Effects of Conventional Speech Therapy with Liuzijue Qigong, a Traditional Chinese Method of Breath Training, in 70 Patients with Post-Stroke Spastic Dysarthria.

BACKGROUND Post-stroke spastic dysarthria (PSSD) is a motor speech impairment that impacts patient communication and quality of life. Liuzijue Qigong (LQG), a traditional Chinese method of breath training, could serve as an effective treatment for PSSD. This study compared the effects of conventional speech therapy and conventional speech therapy combined with LQG in patients with PSSD. MATERIAL AND METHODS Seventy patients with PSSD were randomly divided into a control group (conventional speech therapy, n=35, 77.14% cerebral infarction, 22.86% cerebral hemorrhage) and experimental group (LQG combined with conventional speech therapy, n=35, 85.71% cerebral infarction, 14.29% cerebral hemorrhage). Conventional speech therapy included relaxation, breath control, organ articulation, and pronunciation training. LQG involved producing 6 different sounds (Xu, He, Hu, Si, Chui, and Xi) accompanied by breathing and body movements. Patients were treated once a day, 5 times a week, for 4 weeks. The Frenchay Dysarthria Assessment scale (FDA), speech articulation, maximum phonation time (MPT), loudness, and Montreal Cognitive Assessment scale (MoCA) were evaluated. RESULTS At 4 weeks, the experimental group showed significant improvements compared with the control group in the change of FDA (13.26±6.84 vs 18.03±5.32, P=0.028), speech articulation (63.17±22.40 vs 76.51±15.28, P=0.024), MPT (1.34±1.30 vs 3.89±3.98, P<0.001), loudness (3.46±2.74 vs 7.14±2.56, P=0.009), MoCA (19.40±3.72 vs 22.20±5.30, P=0.020), total effective rate (68.57% vs 88.57%, P=0.041). CONCLUSIONS LQG, when combined with conventional speech therapy, enhanced the comprehensive speech ability of patients with PSSD compared with conventional treatment alone.

Lateral cerebellothalamic tract activation underlies DBS therapy for Essential Tremor.

BACKGROUND: While deep brain stimulation (DBS) therapy can be effective at suppressing tremor in individuals with medication-refractory Essential Tremor, patient outcome variability remains a significant challenge across centers. Proximity of active electrodes to the cerebellothalamic tract (CTT) is likely important in suppressing tremor, but how tremor control and side effects relate to targeting parcellations within the CTT and other pathways in and around the ventral intermediate (VIM) nucleus of thalamus remain unclear. METHODS: Using ultra-high field (7T) MRI, we developed high-dimensional, subject-specific pathway activation models for 23 directional DBS leads. Modeled pathway activations were compared with post-hoc analysis of clinician-optimized DBS settings, paresthesia thresholds, and dysarthria thresholds. Mixed-effect models were utilized to determine how the six parcellated regions of the CTT and how six other pathways in and around the VIM contributed to tremor suppression and induction of side effects. RESULTS: The lateral portion of the CTT had the highest activation at clinical settings (p < 0.05) and a significant effect on tremor suppression (p < 0.001). Activation of the medial lemniscus and posterior-medial CTT was significantly associated with severity of paresthesias (p < 0.001). Activation of the anterior-medial CTT had a significant association with dysarthria (p < 0.05). CONCLUSIONS: This study provides a detailed understanding of the fiber pathways responsible for therapy and side effects of DBS for Essential Tremor, and suggests a model-based programming approach will enable more selective activation of lateral fibers within the CTT.

Home-based biofeedback speech treatment improves dysarthria in repeat-expansion SCAs.

