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Showing papers on "Dysarthria published in 2016"


Journal ArticleDOI
TL;DR: The concept of the cerebellar syndrome is revisited in the light of recent advances in the understanding of Cerebellar operations and the key symptoms and signs of cerebellars dysfunction are discussed.
Abstract: The cerebellum is involved in sensorimotor operations, cognitive tasks and affective processes. Here, we revisit the concept of the cerebellar syndrome in the light of recent advances in our understanding of cerebellar operations. The key symptoms and signs of cerebellar dysfunction, often grouped under the generic term of ataxia, are discussed. Vertigo, dizziness, and imbalance are associated with lesions of the vestibulo-cerebellar, vestibulo-spinal, or cerebellar ocular motor systems. The cerebellum plays a major role in the online to long-term control of eye movements (control of calibration, reduction of eye instability, maintenance of ocular alignment). Ocular instability, nystagmus, saccadic intrusions, impaired smooth pursuit, impaired vestibulo-ocular reflex (VOR), and ocular misalignment are at the core of oculomotor cerebellar deficits. As a motor speech disorder, ataxic dysarthria is highly suggestive of cerebellar pathology. Regarding motor control of limbs, hypotonia, a- or dysdiadochokinesia, dysmetria, grasping deficits and various tremor phenomenologies are observed in cerebellar disorders to varying degrees. There is clear evidence that the cerebellum participates in force perception and proprioceptive sense during active movements. Gait is staggering with a wide base, and tandem gait is very often impaired in cerebellar disorders. In terms of cognitive and affective operations, impairments are found in executive functions, visual-spatial processing, linguistic function, and affective regulation (Schmahmann's syndrome). Nonmotor linguistic deficits including disruption of articulatory and graphomotor planning, language dynamics, verbal fluency, phonological, and semantic word retrieval, expressive and receptive syntax, and various aspects of reading and writing may be impaired after cerebellar damage. The cerebellum is organized into (a) a primary sensorimotor region in the anterior lobe and adjacent part of lobule VI, (b) a second sensorimotor region in lobule VIII, and (c) cognitive and limbic regions located in the posterior lobe (lobule VI, lobule VIIA which includes crus I and crus II, and lobule VIIB). The limbic cerebellum is mainly represented in the posterior vermis. The cortico-ponto-cerebellar and cerebello-thalamo-cortical loops establish close functional connections between the cerebellum and the supratentorial motor, paralimbic and association cortices, and cerebellar symptoms are associated with a disruption of these loops.

251 citations


Journal ArticleDOI
TL;DR: In patients presenting with nfvPPA, presence of early severe dysarthria, relatively selective white matter atrophy at presentation, and a greater rate of change in the brainstem measured by longitudinal imaging may be useful for differentiating underlying PSP from CBD pathology during life.
Abstract: Importance We provide novel evidence of specific clinical and neuroimaging features that may help for the in vivo prediction of underlying pathology in patients with nonfluent/agrammatic primary progressive aphasia (nfvPPA) and progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD) proved by autopsy. Objective To characterize the neurological, cognitive, and neuroimaging features of patients with nfvPPA—in whom either PSP or CBD was eventually confirmed at autopsy—at initial presentation and at 1-year follow-up. Design, Setting, and Participants A prospective longitudinal clinical-pathological study was conducted in a tertiary research clinic that specialized in cognitive disorders. Fourteen patients were evaluated between January 2002 and December 2014. Inclusion criteria for the study were a clinical diagnosis of nfvPPA; the availability of speech, language, and cognitive testing for at least 1 evaluation; magnetic resonance imaging within 6 months of initial evaluation; and a postmortem pathological diagnosis of PSP or CBD. Ten matched healthy control participants were also included. Main Outcomes and Measures Clinical, cognitive, and neuroimaging longitudinal data were analyzed to characterize the whole nfvPPA–4-repeat–tau group and identify differences between nfvPPA-PSP and nfvPPA-CBD both at presentation and longitudinally. Results Patient groups did not differ significantly in age, sex, or handedness (nfvPPA-PSP group: median [interquartile range (IQR)] age, 74 [67-76] years; 1 of 5 male [20%]; 1 of 5 left-handed [20%]; and nfvPPA-CBD group: mean [IQR] age, 65 [54-81] years; 3 of 9 male [33%]; 0 left-handed). Motor speech impairment and left frontal white matter atrophy were the most prominent common features. At presentation, dysarthria (Motor Speech Examination median [IQR] score: nfvPPA-PSP, 4 [2-7]; nfvPPA-CBD, 0 [0-4]; P = .02), depression (Geriatric Depression Scale median [IQR] score: nfvPPA-PSP, 19 [3-28]; nfvPPA-CBD, 4 [0-16]; P = .04), and relatively selective white matter atrophy were typical of the nfvPPA-PSP group, while greater gray matter atrophy and a trend toward greater sentence comprehension deficits (median [IQR] sentence comprehension correct: nfvPPA-PSP, 98% [80-100]; nfvPPA-CBD, 81% [65-98]; P = .08) were found in the nfvPPA-CBD group. At follow-up after 1 year, we observed no significant differences in any speech or language measures. Furthermore, atrophy in patients with PSP progressed within the subcortical/brainstem motor system generating greater oculomotors deficits and swallowing difficulty; atrophy in patients with CBD spread anteriorly in prefrontal regions consistent with their greater working memory impairment and development of behavioral symptoms. Conclusions and Relevance In patients presenting with nfvPPA, presence of early severe dysarthria, relatively selective white matter atrophy at presentation, and a greater rate of change in the brainstem measured by longitudinal imaging may be useful for differentiating underlying PSP from CBD pathology during life.

