions such as/or head injury. In its severest form, dysarthric speech is unintelligible to others and may take the form of producing vocal utterances, rather than words recognisable to unfamiliar communication partners. The combination of speech and general physical disability can make it particularly problematic for people to interact in their environment and can severely limit independence and inclusion. This paper examines some of the areas for e-inclusion of people with disabilities that can benefit from the use of speech technology. These areas include access, control, communication, rehabilitation and therapy. In all areas, the use of speech technology for people with dysarthric speech is particularly examined and discussed.
TL;DR: Results clearly favour the second type of procedure which in interaction with Bobath's technique proved able to bring the children from unintelligible to an acceptable level of functional speech.
Abstract: A 4-year longitudinal intervention was conducted with 10 young severely dysarthric children with cerebral palsy. Two procedures were implemented, each one for a period of 2 years. The first procedure centred on training the oral praxies, whereas the second one favoured a more functional approach based on voice and prosody training as well as parents' and school teachers' involvement. Bobath neurodevelopmental treatment was given throughout the 4-year period. Results clearly favour the second type of procedure which in interaction with Bobath's technique proved able to bring the children from unintelligible to an acceptable level of functional speech.
TL;DR: The results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.
Abstract: Background. Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.Aims. This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.Methods and procedures. Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.Outcomes and results. Doctors were significantly less confident of the ...
TL;DR: The epilepsy in Landau–Kleffner syndrome (LKS) usually has a good prognosis; however, in a large subgroup, language disturbances remain.
Abstract: In 1957, Landau and Kleffner described six children with a syndrome of acquired aphasia occurring between the second and eighth years of life.1 In the majority of cases, clinical seizures of various types occur. The EEG shows temporal or parieto-occipital multifocal spikes or spike waves with a potentiation during sleep. The epilepsy in Landau–Kleffner syndrome (LKS) usually has a good prognosis; however, in a large subgroup, language disturbances remain.2
A now 7-year-old boy was born at term after an uneventful pregnancy. His parents are nonconsanguineous, and there is no family history of epilepsy, speech retardation, or hearing problems. His motor development was normal. He walked at 12 months and now, at age 7, has well developed fine motor skills. His speech development was normal until age 2½. He spoke his first words at 12 months and two-word sentences at age 2 years. At age 2½, dysarthria was first noted, but at that stage, …
28 Sep 2005
TL;DR: All rehabilitation measures have to take account of frequently associated disorders of body motor control and/or impairment of cognition and behaviour.
Abstract: Speech disorders can result (1) from sensorimotor impairments of articulatory movements = dysarthria, or (2) from structural changes of the speech organs, in adults particularly after surgical and radiochemical treatment of tumors = dysglossia. The decrease of intelligibility, a reduced vocal stamina, the stigmatization of a conspicuous voice and manner of speech, the reduction of emotional expressivity all mean greatly diminished quality of life, restricted career opportunities and diminished social contacts. Intensive therapy based on the pathophysiological facts is absolutely essential: Functional exercise therapy plays a central role; according to symptoms and their progression it can be complemented with prosthetic and surgical approaches. In severe cases communicational aids have to be used. All rehabilitation measures have to take account of frequently associated disorders of body motor control and/or impairment of cognition and behaviour.
Journal Article•
TL;DR: In this paper, a 30-year-old male with disordered articulation following traumatic brain injury (TBI) was used as a biofeedback tool in a case study.
Abstract: Electropalatography (EPG) was used as a biofeedback tool in a case study of a 30-year-old male with disordered articulation following traumatic brain injury (TBI). Based on qualitative measures of the participant's intelligibility, improved articulation of the fricatives /s/ and /integral/ were selected as treatment targets. Therapy was administered three times a week for 5 weeks. Results showed that word and sentence intelligibility increased approximately 10%, and error patterns for lingual articulation indicated that fricative -> stop and other fricative errors decreased considerably. EPG measures for /s/ exhibited a significantly more anterior main focus of articulatory contact post therapy. Consonant durations were significantly longer during weeks 3 and 4, and this finding was associated with the emergence of an articulatory contact pattern with a groove rather than complete closure. This articulatory pattern appeared inconsistently and was found to vary across articulations of /s/ but also within a single consonant production. For /integral/, the amount of contact was significantly reduced post therapy and an increase in duration was noted during week 4, similar to that occurring in the production of /s/. Spatial and timing measures were more variable than in normal speakers of English and indicated a general increase in variability across weeks for both /s/ and /integral/. It was concluded that, although the correct fricative patterns appeared only intermittently during production of the consonants, there seemed to be sufficient information for the listener to be able to classify the sound as a fricative. As a part of an intervention program, visual EPG biofeedback therapy would appear to have a definite role in assisting dysarthric speakers exhibiting difficulties with lingual articulation in understanding their errors, learning how to exploit kinesthetic, and acoustic sources of feedback, and how to make appropriate adjustments in tongue articulation to increase the level of speech intelligibility.