CAG repeat-expansion spinocerebellar ataxias (CAG-SCAs) are genetically defined multisystemic degenerative diseases, resulting in motor symptoms including dysarthria with a substantial impact on daily living. Whilst speech therapy is widely recommended in ataxia, very limited evidence exists for its use. We evaluated the efficacy of a home-delivered, ataxia-tailored biofeedback-driven speech therapy in CAG-SCA in 16 individuals with SCA1, 2, 3, or 6. Treatment was delivered intensively over 20 days. Efficacy was evaluated by blinded ratings of intelligibility (primary) and acoustic measures (secondary) leveraging an intra-individual control design. Intelligibility improved post-treatment (Z = -3.18, p = 0.004) whilst remaining stable prior to treatment (Z = 0.53, p = 1.00).

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.

Feasibility of a standardized protocol for respiratory training with intermitted positive pressure breathing ventilator application in dysphonia and dysarthria.

BACKGROUND: Brain damage can affect several functions related to speech production leading to dysphonia and dysarthria. Most rehabilitation treatments focus on articulation training rather than on pneumophonic coordination and respiratory muscle strength. Respiratory training using an intermitted positive pressure breathing (IPPB) ventilator can be used for this last purpose; no agreement on a standard protocol has been reached to date. AIM: To evaluate the feasibility and the effectiveness of a standardized incremental protocol of respiratory training using IPPB to treat dysphonia and dysarthria. DESIGN: Case series study. SETTING: Neuropsychological Rehabilitation Unit in an Italian Neurorehabilitation Division. POPULATION: Thirty-two subjects with dysphonia and dysarthria resulting from neurological lesion. METHODS: Participants were assessed using clinical evaluation scales (GIRBAS scale of dysphonia, Robertson dysarthria profile), respiratory function test, and arterial blood gas analysis in air. The evaluations were performed at baseline and after 20 sessions of respiratory training with IPPB. The protocol provided a default increment of ventilator parameters. All subjects also underwent a standard speech and language therapy treatment. A satisfaction survey to assess acceptability and the Goal Attainment Scale were applied. RESULTS: All participants fulfilled the protocol. No complications or discomfort were reported. Subjects' satisfaction at survey was 97.7%. After respiratory training, all respiratory function parameters increased, but only maximal voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were statistically significant (P<0.05). Clinical evaluation scales significantly improved (P<0.05). Correlation between respiratory function parameters and clinical evaluation scales showed a moderate correlation between MVV, MEP, MIP, and Robertson dysarthria profile (P<0.01). A weak correlation was found between MIP, MVV, and GIRBAS scale (P<0.05). CONCLUSIONS: Our protocol showed to be practical and well-tolerated. After respiratory training, MVV, MIP and MEP improved in significantly. Clinical scale scores improved in all participants. CLINICAL REHABILITATION IMPACT: Respiratory training using IPPB ventilator can be useful in implementing speech and language treatments in subjects with dysphonia and dysarthria linked to brain injury.

Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial.

OBJECTIVE: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. INTERVENTION: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. MAIN OUTCOME MEASURES: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. RESULTS: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. CONCLUSIONS: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

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.

Psychosocial Impact of Dysarthria: The Patient-Reported Outcome as Part of the Clinical Management.

BACKGROUND: Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable. OBJECTIVE: We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases. METHODS: We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson's disease [PD], Huntington's disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP. RESULTS: The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = -0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact. CONCLUSIONS: All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.

[Acupuncture for dysarthria: systematic review].

