The Impact of Stimulus Length in Tongue and Lip Movement Pattern Stability in Amyotrophic Lateral Sclerosis.

PURPOSE: This study aimed to investigate the effect of stimulus signal length on tongue and lip motion pattern stability in speakers diagnosed with amyotrophic lateral sclerosis (ALS) compared to healthy controls. METHOD: Electromagnetic articulography was used to derive articulatory motion patterns from individuals with mild (n = 27) and severe (n = 16) ALS and healthy controls (n = 25). The spatiotemporal index (STI) was used as a measure of articulatory stability. Two experiments were conducted to evaluate signal length effects on the STI: (a) the effect of the number of syllables on STI values and (b) increasing lengths of subcomponents of a single phrase. Two-way mixed analyses of variance were conducted to assess the effects of syllable length and group on the STI for the tongue tip (TT), tongue back (TB), and lower lip (LL). RESULTS: Experiment 1 showed a significant main effect of syllable length (TT, p < .001; TB, p < .001; and LL, p < .001) and group (TT, p = .037; TB, p = .007; and LL, p = .017). TB and LL stability was generally higher with speech stimuli that included a greater number of syllables. Articulatory variability was significantly higher in speakers diagnosed with ALS compared to healthy controls. Experiment 2 showed a significant main effect of length (TT, p < .001; TB, p = .015; and LL, p < .001), providing additional support that STI values tend to be greater when calculated on longer speech signals. CONCLUSIONS: Articulatory stability is influenced by the length of speech signals and manifests similarly in both healthy speakers and persons with ALS. TT stability may be significantly impacted by phonemic content due to greater movement flexibility. Compared to healthy controls, there was an increase in articulatory variability in those with ALS, which likely reflects deviations in speech motor control. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24463924.

Measuring Articulatory Patterns in Amyotrophic Lateral Sclerosis Using a Data-Driven Articulatory Consonant Distinctiveness Space Approach.

PURPOSE: The aim of this study was to leverage data-driven approaches, including a novel articulatory consonant distinctiveness space (ACDS) approach, to better understand speech motor control in amyotrophic lateral sclerosis (ALS). METHOD: Electromagnetic articulography was used to record tongue and lip movement data during the production of 10 consonants from healthy controls (n = 15) and individuals with ALS (n = 47). To assess phoneme distinctness, speech data were analyzed using two classification algorithms, Procrustes matching (PM) and support vector machine (SVM), and the area/volume of the ACDS. Pearson's correlation coefficient was used to examine the relationship between bulbar impairment and the ACDS. Analysis of variance was used to examine the effects of bulbar impairment on consonant distinctiveness and consonant classification accuracies in clinical subgroups. RESULTS: There was a significant relationship between the ACDS and intelligible speaking rate (area, p = .003; volume, p = .010), and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore (area, p = .009; volume, p = .027). Consonant classification performance followed a consistent pattern with bulbar severity, where consonants produced by speakers with more severe ALS were classified less accurately (SVM = 75.27%; PM = 74.54%) than the healthy, asymptomatic, and mild-moderate groups. In severe ALS, area of the ACDS was significantly condensed compared to both asymptomatic (p = .004) and mild-moderate (p = .013) groups. There was no statistically significant difference in area between the severe ALS group and healthy speakers (p = .292). CONCLUSIONS: Our comprehensive approach is sensitive to early oromotor changes in response due to disease progression. The preserved articulatory consonant space may capture the use of compensatory adaptations to counteract influences of neurodegeneration. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22044320.

Tongue and Lip Acceleration as a Measure of Speech Decline in Amyotrophic Lateral Sclerosis.

