Pneumo-phono-articulatory coordination assessment in dysarthria cases: a cross-sectional study.

BACKGROUND: Pneumo-phono-articulatory coordination is often impaired in dysarthric patients. Because all speech is produced upon exhalation, adequate respiratory support and coordination are essential for communication. Nevertheless, studies investigating respiratory parameters for speech are scarce. The objectives of the present study were to analyze and compare the numbers of words and syllables (universal measurement) per exhalation among healthy and dysarthric speakers, in different speech tasks. DESIGN AND SETTING: A cross-sectional analytical study with a control group was conducted at the Department of Speech, Language and Hearing Sciences at UNIFESP. METHODS: The study sample consisted of 62 individuals: 31 dysarthric patients and 31 healthy individuals matched for sex, age and education level. All participants performed number counting and text reading tests in which the numbers of words and syllables per exhalation were recorded. All measurements obtained from the two groups were compared. RESULTS: Statistically significant differences between the dysarthric and healthy groups were found in the two tasks (counting of syllables and words per exhalation) (P < 0.001). In contrast, the performance of the dysarthric patients did not vary according to the task: reading and number counting in syllables/exhalation (P = 0.821) or words/exhalation (P = 0.785). CONCLUSIONS: The mean numbers of words and syllables per exhalation among dysarthric subjects did not vary according to the speech task used but they clearly showed differences between dysarthric patients and normal healthy subjects. The study also made it possible to obtain preliminary data on the average numbers of words and syllables per expiration produced by healthy individuals during their speech production.

Otoneurological findings prevalent in hereditary ataxias.

Objective To describe and compare the vestibular findings most evident among the hereditary ataxias, as well as correlate their clinical features with the nervous structures affected in this disease. Methods Seventy-five patients were evaluated and underwent a case history, otorhinolaryngological and vestibular assessments. Results Clinically, the patients commonly had symptoms of gait disturbances (67.1%), dizziness (47.3%), dysarthria (46%) and dysphagia (36.8%). In vestibular testing, alterations were predominantly evident in caloric testing (79%), testing for saccadic dysmetria (51%) and rotational chair testing (47%). The presence of alterations occurred in 87% of these patients. A majority of the alterations were from central vestibular dysfunction (69.3%). Conclusion This underscores the importance of the contribution of topodiagnostic labyrinthine evaluations for neurodegenerative diseases as, in most cases, the initial symptoms are otoneurological; and these evaluations should also be included in the selection of procedures to be performed in clinical and therapeutic monitoring.

Pneumo-phono-articulatory coordination assessment in dysarthria cases: a cross-sectional study

ABSTRACT BACKGROUND: Pneumo-phono-articulatory coordination is often impaired in dysarthric patients. Because all speech is produced upon exhalation, adequate respiratory support and coordination are essential for communication. Nevertheless, studies investigating respiratory parameters for speech are scarce. The objectives of the present study were to analyze and compare the numbers of words and syllables (universal measurement) per exhalation among healthy and dysarthric speakers, in different speech tasks. DESIGN AND SETTING: A cross-sectional analytical study with a control group was conducted at the Department of Speech, Language and Hearing Sciences at UNIFESP. METHODS: The study sample consisted of 62 individuals: 31 dysarthric patients and 31 healthy individuals matched for sex, age and education level. All participants performed number counting and text reading tests in which the numbers of words and syllables per exhalation were recorded. All measurements obtained from the two groups were compared. RESULTS: Statistically significant differences between the dysarthric and healthy groups were found in the two tasks (counting of syllables and words per exhalation) (P < 0.001). In contrast, the performance of the dysarthric patients did not vary according to the task: reading and number counting in syllables/exhalation (P = 0.821) or words/exhalation (P = 0.785). CONCLUSIONS: The mean numbers of words and syllables per exhalation among dysarthric subjects did not vary according to the speech task used but they clearly showed differences between dysarthric patients and normal healthy subjects. The study also made it possible to obtain preliminary data on the average numbers of words and syllables per expiration produced by healthy individuals during their speech production.