109 citations


Journal ArticleDOI
TL;DR: A variety of clinical findings suggest that in at least a sizable proportion of patients with ET, there is an underlying abnormality of the cerebellum and/or its pathways.
Abstract: Essential tremor (ET) might be a family of diseases unified by the presence of kinetic tremor, but also showing etiological, pathological, and clinical heterogeneity. In this review, we will describe the most significant clinical evidence, which suggests that ET is linked to the cerebellum. Data for this review were identified by searching PUBMED (January 1966 to May 2015) crossing the terms "essential tremor" (ET) and "cerebellum," which yielded 201 entries, 11 of which included the term "cerebellum" in the article title. This was supplemented by articles in the author's files that pertained to this topic. The wide spectrum of clinical features of ET that suggest that it originates as a cerebellar or cerebellar outflow problem include the presence of intentional tremor, gait and balance abnormalities, subtle features of dysarthria, and oculomotor abnormalities, as well as deficits in eye-hand coordination, motor learning deficits, incoordination during spiral drawing task, abnormalities in motor timing and visual reaction time, impairment of social abilities, improvement in tremor after cerebellar stroke, efficacy of deep brain stimulation (which blocks cerebellar outflow), and cognitive dysfunction. It is unlikely, however, that cerebellar dysfunction, per se, fully explains ET-associated dementia, because the cognitive deficits that have been described in patients with cerebellar lesions are generally mild. Overall, a variety of clinical findings suggest that in at least a sizable proportion of patients with ET, there is an underlying abnormality of the cerebellum and/or its pathways.

72 citations


Journal ArticleDOI
01 Jan 2016-Stroke
TL;DR: Damage to the left precentral gyrus is associated with AOS in acute to subacute stroke patients, suggesting a role of this brain region in motor speech production.
Abstract: Background and purpose Apraxia of speech (AOS) is a motor speech disorder, which is clinically characterized by the combination of phonemic segmental changes and articulatory distortions. AOS has been believed to arise from impairment in motor speech planning/programming and differentiated from both aphasia and dysarthria. The brain regions associated with AOS are still a matter of debate. The aim of this study was to address this issue in a large number of consecutive acute ischemic stroke patients. Methods We retrospectively studied 136 patients with isolated nonlacunar infarcts in the left middle cerebral artery territory (70.5±12.9 years old, 79 males). In accordance with speech and language assessments, the patients were classified into the following groups: pure form of AOS (pure AOS), AOS with aphasia (AOS-aphasia), and without AOS (non-AOS). Voxel-based lesion-symptom mapping analysis was performed on T2-weighted images or fluid-attenuated inversion recovery images. Using the Liebermeister method, group-wise comparisons were made between the all AOS (pure AOS plus AOS-aphasia) and non-AOS, pure AOS and non-AOS, AOS-aphasia and non-AOS, and pure AOS and AOS-aphasia groups. Results Of the 136 patients, 22 patients were diagnosed with AOS (7 patients with pure AOS and 15 patients with AOS-aphasia). The voxel-based lesion-symptom mapping analysis demonstrated that the brain regions associated with AOS were centered on the left precentral gyrus. Conclusions Damage to the left precentral gyrus is associated with AOS in acute to subacute stroke patients, suggesting a role of this brain region in motor speech production.

