Showing papers on "Dysarthria published in 2017"

Speech and Communication Changes Reported by People with Parkinson's Disease.

Abstract: Background Changes in communicative functions are common in Parkinson's disease (PD), but there are only limited data provided by individuals with PD on how these changes are perceived, what their consequences are, and what type of intervention is provided. Aim To present self-reported information about speech and communication, the impact on communicative participation, and the amount and type of speech-language pathology services received by people with PD. Methods Respondents with PD recruited via the Swedish Parkinson's Disease Society filled out a questionnaire accessed via a Web link or provided in a paper version. Results Of 188 respondents, 92.5% reported at least one symptom related to communication; the most common symptoms were weak voice, word-finding difficulties, imprecise articulation, and getting off topic in conversation. The speech and communication problems resulted in restricted communicative participation for between a quarter and a third of the respondents, and their speech caused embarrassment sometimes or more often to more than half. Forty-five percent of the respondents had received speech-language pathology services. Conclusions Most respondents reported both speech and language symptoms, and many experienced restricted communicative participation. Access to speech-language pathology services is still inadequate. Services should also address cognitive/linguistic aspects to meet the needs of people with PD.

Cerebellar Dysfunction in Multiple Sclerosis.

Abstract: Multiple sclerosis (MS) commonly affects the cerebellum causing acute and chronic symptoms. Cerebellar signs contribute significantly to clinical disability, and symptoms such as tremor, ataxia and dysarthria are particularly difficult to treat. Increasing knowledge concerning the pathophysiology of cerebellar disease in MS from human post mortem studies, experimental models and clinical trials has raised the hope that cerebellar symptoms will be better treated in the future.

Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury

Abstract: Background Dysarthria is an acquired speech disorder following neurological injury that reduces intelligibility of speech due to weak, imprecise, slow and/or unco-ordinated muscle control. The impact of dysarthria goes beyond communication and affects psychosocial functioning. This is an update of a review previously published in 2005. The scope has been broadened to include additional interventions, and the title amended accordingly. Objectives To assess the effects of interventions to improve dysarthric speech following stroke and other non-progressive adult-acquired brain injury such as trauma, infection, tumour and surgery. Search methods We searched the Cochrane Stroke Group Trials Register (May 2016), CENTRAL (Cochrane Library 2016, Issue 4), MEDLINE, Embase, and CINAHL on 6 May 2016. We also searched Linguistics and Language Behavioral Abstracts (LLBA) (1976 to November 2016) and PsycINFO (1800 to September 2016). To identify further published, unpublished and ongoing trials, we searched major trials registers: WHO ICTRP, the ISRCTN registry, and ClinicalTrials.gov. We also handsearched the reference lists of relevant articles and contacted academic institutions and other researchers regarding other published, unpublished or ongoing trials. We did not impose any language restrictions. Selection criteria We selected randomised controlled trials (RCTs) comparing dysarthria interventions with 1) no intervention, 2) another intervention for dysarthria (this intervention may differ in methodology, timing of delivery, duration, frequency or theory), or 3) an attention control. Data collection and analysis Three review authors selected trials for inclusion, extracted data, and assessed risk of bias. We attempted to contact study authors for clarification and missing data as required. We calculated standardised mean difference (SMD) and 95% confidence interval (CI), using a random-effects model, and performed sensitivity analyses to assess the influence of methodological quality. We planned to conduct subgroup analyses for underlying clinical conditions. Main results We included five small trials that randomised a total of 234 participants. Two studies were assessed as low risk of bias; none of the included studies were adequately powered. Two studies used an attention control and three studies compared to an alternative intervention, which in all cases was one intervention versus usual care intervention. The searches we carried out did not find any trials comparing an intervention with no intervention. The searches did not find any trials of an intervention that compared variations in timing, dose, or intensity of treatment using the same intervention. Four studies included only people with stroke; one included mostly people with stroke, but also those with brain injury. Three studies delivered interventions in the first few months after stroke; two recruited people with chronic dysarthria. Three studies evaluated behavioural interventions, one investigated acupuncture and another transcranial magnetic stimulation. One study included people with dysarthria within a broader trial of people with impaired communication. Our primary analysis of a persisting (three to nine months post-intervention) effect at the activity level of measurement found no evidence in favour of dysarthria intervention compared with any control (SMD 0.18, 95% CI -0.18 to 0.55; 3 trials, 116 participants, GRADE: low quality, I² = 0%). Findings from sensitivity analysis of studies at low risk of bias were similar, with a slightly wider confidence interval and low heterogeneity (SMD 0.21, 95% CI -0.30 to 0.73, I² = 32%; 2 trials, 92 participants, GRADE: low quality). Subgroup analysis results for stroke were similar to the primary analysis because few non-stroke participants had been recruited to trials (SMD 0.16, 95% CI -0.23 to 0.54, I² = 0%; 3 trials, 106 participants, GRADE: low quality). Similar results emerged from most of the secondary analyses. There was no evidence of a persisting effect at the impairment (SMD 0.07, 95% CI -0.91 to 1.06, I² = 70%; 2 trials, 56 participants, GRADE: very low quality) or participation level (SMD -0.11, 95% CI -0.56 to 0.33, I² = 0%; 2 trials, 79 participants, GRADE: low quality) but substantial heterogeneity on the former. Analyses of immediate post-intervention outcomes provided no evidence of any short-term benefit on activity (SMD 0.29, 95% CI -0.07 to 0.66, I² = 0%; 3 trials, 117 participants, GRADE: very low quality); or participation (SMD -0.24, 95% CI -0.94 to 0.45; 1 study, 32 participants) levels of measurement. There was a statistically significant effect favouring intervention at the immediate, impairment level of measurement (SMD 0.47, 95% CI 0.02 to 0.92, P = 0.04, I² = 0%; 4 trials, 99 participants, GRADE: very low quality) but only one of these four trials had a low risk of bias. Authors' conclusions We found no definitive, adequately powered RCTs of interventions for people with dysarthria. We found limited evidence to suggest there may be an immediate beneficial effect on impairment level measures; more, higher quality research is needed to confirm this finding. Although we evaluated five studies, the benefits and risks of interventions remain unknown and the emerging evidence justifies the need for adequately powered clinical trials into this condition. People with dysarthria after stroke or brain injury should continue to receive rehabilitation according to clinical guidelines.

