The relationship of rate and pause features to the communicative participation of people living with ALS.

INTRODUCTION/AIMS: Many people living with amyotrophic lateral sclerosis (PALS) report restrictions in their day-to-day communication (communicative participation). However, little is known about which speech features contribute to these restrictions. This study evaluated the effects of common speech symptoms in PALS (reduced overall speaking rate, slowed articulation rate, and increased pausing) on communicative participation restrictions. METHODS: Participants completed surveys (the Communicative Participation Item Bank-short form; the self-entry version of the ALS Functional Rating Scale-Revised) and recorded themselves reading the Bamboo Passage aloud using a smartphone app. Rate and pause measures were extracted from the recordings. The association of various demographic, clinical, self-reported, and acoustic speech features with communicative participation was evaluated with bivariate correlations. The contribution of salient rate and pause measures to communicative participation was assessed using multiple linear regression. RESULTS: Fifty seven people living with ALS participated in the study (mean age = 61.1 years). Acoustic and self-report measures of speech and bulbar function were moderately to highly associated with communicative participation (Spearman rho coefficients ranged from rs = 0.48 to rs = 0.77). A regression model including participant age, sex, articulation rate, and percent pause time accounted for 57% of the variance of communicative participation ratings. DISCUSSION: Even though PALS with slowed articulation rate and increased pausing may convey their message clearly, these speech features predict communicative participation restrictions. The identification of quantitative speech features, such as articulation rate and percent pause time, is critical to facilitating early and targeted intervention and for monitoring bulbar decline in ALS.

Remote Assessment for ALS using Multimodal Dialog Agents: Data Quality, Feasibility and Task Compliance.

We investigate the feasibility, task compliance and audiovisual data quality of a multimodal dialog-based solution for remote assessment of Amyotrophic Lateral Sclerosis (ALS). 53 people with ALS and 52 healthy controls interacted with Tina, a cloud-based conversational agent, in performing speech tasks designed to probe various aspects of motor speech function while their audio and video was recorded. We rated a total of 250 recordings for audio/video quality and participant task compliance, along with the relative frequency of different issues observed. We observed excellent compliance (98%) and audio (95.2%) and visual quality rates (84.8%), resulting in an overall yield of 80.8% recordings that were both compliant and of high quality. Furthermore, recording quality and compliance were not affected by level of speech severity and did not differ significantly across end devices. These findings support the utility of dialog systems for remote monitoring of speech in ALS.

Longitudinal Recovery of Speech Motor Function Following Facial Transplantation: A Prospective Observational Study.

OBJECTIVES: Although facial transplantation is considered effective for restoring facial appearance, research on speech outcomes following surgery is limited. More research is critically needed to inform patients of expected rates and extent of recovery, and to develop interventions aimed at improving speech outcomes. METHODS: Four patients in early recovery (3 weeks-24 months postsurgery) and three patients in late recovery (36-60 months postsurgery) were included. Clinical measures of speech recovery, including speech intelligibility measured using the Sentence Intelligibility Test, a lip strength testing device (Iowa Oral Performance Instrument), and kinematic measures of lip and jaw function measured using high-resolution 3D optical motion capture were used to describe the rate and extent of functional speech and lip recovery, describe and compare the rate of functional speech recovery and kinematic lip and jaw changes in early and late stages of recovery, and explore the association between kinematic measures and functional speech. RESULTS: Speech intelligibility, speaking rate, and lip strength were below normative values in the first 2 years of postsurgery. Participants in the first 2 years of recovery demonstrated steeper slopes of improvement in clinical and kinematic measures than participants in the later stages of recovery (36-64 months). Gains in jaw range of movement and gains in lip speed and range of movement were significantly correlated with rates of sentence intelligibility improvement. Gains in lip strength were not associated with functional speech improvement. CONCLUSIONS: These findings motivate ongoing work aimed at developing interventions for improving motor speech function in this population. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2359-2367, 2022.

Modulation of Intermuscular Beta Coherence in Different Rhythmic Mandibular Behaviors.