70 citations


Journal ArticleDOI
TL;DR: Simple quantitative speech motor measures may be suitable for the reliable detection of prodromal neurodegeneration in subjects with RBD, and therefore may provide important outcomes for future therapy trials.

65 citations


Journal ArticleDOI
TL;DR: The results of this study suggest that this new intensive treatment may have potential as an effective intervention for nonprogressive dysarthria, however, controlled studies are required to establish treatment efficacy.
Abstract: Purpose This article describes the effects of a new intensive dysarthria treatment program (Be Clear) on speech intelligibility in adults with dysarthria secondary to stroke and traumatic brain inj...

59 citations


Book
23 Jun 2016
TL;DR: In FOXP2-plus-related disorders oral motor deficits, global developmental delay, and autism spectrum disorder are common and nonverbal (performance) IQ is typically more preserved compared to verbal IQ.
Abstract: Clinical characteristicsAll FOXP2-related speech and language disorders, regardless of the underlying genetic alteration, have a core phenotype: childhood apraxia of speech (CAS), a disorder of speech motor programming or planning that affects the production, sequencing, timing, and stress of sounds, syllables, and words. All individuals with CAS – whether caused by an alteration of FOXP2 or of an unknown cause – have difficulties in automatically and accurately sequencing speech sounds into syllables, syllables into words, and words into sentences with the correct prosody. Additional findings in FOXP2-related speech and language disorders can include oral motor dyspraxia (difficulty planning or programming oral movements on command); dysarthria (a neuromuscular-based speech disorder that may affect nasal resonance, voice quality, prosody, and breath support for speech); moderate to severe receptive and expressive language disorder; and reading and spelling impairments. The underlying genetic cause of FOXP2-related speech and language disorders is either disruption of FOXP2 only (referred to in this GeneReview as FOXP2-only-related speech and language disorder) or large copy number variants (i.e., contiguous gene deletions), structural variants (i.e., chromosome translocation or inversion), or maternal uniparental disomy of chromosome 7 (UPD7) involving FOXP2 (here referred to as FOXP2-plus speech and language disorders). The genetic alteration determines if only speech and language problems are present (FOXP2-only-related speech and language disorder) or if more global developmental and behavioral issues are likely to be present as well (FOXP2-plus speech and language disorder). In FOXP2-only-related disorders, nonverbal (performance) IQ is typically more preserved compared to verbal IQ. Fine motor skills may be impaired (e.g., buttoning clothes, tying shoelaces), yet gross motor skills are normal. Autistic features and dysmorphic findings have been reported in a few affected individuals. In FOXP2-plus-related disorders oral motor deficits, global developmental delay, and autism spectrum disorder are common.Diagnosis/testingThe diagnosis of a FOXP2-related speech and language disorder is established in a proband by detection of one of the following: A large non-recurrent contiguous gene deletion that includes FOXP2 (52% of affected individuals). A sequence variant within FOXP2 (~29%). Maternal uniparental disomy of chromosome 7 (UPD7) that reduces FOXP2 expression (~11%). A structural variant (e.g., chromosome translocation, inversion) that disrupts FOXP2 (~8%).ManagementTreatment of manifestations: Optimally management of the speech and/or language disorder is determined by a speech pathologist based on the individual's findings (typically: presence and severity of CAS, dysarthria, language deficits, and literacy impairments). A clinical psychologist or neuropsychologist may provide strategies to help manage deficits in specific cognitive domains and an occupational therapist and physiotherapist can provide strategies to help with fine and gross motor deficits, respectively. Surveillance: Follow-up evaluations with standardized tests by a speech and language pathologist. Evaluation of relatives at risk: Clarification of the genetic status of pre-symptomatic relatives at risk identifies as early as possible those who would benefit from prompt evaluation for speech and language disorders and initiation of treatment.Genetic counselingRecurrence risk for sibs of proband with a FOXP2-related speech and language disorder depends on the genetic alteration: Non-recurrent contiguous gene deletions (80% are de novo and the remainder are inherited in an autosomal dominant manner) FOXP2 sequence variants (~70% are de novo and the remainder are inherited in an autosomal dominant manner) Maternal UPD7 (no increased risk to sibs) A structural variant (e.g., chromosome translocation, inversion. If one parent has a structural variant, the risk to sibs is increased and depends on the specific structural variant.) Prenatal testing and preimplantation genetic diagnosis are possible if the causative genetic alteration has been identified in an affected family member.

