The Effects of Intensive Voice Treatment in Mandarin Speakers With Parkinson's Disease: Acoustic and Perceptual Findings.

PURPOSE: This study investigated the effects of intensive voice treatment on subjective and objective measures of speech production in Mandarin speakers with hypokinetic dysarthria. METHOD: Nine Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease received 4 weeks of intensive voice treatment (4 × 60 min per week). The speakers were recorded reading a passage before treatment (PRE), immediately after treatment (POST), and at 6-month follow-up (FU). Listeners (n = 15) rated relative ease of understanding (EOU) of paired speech samples on a visual analogue scale. Acoustic analyses were performed. Changes in EOU, vocal intensity, global and local fundamental frequency (f o) variation, speech rate, and acoustic vowel space area (VSA) were examined. RESULTS: Increases were found in EOU and vocal intensity from PRE to POST and from PRE to FU, with no change found from POST to FU. Speech rate increased from PRE to POST, with limited evidence of an increase from PRE to FU and no change from POST to FU. No changes in global or local f o variation or in VSA were found. CONCLUSIONS: Intensive voice treatment shows promise for improving speech production in Mandarin speakers with hypokinetic dysarthria. Vocal intensity, speech rate, and, crucially, intelligibility, may improve for up to 6 months posttreatment. In contrast, f o variation and VSA may not increase following the treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19529017.

The effects of thalamic and posterior subthalamic deep brain stimulation on speech in patients with essential tremor - A prospective, randomized, doubleblind crossover study.

OBJECTIVE: To prospectively evaluate the effect of PSA- and VIM DBS on speech in ET patients. METHODS: Leads were implanted bilaterally with contacts placed in both VIM and PSA. Thirteen patients were analyzed pre- and postoperatively. Preoperative speech of ET patients was compared to healthy controls. PSA- and VIM-DBS were evaluated in a randomized, double-blind crossover phase. RESULTS: At preoperative baseline, we found reduced intelligibility. Differences in acoustic and VAS data ('ability to speak') compared to controls were gradient. Articulation rate could be predicted by disease duration. Decreased articulation rate, spirantization and voicing were found for PSA- and VIM-DBS. Targets did not differ in terms of speech deterioration. CONCLUSION: Speech in ET patients without DBS can be impaired, dependent on patient's individual characteristics. Both PSA- and VIM-DBS affect speech in a comparable way. Thus, the PSA can be considered an alternative DBS target in ET without higher risk of dysarthria.

Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial.

BACKGROUND: Stroke-induced dysarthria is caused by muscle weakness, sacral or muscular dystonia, and incoordination of the articulatory organ formed by organic lesions caused by cerebral vascular obstruction or sudden bursting of blood vessels in the brain, which may cause abnormal breathing patterns, pronunciation, resonance, rhythm, and unclear articulation. The Six Character Formula, or Liuzijue qigong (LQG), is an essential part of Chinese traditional exercises and focuses on breathing-speech synchronization. The purpose of the present study was to compare the effects of LQG with traditional breathing training (combined with basic articulation training in both groups) in patients with post-stroke dysarthria. METHODS/DESIGN: The proposed study will be a single-center randomized controlled trial. A total of 100 patients, with a modified Frenchay Dysarthria Assessment (FDA) dysarthria assessment score < 27 and with a FDA speech breathing level ≥ b will be randomly divided into study (LQG, n = 50) and control (conventional breathing training, n = 50) groups. Basic articulation training will be conducted once a day, five times a week for 3 weeks. Data collection will be conducted at baseline, 1 week, and 2 weeks post-treatment initiation and after completion of the treatment (3 weeks). Comprehensive analyses will be conducted to measure and compare any differences in speech breathing dysfunction levels, comprehensive evaluation of dysarthria, maximum phonation time (MPT), maximal counting ability, signal-noise (S/Z) ratio, and loudness scales between the study and control groups. DISCUSSION: This trial will provide evidence about the effectiveness of LQG for improvement of speech breathing function and speech ability in patients with post-stroke dysarthria complicated with abnormal breathing. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-INR-16010215. Registered 21 December 2016.