Speech Versus Speaking: The Experiences of People With Parkinson's Disease and Implications for Intervention.

Abstract: Purpose In this project, we explore the experiences of people who report speech changes associated with Parkinson's disease as they describe taking part in everyday communication situations and rep...

Regularized Speaker Adaptation of KL-HMM for Dysarthric Speech Recognition

Abstract: This paper addresses the problem of recognizing the speech uttered by patients with dysarthria, which is a motor speech disorder impeding the physical production of speech. Patients with dysarthria have articulatory limitation, and therefore, they often have trouble in pronouncing certain sounds, resulting in undesirable phonetic variation. Modern automatic speech recognition systems designed for regular speakers are ineffective for dysarthric sufferers due to the phonetic variation. To capture the phonetic variation, Kullback–Leibler divergence-based hidden Markov model (KL-HMM) is adopted, where the emission probability of state is parameterized by a categorical distribution using phoneme posterior probabilities obtained from a deep neural network-based acoustic model. To further reflect speaker-specific phonetic variation patterns, a speaker adaptation method based on a combination of L2 regularization and confusion-reducing regularization, which can enhance discriminability between categorical distributions of the KL-HMM states while preserving speaker-specific information is proposed. Evaluation of the proposed speaker adaptation method on a database of several hundred words for 30 speakers consisting of 12 mildly dysarthric, 8 moderately dysarthric, and 10 non-dysarthric control speakers showed that the proposed approach significantly outperformed the conventional deep neural network-based speaker adapted system on dysarthric as well as non-dysarthric speech.

Sentence-Level Movements in Parkinson's Disease: Loud, Clear, and Slow Speech

Abstract: Purpose To further understand the effect of Parkinson's disease (PD) on articulatory movements in speech and to expand our knowledge of therapeutic treatment strategies, this study examined movemen...

Automatic assessment of dysarthria severity level using audio descriptors

Abstract: Dysarthria is a motor speech impairment, often characterized by speech that is generally indiscernible by human listeners. Assessment of the severity level of dysarthria provides an understanding of the patient's progression in the underlying cause and is essential for planning therapy, as well as improving automatic dysarthric speech recognition. In this paper, we propose a non-linguistic manner of automatic assessment of severity levels using audio descriptors or a set of features traditionally used to define timbre of musical instruments and have been modified to suit this purpose. Multitapered spectral estimation based features were computed and used for classification, in addition to the audio descriptors for timbre. An Artificial Neural Network (ANN) was trained to classify speech into various severity levels within Universal Access dysarthric speech corpus and the TORGO database. An average classification accuracy of 96.44% and 98.7% was obtained for UA speech corpus and TORGO database respectively.