Journal Article•
TL;DR: Two physiological assessments were used simultaneously to investigate the articulatory dynamics in an 18-year-old male with dysarthria 9 years following traumatic brain injury (TBI), finding that the approach and release phase durations of the consonant productions were within normal limits.
Abstract: Two physiological assessments, electromagnetic articulography (EMA) and electropalatography (EPG), were used simultaneously to investigate the articulatory dynamics in an 18-year-old male with dysarthria 9 years following traumatic brain injury (TBI). Eight words consisting of /t, s, integral, k/ in word initial and word final positions were produced up to 10 times. A nonneurologically impaired male served as a control subject. Six parameters were analyzed using EMA: velocity, acceleration, deceleration, distance, duration, and motion path of tongue movements. Using EPG, the pattern and amount of tongue-to-palate contact and the duration of the closure/constriction phase of each consonant produced were assessed. Timing disturbances in the TBI speaker's speech were highlighted in perceptual assessments in the form of prolonged phonemes and a reduced speech rate. EMA analysis revealed that the approach and release phase durations of the consonant productions were within normal limits. Kinematic strategies such as decreased velocity and decreased distances traveled by the tongue, however, may have counterbalanced each other to produce these appropriate results. EPG examination revealed significantly longer closure/constriction phase periods, which may have contributed to the prolonged phonemes and reduced speech rate observed. The implications of these findings for the development of treatment programs for dysarthria subsequent to TBI will be highlighted.
01 Jan 2005
TL;DR: In this article, the authors present results of preliminary research of voice pathological changes caused by dysarthria, which serve as a basis for the construction of objective examination model for diagnosis of neurodegenerative diseases.
Abstract: Computer analysis of voice isolated sounds may lead to identification of parameters correlated with neurological diseases. This paper presents results of preliminary research of voice pathological changes caused by dysarthria. The selection of linguistic material was characterized according to the place and manner of articulation in the phonetic system of Polish. Results of clinical examination allowed to determine simple markers of neurodegenerative diseases, which serves as a basis for construction of objective examination model.
01 Jan 2005
TL;DR: A novel soft computing system based on hierarchical fuzzy cognitive maps (FCMs) capable of differentiating between the six types of dysarthria as well as apraxia of speech is presented.
Abstract: This paper presents a novel soft computing system for differential diagnosis of the dysarthrias and apraxia of speech based on well accepted dysarthrias' classification system used by speech and language pathologists. The dysarthrias and apraxia are complex disorders of speech because they represent a variety of neurological disturbances that can potentially affect every component of speech production. Since an accurate diagnosis is a very challenging task for the clinician, the under development system based on hierarchical fuzzy cognitive maps (FCMs) will be used as a "second opinion" or training system. The hierarchical FCM differential diagnosis system is capable of differentiating between the six types of dysarthria as well as apraxia. The system was tested using published case studies and real patients and examples are presented here
TL;DR: Differential motor speech outcomes occur for children treated for CMCT and these are discussed within the realm of possible mechanisms responsible for these differences.
Abstract: Primary objective: To investigate the nature of the motor speech impairments and dysarthria that can arise subsequent to treatment for childhood mid-line cerebellar tumours (CMCT).Research design: The motor speech ability of six cases of children with CMCT was analysed using perceptual and physiological measures and compared with that of a group of non-neurologically impaired children matched for age and sex.Main outcome and results: Three of the children with CMCT were perceived to exhibit dysarthric speech, while the remaining three were judged to have normal speech. The speech disorder in three of the children with CMCT was marked by deviances in prosody, articulation and phonation. The underlying pathophysiology was linked to cerebellar damage and expressed as difficulty in co-ordinating the motor speech musculature as required for speech production. These deficits were not identified in the three non-dysarthric children with CMCT.Conclusion: Differential motor speech outcomes occur for children treat...