58 citations


Journal ArticleDOI
TL;DR: Lower variation of fundamental frequency in PD patients with HD is confirmed and increased variability of speech intensity compared to healthy speakers has been detected, and further development of prosodic features quantifying the relationship between monopitch, monoloudness and speech rate disruptions in HD can have a great potential in future PD analysis.

56 citations


Journal ArticleDOI
TL;DR: This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria.
Abstract: Background Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. Objectives To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015. Selection criteria We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. Data collection and analysis One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. Main results No randomised controlled trials or group studies were identified. Authors' conclusions This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.

52 citations


Posted Content
TL;DR: In this article, a smartwatch-based system was designed to remotely monitor speech and voice exercises as prescribed by speech-language pathologists (SLPs) to enhance generalization of speech strategies outside of the treatment room.
Abstract: About 90 percent of people with Parkinson's disease (PD) experience decreased functional communication due to the presence of voice and speech disorders associated with dysarthria that can be characterized by monotony of pitch (or fundamental frequency), reduced loudness, irregular rate of speech, imprecise consonants, and changes in voice quality. Speech-language pathologists (SLPs) work with patients with PD to improve speech intelligibility using various intensive in-clinic speech treatments. SLPs also prescribe home exercises to enhance generalization of speech strategies outside of the treatment room. Even though speech therapies are found to be highly effective in improving vocal loudness and speech quality, patients with PD find it difficult to follow the prescribed exercise regimes outside the clinic and to continue exercises once the treatment is completed. SLPs need techniques to monitor compliance and accuracy of their patients exercises at home and in ecologically valid communication situations. We have designed EchoWear, a smartwatch-based system, to remotely monitor speech and voice exercises as prescribed by SLPs. We conducted a study of 6 individuals; three with PD and three healthy controls. To assess the performance of EchoWear technology compared with high quality audio equipment obtained in a speech laboratory. Our preliminary analysis shows promising outcomes for using EchoWear in speech therapies for people with PD. Keywords: Dysarthria; knowledge-based speech processing; Parkinson's disease; smartwatch; speech therapy; wearable system.

48 citations


Journal ArticleDOI
TL;DR: The complexity of the functional impairment described and the consequences on the individuals' communication call for a stronger consideration of dysarthria in CP both in clinical care and in research.
Abstract: Purpose Although dysarthria affects the large majority of individuals with cerebral palsy (CP) and can substantially complicate everyday communication, previous research has provided an incomplete ...

Journal ArticleDOI
TL;DR: Evidence is provided regarding the ecological validity of perceptual-training paradigms designed to improve intelligibility of dysarthric speech, thereby supporting their continued advancement as a listener-targeted treatment option.
Abstract: Purpose It has been documented in laboratory settings that familiarizing listeners with dysarthric speech improves intelligibility of that speech. If these findings can be replicated in real-world ...

Book ChapterDOI
TL;DR: A comparison between architectures shows that, even with a small database, hybrid DNN-HMM models outperform classical GMM-H MM according to word error rate measures.
Abstract: Automatic Speech Recognition has reached almost human performance in some controlled scenarios. However, recognition of impaired speech is a difficult task for two main reasons: data is (i) scarce and (ii) heterogeneous. In this work we train different architectures on a database of dysarthric speech. A comparison between architectures shows that, even with a small database, hybrid DNN-HMM models outperform classical GMM-HMM according to word error rate measures. A DNN is able to improve the recognition word error rate a 13 % for subjects with dysarthria with respect to the best classical architecture. This improvement is higher than the one given by other deep neural networks such as CNNs, TDNNs and LSTMs. All the experiments have been done with the Kaldi toolkit for speech recognition for which we have adapted several recipes to deal with dysarthric speech and work on the TORGO database. These recipes are publicly available.