Effect of Dysarthria Type, Speaking Condition, and Listener Age on Speech Intelligibility.

Abstract: Purpose The aim of this study was to examine the effect of loud and slow speech cues on younger and older listeners' comprehension of dysarthric speech, specifically, (a) whether one strategy, as o...

A relationship between processing speech in noise and dysarthric speech.

Abstract: There is substantial individual variability in understanding speech in adverse listening conditions. This study examined whether a relationship exists between processing speech in noise (environmental degradation) and dysarthric speech (source degradation), with regard to intelligibility performance and the use of metrical stress to segment the degraded speech signals. Ninety native speakers of American English transcribed speech in noise and dysarthric speech. For each type of listening adversity, transcriptions were analyzed for proportion of words correct and lexical segmentation errors indicative of stress cue utilization. Consistent with the hypotheses, intelligibility performance for speech in noise was correlated with intelligibility performance for dysarthric speech, suggesting similar cognitive-perceptual processing mechanisms may support both. The segmentation results also support this postulation. While stress-based segmentation was stronger for speech in noise relative to dysarthric speech, listeners utilized metrical stress to parse both types of listening adversity. In addition, reliance on stress cues for parsing speech in noise was correlated with reliance on stress cues for parsing dysarthric speech. Taken together, the findings demonstrate a preference to deploy the same cognitive-perceptual strategy in conditions where metrical stress offers a route to segmenting degraded speech.

A Cross-Language Study of Acoustic Predictors of Speech Intelligibility in Individuals With Parkinson's Disease.

Abstract: Purpose The present study aimed to compare acoustic models of speech intelligibility in individuals with the same disease (Parkinson's disease [PD]) and presumably similar underlying neuropathologi...

Oral Motor Abilities Are Task Dependent: A Factor Analytic Approach to Performance Rate.

Abstract: Measures of performance rates in speech-like or volitional nonspeech oral motor tasks are frequently used to draw inferences about articulation rate abnormalities in patients with neurologic movement disorders. The study objective was to investigate the structural relationship between rate measures of speech and of oral motor behaviors different from speech. A total of 130 patients with neurologic movement disorders and 130 healthy subjects participated in the study. Rate data was collected for oral reading (speech), rapid syllable repetition (speech-like), and rapid single articulator movements (nonspeech). The authors used factor analysis to determine whether the different rate variables reflect the same or distinct constructs. The behavioral data were most appropriately captured by a measurement model in which the different task types loaded onto separate latent variables. The data on oral motor performance rates show that speech tasks and oral motor tasks such as rapid syllable repetition or repetitive single articulator movements measure separate traits.

Speech-Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function.

Abstract: Background: Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition Speech–language pathologists (SLPs) play an important role in the evaluation and management of dysarthria and dysphagia This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations Methods: A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar Search terms included 1) hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington’s Disease, myoclonus; and evaluation/treatment terms: 2) Speech–Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis Results: The standard SLP clinical speech and swallowing evaluation of chorea/Huntington’s disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1) case history; 2) examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (ie, cranial nerve assessment); 3) evaluation of speech characteristics; and 4) patient self-report of the impact of their disorder on activities of daily living SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation Discussion: SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and deglutition associated with hyperkinetic disorders

Generalized Adaptation to Dysarthric Speech

Abstract: Purpose Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysar...

Therapeutic effects of intensive voice treatment (LSVT LOUD®) for children with spastic cerebral palsy and dysarthria: A phase I treatment validation study

Abstract: Purpose: The aim of the present study was to validate and extend the evaluation of treatment outcomes following LSVT LOUD® in children with dysarthria secondary to cerebral palsy (CP).Method: Seven children (5 females, 6–10 years) with spastic quadriplegia and dysarthria received LSVT LOUD. Outcomes included: (a) quantitative and qualitative indices of communication and social functioning representing therapeutic effects and (b) features of the acoustic signal representing physiological effects on the speech mechanism. A matched group of typically developing children served as controls. Testing occurred just prior to (PRE), immediately following (POST), and at 12 weeks post-treatment (FUP).Result: Expert listeners preferred voice quality and articulatory precision of children with CP at FUP as compared to PRE. Acoustic data indicated improvements on select measures of vocal functioning at POST with some maintenance at FUP. Single word intelligibility improved immediately POST, but was not maintain...

Gauging the Auditory Dimensions of Dysarthric Impairment: Reliability and Construct Validity of the Bogenhausen Dysarthria Scales (BoDyS).