Understanding dysrhythmic speech: When rhythm does not matter and learning does not happen.

A positive relationship between rhythm perception and improved understanding of a naturally dysrhythmic speech signal, ataxic dysarthria, has been previously reported [Borrie, Lansford, and Barrett. (2017). J. Speech Lang. Hear. Res. 60, 3110-3117]. The current follow-on investigation suggests that this relationship depends on the nature of the dysrhythmia. When the corrupted rhythm cues are relatively predictable, affording some learnable acoustic regularity, the relationship is replicated. However, this relationship is nonexistent, along with any intelligibility improvements, when the corrupted rhythm cues are unpredictable. Findings highlight a key role for rhythm perception and distributional regularities in adaptation to dysrhythmic speech.

Combining degradations: The effect of background noise on intelligibility of disordered speech.

The effect of background noise on intelligibility of disordered speech was assessed. Speech-shaped noise was mixed with neurologically healthy (control) and disordered (dysarthric) speech at a series of signal-to-noise ratios. In addition, bandpass filtered control and dysarthric speech conditions were assessed to determine the effect of noise on both naturally and artificially degraded speech. While significant effects of both the amount of noise and the type of speech were revealed, no interaction between the two factors was observed, in either the broadband or filtered testing conditions. Thus, it appears that there is no multiplicative effect of the presence of background noise on intelligibility of disordered speech relative to control speech. That is, the decrease in intelligibility due to increasing levels of noise is similar for both types of speech, and both types of testing conditions, and the function for dysarthric speech is simply shifted downward due to the inherent source degradations of the speech itself. Last, large-scale online crowdsourcing via Amazon Mechanical Turk was utilized to collect data for the current study. Findings and implications for this data and data collection approach are discussed.

A relationship between processing speech in noise and dysarthric speech.

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.

Visual speech information: a help or hindrance in perceptual processing of dysarthric speech.

This study investigated the influence of visual speech information on perceptual processing of neurologically degraded speech. Fifty listeners identified spastic dysarthric speech under both audio (A) and audiovisual (AV) conditions. Condition comparisons revealed that the addition of visual speech information enhanced processing of the neurologically degraded input in terms of (a) acuity (percent phonemes correct) of vowels and consonants and (b) recognition (percent words correct) of predictive and nonpredictive phrases. Listeners exploited stress-based segmentation strategies more readily in AV conditions, suggesting that the perceptual benefit associated with adding visual speech information to the auditory signal-the AV advantage-has both segmental and suprasegmental origins. Results also revealed that the magnitude of the AV advantage can be predicted, to some degree, by the extent to which an individual utilizes syllabic stress cues to inform word recognition in AV conditions. Findings inform the development of a listener-specific model of speech perception that applies to processing of dysarthric speech in everyday communication contexts.

Speech therapy and communication device: impact on quality of life and mood in patients with amyotrophic lateral sclerosis.

Dysarthria has a drastic impact on the quality of life of ALS patients. Most patients suffering from dysarthria are offered speech therapy. Communication devices are prescribed less frequently. In the present study we investigated the impact of these therapeutic arrangements on quality of life in ALS patients. Thirty-eight ALS patients with dysarthria or anarthria, who underwent speech therapy and/or used communication devices answered three standardized questionnaires (Beck Depression Inventory - II (BDI), SF-36 Health Survey questionnaire (SF-36) and ALS Functional Rating Scale-revised (ALSFRS-R)) and were further interviewed about their experience with and benefit of speech therapy and communication devices. Most of the patients described a high impact of the communication device on their quality of life while the influence of speech therapy was rated less. By multiple regression analysis we confirmed an independent positive effect of communication device use on depression and psychological distress. In conclusion, communication systems improve or at least stabilize quality of life and mood in dysarthric ALS patients, and should be provided early in the disease course.

The intonation-syntax interface in the speech of individuals with Parkinson's disease.