Journal ArticleDOI
TL;DR: It is concluded that speech/voice disturbances are widely identified by the Robertson dysarthria profile in early parkinsonian patients, even when the disturbances do not carry a significant level of disability.
Abstract: Changes in voice and speech are thought to involve 75-90% of people with PD, but the impact of PD progression on voice/speech parameters is not well defined. In this study, we assessed voice/speech symptoms in 48 parkinsonian patients staging <3 on the modified Hoehn and Yahr scale and 37 healthy subjects using the Robertson dysarthria profile (a clinical-perceptual method exploring all components potentially involved in speech difficulties), the Voice handicap index (a validated measure of the impact of voice symptoms on quality of life) and the speech evaluation parameter contained in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III). Accuracy and metric properties of the Robertson dysarthria profile were also measured. On Robertson dysarthria profile, all parkinsonian patients yielded lower scores than healthy control subjects. Differently, the Voice Handicap Index and the speech evaluation parameter contained in the UPDRS-III could detect speech/voice disturbances in 10 and 75% of PD patients, respectively. Validation procedure in Parkinson's disease patients showed that the Robertson dysarthria profile has acceptable reliability, satisfactory internal consistency and scaling assumptions, lack of floor and ceiling effects, and partial correlations with UPDRS-III and Voice Handicap Index. We concluded that speech/voice disturbances are widely identified by the Robertson dysarthria profile in early parkinsonian patients, even when the disturbances do not carry a significant level of disability. Robertson dysarthria profile may be a valuable tool to detect speech/voice disturbances in Parkinson's disease.

Journal ArticleDOI
TL;DR: Speech dysfluency represents a disorder of motor speech control, possibly sharing pathophysiological mechanisms with FOG, and is associated to advanced disease stages and independent of disease duration.

Journal ArticleDOI
TL;DR: Investigation of motor speech deficits in children with Down syndrome indicated that the children with DS exhibited symptoms of CAS, CD and MSD-NOS, with variability within the group and overlapping symptoms of the disorder types.
Abstract: Purpose: Motor speech characteristics of children with Down syndrome (DS) have historically been viewed as either Childhood Dysarthria (CD) or, more infrequently, as Childhood Apraxia of Speech (CAS). The objective of this study was to investigate motor speech deficits in a systematic manner, considering characteristics from both CAS and CD.Method: Motor speech assessments were carried out on seven 3;4–8;11-year old children with DS in comparison with younger, typically-developing children using a Language-Neutral Assessment of Motor Speech for young children (LAMS). Additionally, the motor speech and non-speech oral motor skills of all participants were analysed qualitatively using an investigator checklist of characteristics of CAS, CD and Motor Speech Disorder–Not Otherwise Specified (MSD-NOS).Result: Results indicated that the children with DS exhibited symptoms of CAS, CD and MSD-NOS, with variability within the group and overlapping symptoms of the disorder types. This finding is different f...

Journal ArticleDOI
TL;DR: This paper proposes an automatic speaker recognition approach especially adapted to identify dysarthric speakers and a method for the automatic assessment of the dysarthria severity level, and presents new approaches to improve the analysis and classification of disordered speech.

Journal ArticleDOI
TL;DR: The development of the phonemic and syllabic repertoire appears to be completed in adults with mild-to-moderate ID, and charted speech difficulties can be interpreted to indicate speech motor control and planning difficulties.
Abstract: Purpose: Adults with intellectual disabilities (ID) often show reduced speech intelligibility, which affects their social interaction skills. This study aims to establish the main predictors of this reduced intelligibility in order to ultimately optimise management. Method: Spontaneous speech and picture naming tasks were recorded in 36 adults with mild or moderate ID. Twenty-five naive listeners rated the intelligibility of the spontaneous speech samples. Performance on the picture-naming task was analysed by means of a phonological error analysis based on expert transcriptions. Results: The transcription analyses showed that the phonemic and syllabic inventories of the speakers were complete. However, multiple errors at the phonemic and syllabic level were found. The frequencies of specific types of errors were related to intelligibility and quality ratings. Conclusions: The development of the phonemic and syllabic repertoire appears to be completed in adults with mild-to-moderate ID. The charted speech difficulties can be interpreted to indicate speech motor control and planning difficulties. These findings may aid the development of diagnostic tests and speech therapies aimed at improving speech intelligibility in this specific group.

Journal ArticleDOI
01 Nov 2016-BMJ Open
TL;DR: The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese).
Abstract: Introduction Individuals with Parkinson9s disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). Methods and analysis Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. Ethics and dissemination The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. Trial registration number NCT02753192, Pre-results.