Abstract: Purpose Standardized clinical assessment of dysarthria is essential for management and research. We present a new, fully standardized dysarthria assessment, the Bogenhausen Dysarthria Scales (BoDyS...

Cross-Database Models for the Classification of Dysarthria Presence.

Abstract: Dysarthria is a motor speech disorder that impacts verbal articulation and co-ordination, resulting in slow, slurred and imprecise speech. Automated classification of dysarthria subtypes and severities could provide a useful clinical tool in assessing the onset and progress in treatment. This study represents a pilot project to train models to detect the presence of dysarthria in continuous speech. Subsets of the Universal Access Research Dataset (UA-Speech) and the Atlanta Motor Speech Disorders Corpus (AMSDC) database were utilized in a cross-database training strategy (training on UA-Speech / testing on AMSDC) to distinguish speech with and without dysarthria. In addition to traditional spectral and prosodic features, the current study also includes features based on the Teager Energy Operator (TEO) and the glottal waveform. Baseline results on the UA-Speech dataset maximize wordand participant-level accuracies at 75.3% and 92.9% using prosodic features. However, the cross-training of UA-Speech tested on the AMSDC maximize wordand participant-level accuracies at 71.3% and 90% based on a TEO feature. The results of this pilot study reinforce consideration of dysarthria subtypes in cross-dataset training as well as highlight additional features that may be sensitive to the presence of dysarthria in continuous speech.

Royal College of Speech & Language Therapists Clinical Guidelines

Abstract: The aim of these guidelines is to provide clinicians, managers and service users with statements regarding the clinical management of specific disorders or conditions and in some instances, particular populations. The guidelines assist in the clinical decision-making process by providing information on what is considered to be the minimum best practice. Each guideline contains recommendations that are explicit statements providing specific clinical guidance on the assessment and management of each area. Each recommendation is supported by evidence from the literature or is based upon the consensus of clinical experts. Sections include: Pre-School children with communication, language speech needs; School-aged children with speech, language communication difficulties; Autistic spectrum disorders; Cleft palate and velopharyngeal abnormalities; Clinical voice disorders; Deafness/hearing loss; Disorders of fluency; Disorders of feeding, eating, drinking swallowing (dysphagia); Disorders of mental health dementia; Dysarthria; Aphasia; Head neck cancer. A Position Statement on working with Adults with Learning Disabilities is included in place of a guideline. Every practising UK speech language therapist needs to have access to these guidelines, and they will also be of value to health, social and educational professionals that may become involved with individuals who have a communication or swallowing disorder.

Assessing Vowel Centralization in Dysarthria: A Comparison of Methods.

Abstract: Purpose The strength of the relationship between vowel centralization measures and perceptual ratings of dysarthria severity has varied considerably across reports. This article evaluates methods o...

Acoustic and Perceptual Consequences of Speech Cues for Children With Dysarthria

Abstract: Purpose Reductions in articulatory working space and vocal intensity have been linked to intelligibility deficits in children with dysarthria due to cerebral palsy. However, few studies have examined the outcomes of behavioral treatments aimed at these underlying impairments or investigated which treatment cues might best facilitate improved intelligibility. This study assessed the effects of cues targeting clear speech (i.e., “Speak with your big mouth”) and greater vocal intensity (i.e., “Speak with your strong voice”) on acoustic measures of speech production and intelligibility. Method Eight children with spastic dysarthria due to cerebral palsy repeated sentence- and word-level stimuli across habitual, big mouth, and strong voice conditions. Acoustic analyses were conducted, and 48 listeners completed orthographic transcription and scaled intelligibility ratings. Results Both cues resulted in significant changes to vocal intensity and speech rate although the degree of change varied by condition. In ...

A survey of speech–language therapy provision for people with post‐stroke dysarthria in the UK