INTRODUCTION: Jaw movement during chewing and speech is facilitated by neural activation patterns for opening and closing movements of the mandible. This study investigated anatomic- and task-dependent differences in intermuscular coherence (IMC) and their association with the parameters of jaw muscle activity using surface electromyography (sEMG). METHODS: We recorded sEMG activation from bilateral and ipsilateral jaw-closing muscle pairs during non-nutritive and nutritive chewing, and during a syllable repetition task. IMC and cross-correlational analyses between bilateral and ipsilateral muscle pairs were performed. RESULTS: Intermuscular coherence in the beta band was statistically significant between agonist jaw-closing muscle pairs, with beta IMC weaker for rapid syllable repetition compared to chewing tasks. Cross-correlational analysis of muscle co-activation, as well as sEMG burst amplitude, was positively associated with beta IMC strength. DISCUSSION: Beta IMC was influenced heavily by task-dependent behavioral goals and physiologic demands, which was interpreted as evidence of shared neural drive among jaw-closing muscles.

Neuromotor Speech Recovery Across Different Behavioral Speech Modifications in Individuals Following Facial Transplantation.

Despite signs of facial nerve recovery within a few months following face transplantation, speech deficits persist for years. Behavioral speech modifications (e.g., slower-than-normal speaking rate and increased loudness) have shown promising potential to enhance speech intelligibility in populations with dysarthric speech. However, such evidence-based practice approach is lacking in clinical management of speech in individuals with facial transplantation. Because facial transplantation involves complex craniofacial reconstruction and facial nerve coaptation, it is unknown to what extent individuals with face transplant are capable of adapting their motor system to task-specific articulatory demands. The purpose of this study was to identify the underlying articulatory mechanisms employed by individuals with face transplantation in response to speech modification cues at early and late stages of neuromotor recovery. In addition, we aimed to identify speech modifications that conferred improved speech clarity. Participants were seven individuals who underwent full or partial facial vascularized composite allografts that included lips and muscles of facial animation and were in early (~2 months) or late (~42 months) stages of recovery. Participants produced repetitions of the sentence "Buy Bobby a puppy" in normal, fast, loud, and slow speech modifications. Articulatory movement traces were recorded using a 3D optical motion capture system. Kinematic measures of average speed (mm/s) and range of movement (mm3) were extracted from the lower lip (± jaw) marker. Two speech language pathologists rated speech clarity for each speaker using a visual analog scale (VAS) approach. Results demonstrated that facial motor capacity increased from early to late stages of recovery. While individuals in the early group exhibited restricted capabilities to adjust their motor system based on the articulatory demands of each speech modification, individuals in the late group demonstrated faster speed and larger-than-normal range of movement for loud speech, and slower speed and larger-than-normal range of movement for slow speech. In addition, subjects in both groups showed overreliance on jaw rather than lip articulatory function across all speech modifications, perhaps as a compensatory strategy to optimize articulatory stability and maximize speech function. Finally, improved speech clarity was associated with loud speech in both stages of recovery.

Automatic extraction of abnormal lip movement features from the alternating motion rate task in amyotrophic lateral sclerosis.

Purpose: With the long-term goal to develop a clinically feasible tool for assessing articulatory involvement in ALS, we designed an algorithmic approach to automatically extract lip movement features during an alternating motion rate (AMR) task and assessed their efficacy for detecting and monitoring articulatory involvement in amyotrophic lateral sclerosis (ALS). Method: Twenty three spatial, temporal, and spatiotemporal AMR features were extracted from 161 samples of lip movements (139 from participants with ALS; 22 from neurologically-intact participants). The diagnostic value of these features was assessed based on their (1) sensitivity for detecting early bulbar motor involvement, and (2) associations with accepted clinical measures of bulbar disease progression. Result: Among all AMR features, two temporal features were the most affected - temporal variability and syllable frequency, which (1) showed large changes during early disease stages and (2) predicted the progression of bulbar motor involvement and speech intelligibility decline. Spatial features were in general, less sensitive to early bulbar motor involvement. Conclusions: The findings provided preliminary support for the algorithmic approach to quantifying articulatory features predictive of bulbar motor and speech decline in ALS. The differential disease effects on spatial and temporal AMR features might shed light on the mechanism of articulatory involvement during ALS progression.