OBJECTIVE: To systematically evaluate the clinical efficacy of acupuncture for dysarthria, and to explore the rules of acupoints selection for dysarthria. METHODS: The clinical randomized control trial literature regarding acupuncture for dysarthria published before January of 2018 were searched in databases, including CNKI, Wanfang, VIP, CBM, PubMed, Ebsco, Science Direct and Cochrane Library. The information of included studies was extract and the quality was assessed. The Meta analysis was performed by using RevMan 5.3 software. The frequency of acupoints was calculated by using Excel software to analyzed the rules of acupoints selection. RESULTS: Totally 21 papers were included, involving 1651 patients. The pooled effects of clinical efficacy: heterogeneity test P =0.74, I 2=0%, OR =6.36, 95% CI: 4.55, 8.88, Z =10.84 (P<0.01), indicating the efficacy in the treatment group was significantly higher than that in the control group. The pooled effects of the symptom score in Frenchay scale: heterogeneity test P =0.56, I 2=0%, WMD =3.20, 95% CI: 1.38, 5.02, Z =3.45 (P<0.01), indicating the efficacy in the treatment group was significantly higher than that in the control group. The acupoints with frequency of more than 5 times were Fengchi (GB 20), Yuye (EX-HN 13), Jinjin (EX-HN 12), Lianquan (CV 23), Baihui (GV 20), tongue-three needles and Yamen (GV15). The meridians with frequency of more than 5 times were the extra channels, governor vessel, gallbladder channel, conception vessel and stomach channel. CONCLUSION: The clinical efficacy of acupuncture combined with speech training/regular treatment is significantly superior to that of control group (speech training, medication, regular treatment); acupuncture is safe and effective for dysarthria; the majority of selected acupoint is local acupoints around tongue, throat and neck, as well as extra points and empirical points. However, high-quality randomized controlled trials with large sample sizes are still needed to provide further evidence.

[Effects of tongue acupuncture combined with rehabilitation training group of dysarthria on speech function in post-stroke dysarthria patients].

OBJECTIVE: To observe the effects of tongue and nape acupuncture combined with rehabilitation training group of dysarthria on speech function in post-stroke dysarthria patients, and to explore the treatment of dysarthria. METHODS: Eighty patients with dysarthria were randomly divided into an observation group (40 cases) and a control group (40 cases). The patients in the two groups were treated with conventional treatment. The patients in the control group were treated with the acupuncture combined with rehabilitation training group of dysarthria; the patients in the observation group were treated with the control group treatment and tongue acupuncture, once a day, 6 days per week for 2 weeks. The patients were evaluated with general dysarthria scale and dysarthria checklist of Chinese Rehabilitation Study Center before and after 2-week treatment. RESULTS: After treatment, the total score and each item score of general dysarthria scale were reduced (all P<0.05); all the score in the observation group was lower than those in the control group (all P<0.05), except the score of jaw which had no significant difference between the two groups. After treatment, the dysarthria checklist of Chinese Rehabilitation Study Center in the observation group was superior to that in the control group (P<0.05). The total effective rate was 85.0% (34/40) in the observation group, which was higher than 67.5% (27/40) in the control group (P<0.05). CONCLUSION: Tongue acupuncture, nape acupuncture and rehabilitation training group of dysarthria could effectively improve the speech function of post-stroke dysarthria patients.

Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences.

PURPOSE: People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. METHOD: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). RESULTS: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. CONCLUSIONS: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. IMPLICATIONS FOR REHABILITATION: Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

The Role of Somatosensory Information in Speech Perception: Imitation Improves Recognition of Disordered Speech.

PURPOSE: Perceptual learning paradigms involving written feedback appear to be a viable clinical tool to reduce the intelligibility burden of dysarthria. The underlying theoretical assumption is that pairing the degraded acoustics with the intended lexical targets facilitates a remapping of existing mental representations in the lexicon. This study investigated whether ties to mental representations can be strengthened by way of a somatosensory motor trace. METHOD: Following an intelligibility pretest, 100 participants were assigned to 1 of 5 experimental groups. The control group received no training, but the other 4 groups received training with dysarthric speech under conditions involving a unique combination of auditory targets, written feedback, and/or a vocal imitation task. All participants then completed an intelligibility posttest. RESULTS: Training improved intelligibility of dysarthric speech, with the largest improvements observed when the auditory targets were accompanied by both written feedback and an imitation task. Further, a significant relationship between intelligibility improvement and imitation accuracy was identified. CONCLUSIONS: This study suggests that somatosensory information can strengthen the activation of speech sound maps of dysarthric speech. The findings, therefore, implicate a bidirectional relationship between speech perception and speech production as well as advance our understanding of the mechanisms that underlie perceptual learning of degraded speech.

Survey of UK speech and language therapists' assessment and treatment practices for people with progressive dysarthria.