PURPOSE: This study examined the effect of Parkinson's disease (PD) on the intonational marking of final and nonfinal syntactic boundaries and investigated whether the effect of PD on intonation was sex specific. METHOD: Eight women and 8 men with PD and 16 age- and sex-matched control participants read a passage at comfortable pitch, rate, and loudness. Nuclear tones from final and nonfinal syntactic boundaries in clauses and lists were extracted. Measures of fundamental frequency (F0) were made on each tone contour. RESULTS: Individuals with PD demonstrated impaired differentiation of syntactic boundary finality/nonfinality with contour direction. They produced a lower proportion of falling contours in final boundaries and a higher proportion of falling contours in nonfinal boundaries than did control participants. Although not mediated by syntax, the effect of PD on F0 standard deviation (F0 SD) and pitch range in semitones (PRST) was sex specific. Women with PD produced greater F0 SD and PRST than did men with PD and women without PD. Men with PD produced lower PRST than did men without PD. CONCLUSIONS: Impaired intonational marking of syntactic boundaries likely contributes to dysprosody and reduced communicative effectiveness in PD. The effect of PD on intonation was sex specific. The results are not fully explained by PD-related motor execution impairments.

The use of nonspeech oral motor treatments for developmental speech sound production disorders: interventions and interactions.

PURPOSE: The use of nonspeech oral motor treatments (NSOMTs) in the management of pediatric speech sound production disorders is controversial. This article serves as a prologue to a clinical forum that examines this topic in depth. METHOD: Theoretical, historical, and ethical issues are reviewed to create a series of clinical questions that should be considered before one incorporates new methods into clinical practice. CONCLUSION: Speech production disorders are complex and multifaceted. Speech-language pathologists are encouraged to advocate on behalf of clients by adopting the highest standards of clinical practice and by evaluating treatment options in a systematic, critical, and ethical manner.

Nonspeech oral motor treatment issues related to children with developmental speech sound disorders.

PURPOSE: This article examines nonspeech oral motor treatments (NSOMTs) in the population of clients with developmental speech sound disorders. NSOMTs are a collection of nonspeech methods and procedures that claim to influence tongue, lip, and jaw resting postures; increase strength; improve muscle tone; facilitate range of motion; and develop muscle control. In the case of developmental speech sound disorders, NSOMTs are employed before or simultaneous with actual speech production treatment. METHOD: First, NSOMTs are defined for the reader, and there is a discussion of NSOMTs under the categories of active muscle exercise, passive muscle exercise, and sensory stimulation. Second, different theories underlying NSOMTs along with the implications of the theories are discussed. Finally, a review of pertinent investigations is presented. RESULTS: The application of NSOMTs is questionable due to a number of reservations that include (a) the implied cause of developmental speech sound disorders, (b) neurophysiologic differences between the limbs and oral musculature, (c) the development of new theories of movement and movement control, and (d) the paucity of research literature concerning NSOMTs. CLINICAL IMPLICATION: There is no substantive evidence to support NSOMTs as interventions for children with developmental speech sound disorders.

A pilot study into the effect of vocal exercises and singing on dysarthric speech.

This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment--the Sentence Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-treatment and a reduction in the number and length of pauses was verified via waveform analysis. Preliminary findings suggest that a program of vocal exercises and singing may facilitate more normative speech production for people with acquired dysarthria and support the need for further research in this area.

Effects of neurosurgical management of Parkinson's disease on speech characteristics and oromotor function.

The present study examined the effects of neurosurgical management of Parkinson's disease (PD), including the procedures of pallidotomy, thalamotomy, and deep-brain stimulation (DBS) on perceptual speech characteristics, speech intelligibility, and oromotor function in a group of 22 participants with PD. The surgical participant group was compared with a group of 25 non-neurologically impaired individuals matched for age and sex. In addition, the study investigated 16 participants with PD who did not undergo neurosurgical management to control for disease progression. Results revealed that neurosurgical intervention did not significantly change the surgical participants' perceptual speech dimensions or oromotor function despite significant postoperative improvements in ratings of general motor function and disease severity. Reasons why neurosurgical intervention resulted in dissimilar outcomes with respect to participants' perceptual speech dimensions and general motor function are proposed.