Additional evidence for a therapeutic effect of dextromethorphan/quinidine on bulbar motor function in patients with amyotrophic lateral sclerosis: A quantitative speech analysis.

AIMS: A recent double-blind placebo-controlled crossover 70-day trial demonstrated that a fixed combination of dextromethorphan and quinidine (DM/Q) improves speech and swallowing function in most patients with amyotrophic lateral sclerosis. In this study, a subset of participants, many of whom did not substantially improve while on DM/Q, were re-evaluated using computer-based speech analyses and expert clinician ratings of the overall severity of speech impairment. METHODS: Speech samples were recorded from the subset of 10 patients at four visits made at approximately 30-day intervals. The recordings were analysed by automated computer-based analysis of speech pausing patterns. Severity of speech impairment was rated by three experienced speech-language pathologists using direct magnitude estimation. Scores on patient-reported and clinician-administered scales of bulbar motor involvement were obtained at each visit. RESULTS: The effects of DM/Q were detected on several of the objective speech measures, including total pause duration (s) (Cohen's d = 0.73, 95% confidence interval (CI) -1.70, 0.24), pause time (%) (d = 0.77, 95% CI -1.75, 0.21), and mean speech event duration (s) (d = 0.52, 95% CI -0.44, 1.47), but not on clinician ratings of speech or the speech components of the self-report or clinician-administered scales. CONCLUSIONS: These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech.

Differing structural properties of foods affect the development of mandibular control and muscle coordination in infants and young children.

The development of chewing is an essential motor skill that is continually refined throughout early childhood. From a motor control perspective, the advancement of textures is dependent upon the fit between a child's oral anatomic and motor system and food properties. The purpose of this exploratory study is to identify age-related changes in chewing motor coordination and control and to determine if these changes are associated with the differing structural properties of solid foods, as well as to explore the role of explanatory variables such as the emergence of teeth and bite force. The masticatory muscle coordination (i.e., coupling of synergistic and antagonistic muscle pairs) and control (i.e., speed, displacement, chewing rate, duration, and number of chews) of fifty children were assessed cross-sectionally at five ages: 9-, 12-, 18-, 24-, and 36-months using electromyography (EMG) and 3D optical motion capture while children ate three foods that had differing structural properties. The results of this study found that children made gains in their chewing motor control (decreased duration of chewing sequences and lateral jaw displacement) and coordination (improved jaw muscle coupling) throughout this period. The structural differences in foods also affected chewing performance at all ages. These preliminary findings suggest that some solid textures are better adapted for immature mandibular control than others and that the development of chewing is a protracted process that may be impacted by the emergence of teeth and changes to bite force.

The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report.

PURPOSE: Facial transplantation is a relatively new option for individuals with severe facial disfigurements. Clinical case studies on existing patients indicate many instances of persistent facial motor impairment for facial expression, speech, and swallowing. These preliminary findings motivate additional research on the impact of lip-strengthening exercises following facial transplantation. METHOD: In this study, we assessed the efficacy of an 8-week, biofeedback-driven, lip closure-strengthening exercise program in a single patient 1-year status post-full facial transplantation. Exercise was at 60% of peak strength. Outcome measures included instrumental measures of lip strength and mobility, clinical measures of speech, and patient-reported outcomes in feeding and facial expression. RESULTS: Results revealed improvements in labial strength, speed of lip movement, and range of motion during speech. A 3-point improvement in sentence speech intelligibility was also observed following strength-training exercise. The patient reported improvements in her ability to drink from a straw and communicate via facial expression. CONCLUSION: These preliminary findings motivate additional research on the efficacy of lip-strengthening exercises following facial transplantation.

Advancement in Texture in Early Complementary Feeding and the Relevance to Developmental Outcomes.

A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures. Efforts to develop science-based recommendations for complementary feeding include research on the development of chewing motor skills. Chewing development is an essential aspect of feeding readiness that is often overlooked by agencies developing recommendations for complementary feeding, and little is known about the development of chewing motor skills and how children learn to accommodate foods with varying textures. Such information is essential for designing developmentally appropriate foods, minimizing food aversions, providing caregivers science-based guidance regarding the safety and appropriateness of new foods, and identifying children at risk for choking or feeding impairments.