Journal ArticleDOI
TL;DR: It is revealed that ASR performance can be predicted from perceptual disturbances in dysarthric speech with articulatory precision contributing the most to the prediction followed by prosody.
Abstract: State-of-the-art automatic speech recognition (ASR) engines perform well on healthy speech; however recent studies show that their performance on dysarthric speech is highly variable. This is because of the acoustic variability associated with the different dysarthria subtypes. This paper aims to develop a better understanding of how perceptual disturbances in dysarthric speech relate to ASR performance. Accurate ratings of a representative set of 32 dysarthric speakers along different perceptual dimensions are obtained and the performance of a representative ASR algorithm on the same set of speakers is analyzed. This work explores the relationship between these ratings and ASR performance and reveals that ASR performance can be predicted from perceptual disturbances in dysarthric speech with articulatory precision contributing the most to the prediction followed by prosody.

Journal ArticleDOI
TL;DR: Optimal speech outcomes were achieved in 44% of patients and correlated with precise stimulation location within and not outside of the VLp, which was greater for patients with dysarthria than those with normal speech.

Journal ArticleDOI
TL;DR: In this paper, the authors examined within-task acoustic variation in a passage read by speakers with dysarthria and healthy speakers during passage reading and found that there was some degree of acoustic variation across the three operationally defined segments of the reading passage.

Journal ArticleDOI
TL;DR: It is concluded that individuals with Parkinson’s may exploit metrically regular cues in speech through entrainment of speech timing and rhythm with a model speaker in healthy persons and individuals with Parkinsons.
Abstract: This study examines entrainment of speech timing and rhythm with a model speaker in healthy persons and individuals with Parkinson's. We asked whether participants coordinate their speech initiation and rhythm with the model speaker, and whether the regularity of metrical structure of sentences influences this behaviour. Ten native German speakers with hypokinetic dysarthria following Parkinson's and 10 healthy controls heard a sentence ('prime') and subsequently read aloud another sentence ('target'). Speech material comprised 32 metrically regular and irregular sentences, respectively. Turn-taking delays and alignment of speech rhythm were measured using speech wave analyses. Results showed that healthy participants initiated speech more closely in rhythm with the model speaker than patients. Metrically regular prime sentences induced anticipatory responses relative to metrically irregular primes. Entrainment of speech rhythm was greater in metrically regular targets, especially in individuals with Parkinson's. We conclude that individuals with Parkinson's may exploit metrically regular cues in speech.

Journal ArticleDOI
TL;DR: A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke and the identification of Dysarthria as a predictor of dysphAGia can help identify risk for dysphagio in stroke and assist in the therapeutic process of swallowing problems.
Abstract: Background Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. Objective to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. Methods Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and communication disorders. Results Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2%. Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2%; the three conditions co-occurred in 22.6%. Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. Conclusions A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems.

Journal ArticleDOI
TL;DR: Speech rate was increased compared to controls and showed correlations to the volume of certain brain areas known to be involved in the sensory-motor speech networks and correlations to disease burden score and clinical measures like the cognitive score.
Abstract: Objective: Dysarthria is a common feature in Huntington disease (HD). The aim of this cross-sectional pilot study was the description and objective analysis of different speech parameters with special emphasis on the aspect of speech timing of connected speech and nonspeech verbal utterances in premanifest HD (preHD). Methods: A total of 28 preHD mutation carriers and 28 age- and sex-matched healthy speakers had to perform a reading task and several syllable repetition tasks. Results of computerized acoustic analysis of different variables for the measurement of speech rate and regularity were correlated with clinical measures and MRI-based brain atrophy assessment by voxel-based morphometry. Results: An impaired capacity to steadily repeat single syllables with higher variations in preHD compared to healthy controls was found (variance 1: Cohen d = 1.46). Notably, speech rate was increased compared to controls and showed correlations to the volume of certain brain areas known to be involved in the sensory-motor speech networks (net speech rate: Cohen d = 1.19). Furthermore, speech rate showed correlations to disease burden score, probability of disease onset, the estimated years to onset, and clinical measures like the cognitive score. Conclusions: Measurement of speech rate and regularity might be helpful additional tools for the monitoring of subclinical functional disability in preHD. As one of the possible causes for higher performance in preHD, we discuss huntingtin-dependent temporarily advantageous development processes of the brain.