Abstract: Background: A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate management, little is known currently about United Kingdom (UK) service delivery issues relating to speech and language therapy (SLT) assessment and treatment for this group. Such evidence is necessary in order to plan, develop and research services for people with post-stroke dysarthria. / Methods: SLTs in the UK were asked to complete an online survey addressing referral patterns, caseload profiles, and their assessment and intervention methods for post-stroke dysarthria. In the absence of a national register of clinicians working with people with acquired dysarthria, a snowballing method was used to facilitate participant recruitment. Results were analysed using descriptive statistics. / Results: 146 SLTs responded. The majority were employed by the National Health Service (NHS). Most patients were referred within a week post stroke. Almost half of respondents did not regularly use formal assessments and the use of instrumentation was rare, including the use of video recording. The focus of therapy for mild, moderate and severe dysarthria did not differ significantly for clinicians. A little under half of respondents endorsed nonverbal oral exercises in rehabilitation. The survey demonstrated some appreciation of the centrality of regular intensive practice to effect change, but this was in a minority. / Conclusions: Through this research it became clear that basic information regarding post-stroke dysarthria incidence, prevalence and core demographics is currently unavailable. More embedded NHS SLT reporting systems would make a significant contribution to this area. A more in-depth examination is required of the natural history of dysarthria over the months and years following stroke, of SLT practices in relation to post-stroke dysarthria, with investigations to more fully understand the choices SLTs make and how this relates to available evidence to support their clinical decision making.

Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes

Abstract: Objective: To determine whether communication at 2 years predicted communication at 4 years in children with cerebral palsy (CP); and whether the age a child first produces words imitatively predicts change in speech production Method: 30 children (15 males) with CP participated and were seen 5 times at 6-month intervals between 24 and 53 months (mean age at time 1 = 269 months (SD 19)) Variables were communication classification at 24 and 53 months, age that children were first able to produce words imitatively, single-word intelligibility, and longest utterance produced Results: Communication at 24 months was highly predictive of abilities at 53 months Speaking earlier led to faster gains in intelligibility and length of utterance and better outcomes at 53 months than speaking later Conclusion: Inability to speak at 24 months indicates greater speech and language difficulty at 53 months and a strong need for early communication intervention

Representation Learning Based Speech Assistive System for Persons With Dysarthria

Abstract: An assistive system for persons with vocal impairment due to dysarthria converts dysarthric speech to normal speech or text. Because of the articulatory deficits, dysarthric speech recognition needs a robust learning technique. Representation learning is significant for complex tasks such as dysarthric speech recognition. We focus on robust representation for dysarthric speech recognition that involves recognizing sequential patterns of varying length utterances. We propose a hybrid framework that uses a generative learning based data representation with a discriminative learning based classifier. In this hybrid framework, we propose to use Example Specific Hidden Markov Models (ESHMMs) to obtain log-likelihood scores for a dysarthric speech utterance to form fixed dimensional score vector representation. This representation is used as an input to discriminative classifier such as support vector machine.The performance of the proposed approach is evaluatedusingUA-Speechdatabase.The recognitionaccuracy is much better than the conventional hidden Markov model based approach and Deep Neural Network-Hidden Markov Model (DNN-HMM). The efficiency of the discriminative nature of score vector representation is proved for “very low” intelligibility words.

Articulatory Kinematic Characteristics Across the Dysarthria Severity Spectrum in Individuals With Amyotrophic Lateral Sclerosis

Abstract: Purpose The current study investigated whether articulatory kinematic patterns can be extrapolated across the spectrum of dysarthria severity in individuals with amyotrophic lateral sclerosis (ALS)...

Two unrelated children with overlapping 6q25.3 deletions, motor speech disorders, and language delays.

Abstract: Interstitial and terminal 6q25 deletions are associated with developmental delays, hypotonia, eye pathologies, craniofacial dysmorphologies, and structural brain anomalies. In most cases, speech and language deficits are not described in detail. We report on a case (Patient 1, age 7 years) with a de novo 6q25.3-qter deletion, 11.1 Mb long and encompassing 108 genes, and a case (Patient 2, age 5 years) with an inherited interstitial 6q25.3 deletion, located within Patient 1's deletion region and 403 kb long, the smallest 6q25 deletion reported to date. Both children have hypotonia, motor speech disorders, and expressive language delays. Patient 1's speech was characterized by childhood apraxia of speech (CAS) and dysarthria. Other findings include developmental delay, ataxic cerebral palsy, optic nerve dysplagia, and atypical brain morphologies regarding the corpus callosum and gyration patterns, a clinical profile that closely matches a previously reported case with a nearly identical deletion. Patient 2 had speech characterized by CAS and typical nonverbal processing abilities. His father, a carrier, had typical speech and language but showed difficulties with complex motor speech and hand motor tasks, similar to other adults with residual signs of CAS. The small deletion in this family contains the IGF2R-AIRN-SLC22A2-SLC22A3 gene cluster, which is associated with imprinting and maternal-specific expression of Igf2R, Slc22a2, and Slc22a3 in mice, whereas imprinting in humans is a polymorphic trait. The shared phenotypes in the two patients might be associated with the deletion of the gene cluster.