Dysarthria in traumatic brain injury: a breath group and intonational analysis.

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. This study, based on analyses of conversational and sentence speech samples, reports on breath group structure and its temporal and intonational components for 12 subjects with TBI and 8 healthy controls. It introduces the method of f0 close-copy stylization to the study of intonational patterns in dysarthria. The subjects with TBI had reduced mean length and variation of breath groups along with frequent inappropriate locations of breath pause and lengthy and variable breath pauses. Prosodic features that were preserved in the subjects with TBI were phrase final lengthening, f0 downtrend and a relatively normal f0 distribution. However, these subjects had reduced speaking and articulation rates, reduced f0 movement and reduced f0 slope. The phrase final lengthening and f0 downtrend phenomena, which can serve as prosodic cues of syntactic boundary, appear to be robust features of speech production, but the dynamic features of f0 control were more vulnerable to the neurological damage. This study indicates 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.

Cerebellar mutism associated with a midbrain cavernous malformation. Case report and review of the literature.

The authors report a case of cerebellar mutism arising from a hemorrhagic midbrain cavernous malformation in a 14-year-old boy. No cerebellar lesion was identified; however, edema of the dorsal midbrain was noted on postoperative magnetic resonance images. Dysarthric speech spontaneously returned and then completely resolved to normal speech. This case provides further evidence for the theory that involvement of the dentatothalamic tracts, and not a cerebellar lesion per se, is the underlying cause of "cerebellar" mutism.

Subcortical anarthria: a case report.

A 56-year-old right-handed male with a history of hypertension and diabetes presented two episodes of stroke: The first affected territory was the left anterior coroidal artery (capsular and paracapsular infarcts at the level of the genu and posterior arm of the internal capsule) and the second was the right thalamus, due to a hematoma. Following the first stroke, the patient developed severe dysarthria and after the second stroke remained anarthric. The pathophysiology of the disorder is discussed, and the role of the left and right thalamus as far as speech is concerned is reviewed.

The case of the lawyer's lugubrious language: dysarthria plus primary progressive aphasia or dysarthria plus dementia?

A productive, intelligent, 60-year-old practicing attorney slowly begins to notice that the language that he has commanded throughout his life is beginning to become more difficult to produce, exacting its toll on his mental energy and emotional stability. His search for answers to his diminished "memory for words" leads him through the fetid ranks of traditional medicine and into the search for a differential diagnosis involving clinical neurology, neuropsychology, and speech-language pathology. Consistencies and conflicts in the signs and symptoms between the competing diagnoses raise theoretical and clinical classification issues. A course of treatment for aphasia provides evidence to support the diagnosis of primary progressive aphasia, but the development of concommitant spastic dysarthria and dysphagia challenge current wisdom about the underlying neuropathology of aphasia and support a diagnosis of early dementia. A selective but steady and rapid decline of abilities over the course of 2 years leads to the patient's death and autopsy, from which a neuropathologic analysis was to provide the "final" and "ultimate" diagnosis. But it doesn't!

Dysarthria in bilateral thalamic infarction. A case study.

A patient suffering from bilateral thalamic infarction in the region supplied by the paramedian arteries sparing the internal capsules underwent acoustic analysis of sentence utterances. The results were compared with the findings obtained in parkinsonian subjects, in patients with upper motor neuron lesions, and in normal subjects. Acoustic measurements revealed increased pitch, monotonous speech, rough voice quality, and normal speech tempo concomitant with articulatory impreciseness in terms of incomplete closure productions. This constellation resembled parkinsonian dysarthria. Damage to the thalamic projection area of the pallidal efferents, therefore, seems to be the most probable cause of the patient's speech disorders. In parkinsonian subjects stereotactical lesions of this structure ameliorate rigor, but not akinesia. Thus, our patient's speech deficits, and by analogy the corresponding parkinsonian dysarthric disturbances, may be considered akinetic signs.