PURPOSE: The goal of this study was to examine the efficacy of acceleration-based articulatory measures in characterizing the decline in speech motor control due to amyotrophic lateral sclerosis (ALS). METHOD: Electromagnetic articulography was used to record tongue and lip movements during the production of 20 phrases. Data were collected from 50 individuals diagnosed with ALS. Articulatory kinematic variability was measured using the spatiotemporal index of both instantaneous acceleration and speed signals. Linear regression models were used to analyze the relationship between variability measures and intelligible speaking rate (a clinical measure of disease progression). A machine learning algorithm (support vector regression, SVR) was used to assess whether acceleration or speed features (e.g., mean, median, maximum) showed better performance at predicting speech severity in patients with ALS. RESULTS: As intelligible speaking rate declined, the variability of acceleration of tongue and lip movement patterns significantly increased (p < 0.001). The variability of speed and vertical displacement did not significantly predict speech performance measures. Additionally, based on R2 and root mean square error (RMSE) values, the SVR model was able to predict speech severity more accurately from acceleration features (R2 = 0.601, RMSE = 38.453) and displacement features (R2 = 0.218, RMSE = 52.700) than from speed features (R2 = 0.554, RMSE = 40.772). CONCLUSION: Results from these models highlight differences in speech motor control in participants with ALS. The variability in acceleration of tongue and lip movements increases as speech performance declines, potentially reflecting physiological deviations due to the progression of ALS. Our findings suggest that acceleration is a more sensitive indicator of speech deterioration due to ALS than displacement and speed and may contribute to improved algorithm designs for monitoring disease progression from speech signals.

Voice Onset Time in Early- and Late-Stage Amyotrophic Lateral Sclerosis.

PURPOSE: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects bulbar functions including speech and voice. Voice onset time (VOT) was examined in speakers with ALS in early and late stages to explore the coordination of the articulatory and phonatory systems during speech production. METHOD: VOT was measured in nonword /bap/ produced by speakers with early-stage ALS (n = 11), late-stage ALS (n = 6), and healthy controls (n = 13), and compared with speech performance decline (a marker of disease progression) in ALS. RESULTS: Overall comparison of the VOT values among the three groups showed a significant difference, F(2,27) = 11.71, p < .01. Speakers in late-stage ALS displayed longer voicing lead (negative VOT) than both healthy speakers and speakers in early-stage ALS. VOT was also significantly negatively correlated with speech performance (i.e., Intelligible Speaking Rate), r(15) = .74, p < .01. CONCLUSIONS: Speakers with more severe ALS showed greater occurrence of voicing lead and longer voicing lead. Findings show voicing precedes articulatory onset with disease progression in the production of bilabial stops, which suggests that the relative timing of coordination between the supralaryngeal structures and the phonatory system is affected in the late stage of ALS.

Pharyngeal Pressure Variability During Volitional Swallowing Maneuvers.

PURPOSE: Within-individual pharyngeal swallowing pressure variability differs among pharyngeal regions in healthy individuals and increases with age. It remains unknown if pharyngeal pressure variability is impacted by volitional swallowing tasks. We hypothesized that pressure variability would increase during volitional swallowing maneuvers and differ among pharyngeal regions depending on the type of swallowing task being performed. METHOD: Pharyngeal high-resolution manometry was used to record swallowing pressure data from 156 healthy participants during liquid (5 cc) or saliva swallows, and during volitional swallowing tasks including effortful swallow, Mendelsohn maneuver, Masako maneuver, or during postural adjustments. The coefficient of variation was used to determine pressure variability of velopharynx, tongue base, hypopharynx, and upper esophageal sphincter regions. Repeated-measures analysis of variance was used on log-transformed data to examine effects of pharyngeal region and swallowing tasks on swallow-to-swallow variability. RESULTS: There was a significant main effect of task with greater pressure variability for the effortful swallow (p = .002), Mendelsohn maneuver (p < .001), Masako maneuver (p = .002), and the head turn (p = .006) compared with normal effort swallowing. There was also a significant main effect of region (p < .01). In general, swallowing pressure variability was lower for the tongue base and upper esophageal sphincter regions than the hypopharynx. There was no significant interaction of task and region (effortful, p = .182; Mendelsohn, p = .365; Masako, p = .885; chin tuck, p = .840; head turn, p = .059; and inverted, p = .773). CONCLUSIONS: Pharyngeal swallowing pressure variability increases in healthy individuals during volitional swallowing tasks. Less stable swallow patterns may result when tasks are less automatic and greater in complexity. These findings may have relevance to swallowing motor control integrity in healthy aging and individuals with neurogenic dysphagia.