[Could speech rate of Wilson's disease dysarthric patient be improved in dual task condition?]. / Le débit de parole du patient wilsonien dysarthrique peut-il être amélioré en condition de double tâche?

INTRODUCTION: Dysarthria is one of the first sign of neurological Wilson's disease and is often characterized by a decreased speech rate. The aim of this study is to determine the abilities of Wilson's disease dysarthric patients to control their speech rate. We examined the impact of dual-tasking on the speech rate of patients as compared to healthy control speakers and in relation with their ability to accelerate speech rate when instructed to do so. METHODS: Twenty-six patients and twenty-six age- and sex-matched healthy controls repeated a sentence during 20 seconds at a comfortable speech rate used as reference. They were then asked to perform the same repetition task but in dual task conditions, in which sentence repetition was done while performing three types of executive grapho-motor tasks. Finally, the ability to control speech rate was tested by asking the speakers to perform the sentence repetition task alone but at a fast rate of speech. RESULTS: A significantly slower speech rate was observed for all patients as compared to controls. In the dual-task conditions, while the speech rate of healthy speakers accelerated significantly, two behaviors are found for the patients. Forty-two percent of the patients reproduced the control pattern with a significant increased in speech rate, while the other group significantly decreased their speech rate. Comparison of the ability of the two groups to intentionally modulate speech rate, when instructed to accelerate, shows that significantly better acceleration was achieved by speakers in the former group compared with the latter. CONCLUSIONS: This study supports the finding that patients with Wilson's disease exhibit an impaired speech rate and also impaired control of speech rate. Indirect assessment of speech rate modulation with the help of a dual-task paradigm has proven to be useful to distinguish patient behaviors. This paradigm could also be envisioned as a tool for rehabilitation.

[A perceptual study of question and assertive modalities after vertical partial laryngectomies]. / Etude perceptive des modalités interrogatives et assertives après laryngectomies partielles verticales.

OBJECTIVES: Our study concerns the perception of the contrast between assertives and question modalities in patients having undergone a cordectomy or a vertical partial laryngectomy. MATERIAL AND METHODS: Four patients (2 cordectomies and 2 vertical partial laryngectomies), age from 57 to 66 year old (average 61; median 61) were included. They were recorded while producing logatomes, constituents and sentences in the assertive and question modalities. Perceptual evaluation was analysed using Praat software. The assessors (consisting of 8 French native auditors, 4 men and 4 women) evaluated 80 stimuli. RESULTS: Our results show a good average rate of modality recognition with a good intelligibility for these patients. The more frequent errors were in the vertical partial laryngectomies group who had more unpredictable modulations. CONCLUSION: Our small sample does not allow us to generalize but our first observations tend to show that these patients have a good capability in producing question and assertive modalities.

[Evolution of voice assessment and quality of life after endoscopic laser cordectomy]. / Evolution de la voix et de la qualité de vie après cordectomie au laser CO2 par voie endoscopique.

OBJECTIVES: Endoscopic laser cordectomy is a minimally invasive surgical technique for Tis, T1 and selected T2 glottic carcinoma. The purpose of the study was to evaluate prospectively pre-operatively and 3 months after surgery i) acoustic and perceptual parameters, ii) quality of life through a self evaluation (VHI) test. METHODS: A prospective longitudinal evaluation of 13 male patients, shared-out onto 3 surgical procedures (cordectomy type I, grouped type II and III, and type V). Patients were recorded before and at 1 and 3 months after surgery. The parameters recorded were; acoustic parameters (F0, Jitter, Shimmer), Maximum Phonation Time (MPT), perceptual evaluation using the GRBAS scale and the self evaluation scale with the Voice Handicap Index (VHI). RESULTS: No statistics could be done because of the limited number of patients in each group. Perceptual and self evaluation data showed a favorable progression between 1 and 3 months for patients in group Type I, II and III cordectomy. Evolution of acoustic parameters is more difficult to analyze. The voice of the Cordectomy type V group remains whispery at 3 months after surgery. CONCLUSION: The quality of voice is a very important criterion for the patients. During the first 3 months after laser cordectomy, the perceptual vocal function and the self evaluation improves. But for the acoustic data, 3 months is probably too short to objectively quantify an improvement especially after type V cordectomy.