BACKGROUND: Dysarthria knowledge is predominantly impairment-based. As a result, speech and language therapists (SLTs) have traditionally adopted impairment-focused management practices. However, guidance for best practice suggests that SLTs should consider the client holistically, including the impact of dysarthria beyond the impairment. AIMS: To investigate the current assessment and treatment practices used by UK SLTs with clients with progressive dysarthria and to identify whether these satisfy the needs of SLTs in their everyday practice. To investigate the extent to which they consider oromotor abilities, intelligibility, functional communication, participation and interaction to be important regarding assessment and treatment decisions. To explore whether management decisions are affected by level of clinical experience or settings in which SLTs work. METHODS & PROCEDURES: An online survey of UK SLTs working with adults with progressive dysarthria. OUTCOMES & RESULTS: A total of 119 SLTs completed the survey. Respondents considered that targeting the levels of impairment, activity and participation are important in the management of clients with progressive dysarthria, as recommended by clinical guidelines and recent research. However a particularly high proportion of respondents reported the use of impairment-based assessments. Respondents reported lacking the necessary tools to target interaction in assessment and intervention. The intervention that respondents use with clients varies according to the progressive disorder and dysarthria severity. There is evidence for a trend that less experienced SLTs and those working predominantly in hospital-based settings focus on the impairment, whereas more SLTs with more experience and those based in predominantly community-based settings look beyond the impairment. CONCLUSIONS & IMPLICATIONS: The values held by SLTs match guideline recommendations for best practice, however the clinical reality is that the assessment of progressive dysarthria remains predominantly impairment-focused. New tools need to be developed and integrated into practice to target interaction in assessment and intervention, to reduce the gap between best practice recommendations and clinical reality. Ongoing research into the effectiveness of SLT intervention with clients with progressive dysarthria is required to guide clinical management decisions.

Auditory discrimination as a condition for E-learning based Speech Therapy: a proposal for an auditory discrimination test (ADT) for adult dysarthric speakers.

BACKGROUND: Web based speech training for dysarthric speakers, such as E-learning based Speech Therapy (EST), puts considerable demands on auditory discrimination abilities. AIMS: To discuss the development and the evaluation of an auditory discrimination test (ADT) for the assessment of auditory speech discrimination skills in Dutch adult dysarthric speakers as a prelude to EST. METHOD: Five ADT subtests were developed, each addressing a vital speech dimension in speech therapy: articulation (segmental elements), intensity, overall pitch, speech rate and intonation. A healthy control group of 36 participants performed a 'same-different task' in each subtest. ADT items yielding scores of at least 80% but below 100% correctly responding healthy controls were considered sensitive to diminished auditory discrimination. Subsequently, the ADT was carried out by 14 neurological patients with dysarthric speech and 14 matched healthy controls. Score percentages, sensitivity indices and reaction times (ms) on only sensitive items were compared. RESULTS: The majority of the ADT items met the 'minimal 80% to below 100% criterion' in the healthy control group. The neurological participants performed lower on all outcome measures across all subtests than the healthy controls, although not all of these differences achieved statistical significance. CONCLUSIONS: The results of the healthy control group show that the majority of the ADT items meet our criterion for sensitivity to diminished auditory discrimination. The poorer performance of dysarthric patients across all subtests supports the sensitivity of the ADT. However, further research involving larger and more homogeneous groups of neurological patients is required. LEARNING OUTCOMES: Readers will be encouraged to (1) identify potential factors that may hinder web based speech training and (2) estimate the value of assessing auditory discrimination skills as a vital condition for (web based) speech training in dysarthric patients.

[Effect of acupuncture on the speech and acoustics level in patients with dysarthria].