Book
29 Sep 2016
TL;DR: The diagnosis of GRIN2A-related speech disorders and epilepsy is established in a proband by the identification of a GRIN 2A heterozygous pathogenic variant on molecular genetic testing as discussed by the authors.
Abstract: Clinical characteristics GRIN2A-related speech disorders and epilepsy are characterized by speech disorders in all affected individuals and a range of epilepsy syndromes present in about 90%. Severe speech disorders observed can include dysarthria and speech dyspraxia, and both receptive and expressive language delay/regression; more mildly affected individuals may display subtly impaired intelligibility of conversational speech. Epilepsy features include seizure onset usually between ages three and six years, focal epilepsy with language and/or global developmental regression, and electroencephalogram (EEG) showing continuous spike-and-wave discharges in sleep or very active centrotemporal discharges. Seizure types include seizures associated with aura of perioral paresthesia, focal or focal motor seizures (often evolving to generalized tonic-clonic), and atypical absence seizures. Epilepsy syndromes can include: Landau-Kleffner syndrome (LKS), epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), childhood epilepsy with centrotemporal spikes (CECTS), atypical childhood epilepsy with centrotemporal spikes (ACECTS), autosomal dominant rolandic epilepsy with speech dyspraxia (ADRESD), and infantile-onset epileptic encephalopathy. Diagnosis/testing The diagnosis of a GRIN2A-related speech disorder and epilepsy is established in a proband by the identification of a GRIN2A heterozygous pathogenic variant on molecular genetic testing. Management Treatment of manifestations: Significant speech/language deficits require therapy from a speech pathologist. Seizures should be treated with antiepileptic drugs (AEDs). Many different AEDs may be effective, and no one medication has been demonstrated to be effective specifically for these disorders. Prevention of secondary complications: Monitoring for possible adverse effects of AEDs. Surveillance: Developmental surveillance in all affected children; routine monitoring of speech and language by a speech pathologist should be considered for all children, particularly those diagnosed before reaching school age. Agents/circumstances to avoid: In individuals with ECSWS, phenytoin, barbiturates and carbamazepine should be avoided as they are rarely effective, may worsen the EEG, and have negative effects on neuropsychological outcomes. Evaluation of relatives at risk: It is appropriate to clarify the genetic status of apparently asymptomatic at-risk relatives in order to identify as early as possible those who would benefit from prompt evaluation for speech disorders and/or seizures and institution of treatment. Genetic counseling GRIN2A-related speech disorders and epilepsy are inherited in an autosomal dominant manner. The proportion of GRIN2A-related speech disorders and epilepsy caused by a de novo pathogenic variant is unknown. Each child of an individual with a GRIN2A-related speech disorder and epilepsy has a 50% chance of inheriting the GRIN2A pathogenic variant. Once the GRIN2A pathogenic variant has been identified in an affected family member, prenatal testing for a pregnancy at increased risk and preimplantation genetic testing are possible.

Proceedings ArticleDOI
01 Sep 2016
TL;DR: Experimental results demonstrated the feasibility of predicting intelligible speaking rate from only a small number of speech samples, and adding articulatory features to acoustic features improved prediction performance, when decision tree was used as the feature selection technique.
Abstract: Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurological disease that affects the speech motor functions, resulting in dysarthria, a motor speech disorder. Speech and articulation deterioration is an indicator of the disease progression of ALS; timely monitoring of the disease progression is critical for clinical management of these patients. This paper investigated machine prediction of intelligible speaking rate of nine individuals with ALS based on a small number of speech acoustic and articulatory samples. Two feature selection techniques - decision tree and gradient boosting - were used with support vector regression for predicting the intelligible speaking rate. Experimental results demonstrated the feasibility of predicting intelligible speaking rate from only a small number of speech samples. Furthermore, adding articulatory features to acoustic features improved prediction performance, when decision tree was used as the feature selection technique.

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TL;DR: The majority of persons with bulbar-onset ALS in this study were in the latter diagnostic group, which suggests that they are more susceptible to delayed diagnosis and delayed speech therapy assessment.

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TL;DR: No significant differences in singing were observed during the singing of familiar melodies and improvised melodic continuations, which suggests that music could be used to facilitate expressive linguistic prosody in Parkinson's disease.

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TL;DR: Several phenotypic differences differentiated the persistent SSD phenotype in the PM family from the few previously reported studies of large families with SSD, including the absence of comorbid dysarthria and marked orofacial apraxia.