[Vocal effectiveness in speech and singing: acoustical, physiological and perceptive aspects. applications in speech therapy]. / L'efficacité vocale dans la parole et le chant lyrique : aspects acoustique, physiologique et perceptif. applications orthophoniques.

OBJECTIVE: What is vocal effectiveness in lyrical singing in comparison to speech? Our study tries to answer this question, using vocal efficiency and spectral vocal effectiveness. MATERIAL AND METHODS: Vocal efficiency was mesured for a trained and untrained subject. RESULTS: According to these invasive measures, it appears that the trained singer uses her larynx less efficiently. Efficiency of the larynx in terms of energy then appears to be secondary to the desired voice quality. The acoustic measures of spectral vocal effectiveness of vowels and sentences, spoken and sung by 23 singers, reveal two complementary markers: The "singing power ratio" and the difference in amplitude between the singing formant and the spectral minimum that follows it. Magnetic resonance imaging and simulations of [a], [i] and [o] spoken and sung show laryngeal lowering and the role of the piriform sinuses as the physiological foundations of spectral vocal effectiveness, perceptively related to carrying power. CONCLUSION: These scientifical aspects allow applications in voice therapy, such as physiological and perceptual foundations allowing patients to recuperate voice carrying power with or without background noise.

[Dysphonia: current methods of evaluation]. / Méthodes actuelles d'évaluation des dysphonies.

OBJECTIVES: The aim of this review article was to provide an update on current techniques for evaluation of dysphonia in routine clinical practice. MATERIALS AND METHODS: Recent medical and other scientific literature was reviewed and pertinent current theories concerning the physiology of laryngeal function described. RESULTS: Perceptual voice quality evaluation by a professional jury of listeners is still considered to be the most reliable and complete means of evaluating pathologic voice, even though it is difficult to perform in routine and the results lack reproducibility. The objective evaluation of the vocal fundamental frequency and its variations and the spectral characteristics of voice has the advantage of being simple to perform, reproducible and quantifiable. However, automatic measurements need to be analyzed with precaution for severe dysphonia, the computer algorithms being designed for voices retaining a certain periodicity. Aerodynamic measurements are quantifiable and reproducible and provide information as to the quality of laryngeal function as a transducer of aerodynamic energy into acoustic energy. Videostroboscopy and electroglottography provide information as to the quality of the laryngeal vibrations, the source of sound production. CONCLUSIONS: All of these types of analysis are complementary, informing as to different aspects of vocal quality and laryngeal function. No one measurement alone can diagnose or characterize dysphonia.

[Intrinsic and co-intrinsic vowel characteristics in cerebellar and parkinsonian dysarthrias]. / Caractéristiques vocaliques intrinsèques et co-intrinsèques dans les dysarthries cérébelleuse et parkinsonienne.

Few studies were made on the intrinsic and co-intrinsic vowel characteristics in neurologic dysarthrias. This work evaluates these parameters in a group of 4 subjects with cerebellar dysarthria suffering from a cerebellar degenerative syndrome and a group of 4 subjects with Parkinson disease suffering from parkinsonian dysarthria. These subjects were compared with 10 control subjects. An intensive speech treatment inspired from the Lee Silverman voice treatment (LSVT) was applied to one of the parkinsonian subjects of the study, with assessment before and after rehabilitation. The acoustic measures assessed the duration and the frequency of the vowels [a, i, ul indifferent contexts as well as their formant frequency and sentence duration. The results show different impairments according to the type of the dysarthria, and some forms of contrast transposition. Speech therapy restores subnormal contrasts.

[Intelligibility of French consonants after partial supra-cricoid laryngectomy]. / Etude de l'intelligibilité des consonnes du français après laryngectomie partielle supra-cricoïdienne.