OBJECTIVE: To observe the effect of acupuncture combined with speech therapy for dysarthria after stroke or cerebral trauma. METHODS: Sixty-one cases were randomly divided into two groups. The observation group (30 cases) was treated with speech therapy and acupuncture at Lianquan (CV 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), Fengchi (GB 20), Yifeng (TE 17) and Wangu (GB 12) as major acupoints, while the control group (31 cases) was treated with speech therapy only. The changes of speech and acoustics indices were evaluated after 9 weeks treatment. RESULTS: The word articulation and correct rate of text of patients in two groups were both obviously improved after treatment (both P < 0.01). The total effective rate of 96.7% (29/30) in observation group was superior to that of 67.7% (21/31) in control group (P < 0.01). The maximum phonation time (MPT) of patients tested by aeromechanics analyzer were obviously prolonged in observation group (12 cases) and control group (11 cases) (both P < 0.01), and the improvement in observation group was more obvious (P < 0.01). CONCLUSION: Acupuncture combined with speech therapy can improve the effect on language and acoustics level for dysarthria.

Changes to articulation following LSVT(R) and traditional dysarthria therapy in non-progressive dysarthria.

The present study aimed to evaluate the effects of the Lee Silverman Voice Treatment (LSVT(R)) on acoustic and perceptual measures of articulation in non-progressive dysarthria in comparison to traditional dysarthria therapy. The study involved 26 individuals with non-progressive dysarthria who were randomly allocated to receive either LSVT(R) or traditional dysarthria therapy (TRAD), both of which were administered for 16 hourly sessions over 4 weeks. Participants' speech samples were collected over a total of six testing sessions during three assessment phases: (1) prior to treatment, (2) immediately post-treatment, and (3) 6 months post-treatment (FU). Speech samples were analysed perceptually to determine articulatory precision and intelligibility as well as acoustically using vowel space (and vowel formant measures) and first moment differences. Results revealed short and long-term significant increases in vowel space area following LSVT(R). Significantly increased intelligibility was also found at FU in the LSVT(R) group. No significant differences between groups for any variables were found. The study reveals that LSVT(R) may be a suitable treatment option for improving vowel articulation and subsequent intelligibility in some individuals with non-progressive dysarthria.

A phonation therapy approach for Mandarin-English bilingual clients with dysarthria.

This study aims to measure the speech intelligibility of Mandarin-English speakers with dysarthria before and after phonation therapy, in order to determine the effectiveness of this approach. A within-group design was used with two case studies which allowed one to measure therapy variables (single word and sentences); language variables (Mandarin and English); and speech production variables (respiration, phonation, articulation, resonance, and prosody). Both participants demonstrated highly significant improvement in Mandarin intelligibility scores after therapy compared with minimal changes in English intelligibility. These results demonstrate for the first time that phonation therapy is effective in increasing intelligibility, for Mandarin more than for English. Phonation therapy is also effective in enhancing accurate tone production for all four tones of Mandarin. We discuss the evidence that phonation therapy is significantly more effective for rehabilitating Mandarin-English bilinguals with dysarthria in Mandarin (a tonal language) than in English (a non-tonal language).

The tongue: deglutition, orofacial functions and craniofacial growth.

So-called "primary" or "infantile" forms of deglutition, also termed lingual dyspraxia, are treated in different ways by orthodontists using various appliances to correct the condition and are also managed by speech-therapists and physiotherapists. The results obtained are often unstable. We have developed a more holistic approach to this disorder by attempting to grasp the underlying mechanisms in order to achieve more satisfactory correction. By establishing normal salivary deglutition more rapidly, this manual osteopathic technique complements the methods which use voluntary rehabilitation to impress upon the body's physical reflexes the "motor image" of the act to be accomplished. In order to render this article more lively and accessible, we have chosen to let the tongue speak in the first person--which, after all, is only normal!

[Speach breasing optimization with biofeedback on respiratory arrythmia of heart rate].

Dynamics of physiological and psychological characteristics of healthy volunteers (adolescents and adults), speech professionals (logopedics), and stutter patients (adolescents and adults) in process of adoptive self-regulation with biofeedback on objective physiologic indicator - changes of respiratory arrhythmia of hart rate were investigated. High level of efficacy and practicability of the method application was revealed to study, diagnostics, optimization and correction of breathing, speech and behavior.