INTRODUCTION: The purpose of this study was to determine what patterns of perceptual confusions characterize the voice of patients after supracricoïd partial laryngectomy (SCPL) by the identification tests of French consonants. We evaluated the voicing distinction. METHODS: Ten male patients were recorded 18 months after SCPL. Audio recordings of the 16 French consonants in a syllabic context (CV) produced by each talker with three repetitions were presented to three expert listeners. The listeners transcribed their responses using an open-response paradigm. Listeners' pooled responses were converted to confusion matrices. RESULTS: Voicing features were altered with a shift of voiced consonants towards voiceless consonants (24%), predominantly for stop consonants. CONCLUSION: Consonant articulation appears to impose certain constraints on voicing ability of SCPL patients, since voiced consonants are predominantly perceived as voiceless consonants. Presumably, this poor voicing ability is the direct consequence of the mechanical properties of the neoglottis that are far different from those of the vocal folds. Moreover, assessing consonant identification and intelligibility should help to improve voice therapy and efficiency of speech.

Objective voice quality analysis before and after onset of unilateral vocal fold paralysis.

This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery). The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.

[Articulatory compensation after supracricoid partial laryngectomy with cricohyoidoepiglottopexy]. / Compensations articulatoires après laryngectomie partielle supracricoïdienne avec cricohyoïdoépiglottopexie.

OBJECTIVES: The consequences of the modification of the glottis and the shortening of the vocal tract after supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) were investigated prospectively on ten patients. An acoustic analysis of the transfer function of the vocal tract was performed by measuring the formant frequencies of the [a] and [i] vowels. The articulation compensatory mechanisms of the vocal tract were observed with cinefluoroscopy in order to evaluate the phonation and articulation constraints. PATIENTS AND METHODS: Ten male patients were recorded before surgery and at six, 12 and 18 months after surgery. The results were compared with those of 10 male normal speakers having the same range of age. For the acoustic measures, we tracked the three first formant frequencies of the cardinal vowels [a] and [i], before and after surgery. Articulation investigation was performed with cinefluoroscopy for the vowels [a] and [i] uttered by two of the 10 patients. RESULTS: For the [a] vowel, the acoustic analysis showed higher values for all three formants, related to the shortening of the vocal tract after surgery. For the [i] vowel, the lowering of the second formant frequencies after surgery was related to an articulatory compensation. Cinefluoroscopy confirmed the shortening of the vocal tract, the tongue-root retraction for voicing and the anterior position of the tip of the tongue for the [i] vowel. CONCLUSIONS: The consequences of the shortening of the vocal tract after SCPL with CHEP can be evaluated, non invasively, by means of acoustic analysis. The understanding of the articulation compensatory mechanisms resulting from voicing constraints should help voice rehabilitation and improve oral communication in such patients.

Objective voice analysis after autologous fat injection for unilateral vocal fold paralysis.

This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.

Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis.

The aim of this prospective study was to analyse airway improvement and acoustic and aerodynamic parameters after CO2 laser posterior transverse cordotomy (LPTC) in bilateral vocal fold paralysis (BVFP). Four patients (2 males, 2 females) were recorded pre- and post-operatively at 1, 3, 6, 12 and 24 months. Forced inspiratory volume during the first second (FIV), vital capacity, peakflow, and forced expiratory volume during the first second (FEV) were measured with the Gould II spirometer. Acoustic frequency features (average fundamental frequency, standard deviation, jitter, shimmer and harmonic-to-noise ratio) and speech duration parameters (maximum phonation time, number of words read per minute, and number of words per breath) were measured. Aerodynamic parameters were measured with the Aerophone II. Three tasks were completed. Pneumo-phonatory parameters in "maximum sustained phonation" and in "comfortable phonation", and laryngeal aerodynamic parameters (intraoral air pressure, oral airflow and sound pressure level) were measured non-invasively. Glottal resistance and vocal efficiency were calculated. FIV increased significantly after LPTC (p = 0.01). Postoperatively, frequency features were undetectable by standard commercialized algorithms. Acoustic and aerodynamic parameters improved in the measures obtained at the 6th postoperative month. These results were stable 2 years postoperatively in all cases. We conclude that laryngeal aerodynamic parameters can be used objectively to follow patients longitudinally after LPTC.