Otoneurological findings prevalent in hereditary ataxias / Alterações otoneurológicas prevalentes nas ataxias hereditárias

ABSTRACT Objective To describe and compare the vestibular findings most evident among the hereditary ataxias, as well as correlate their clinical features with the nervous structures affected in this disease. Methods Seventy-five patients were evaluated and underwent a case history, otorhinolaryngological and vestibular assessments. Results Clinically, the patients commonly had symptoms of gait disturbances (67.1%), dizziness (47.3%), dysarthria (46%) and dysphagia (36.8%). In vestibular testing, alterations were predominantly evident in caloric testing (79%), testing for saccadic dysmetria (51%) and rotational chair testing (47%). The presence of alterations occurred in 87% of these patients. A majority of the alterations were from central vestibular dysfunction (69.3%). Conclusion This underscores the importance of the contribution of topodiagnostic labyrinthine evaluations for neurodegenerative diseases as, in most cases, the initial symptoms are otoneurological; and these evaluations should also be included in the selection of procedures to be performed in clinical and therapeutic monitoring.

RESUMO Objetivo Descrever e comparar os achados vestibulares mais evidentes entre a ataxia hereditária, bem como correlacionar seus aspectos clínicos com o estudo das estruturas nervosas afetadas nesta doença. Métodos 75 pacientes foram avaliados e submetidos aos seguintes procedimentos: anamnese, avaliação otorrinolaringológica e vestibular. Resultados Clinicamente, os pacientes apresentaram sintomas de distúrbios da marcha (67,1%), tonturas (47,3%), disartria (46%) e disfagia (36,8%). No teste vestibular, as alterações foram predominantemente evidentes no teste calórico (79%), dismetria sacádicas (51%) e no teste rotatório (47%). A presença de alterações ocorreu em 87% dos pacientes. A maioria das alterações observadas foram da disfunção vestibular central (69,3%). Conclusão O estudo ressalta a importância da contribuição da avaliação labiríntica no topodiagnóstico para doenças neurodegenerativas, uma vez que, na maioria dos casos, os sintomas iniciais são otoneurológicos, e essas avaliações também devem ser incluídas na seleção de procedimentos a serem realizados no monitoramento clínico e terapêutico.

Dysarthria and Quality of Life in neurologically healthy elderly and patients with Parkinson's disease.

PURPOSE: To compare the speech and voice of Parkinson's disease (PD) patients and neurologically healthy elderly adults (control group, CG), to find out whether these features are related to the disease or the normal aging process, and investigate the impact that dysarthria has on the Quality of Life (QoL) of these individuals. METHODS: This is a cross-sectional study involving 25 individuals, 13 patients with PD and 12 CG. All the participants underwent vocal assessment, perceptual and acoustic analysis, based on "Dysarthria Assessment Protocol" and analysis of QoL using a questionnaire, "Living with Dysarthria". The data underwent statistical analysis to compare the groups in each parameter. RESULTS: In the assessment of dysarthria, patients with PD showed differences in prosody parameter (p=0.012), at the habitual frequency for females (p=0.025) and males (p=0.028), and the extent of intensity (p=0.039) when compared to CG. In QoL questionnaire, it was observed that patients with PD showed more negative impact on the QoL compared to CG, as indicated by the total score (p=0.005) with various aspects influencing this result. CONCLUSION: The degree of modification of speech and voice of patients with PD resembles those seen in normal aging process, with the exception of prosody and the habitual frequency, which are related to the greatest negative impact on the QoL of patients with PD.

Dysarthria and Quality of Life in neurologically healthy elderly and patients with Parkinson's disease / Disartria e Qualidade de Vida em idosos neurologicamente sadios e pacientes com doença de Parkinson

PURPOSE: To compare the speech and voice of Parkinson's disease (PD) patients and neurologically healthy elderly adults (control group, CG), to find out whether these features are related to the disease or the normal aging process, and investigate the impact that dysarthria has on the Quality of Life (QoL) of these individuals. METHODS: This is a cross-sectional study involving 25 individuals, 13 patients with PD and 12 CG. All the participants underwent vocal assessment, perceptual and acoustic analysis, based on "Dysarthria Assessment Protocol" and analysis of QoL using a questionnaire, "Living with Dysarthria". The data underwent statistical analysis to compare the groups in each parameter. RESULTS: In the assessment of dysarthria, patients with PD showed differences in prosody parameter (p=0.012), at the habitual frequency for females (p=0.025) and males (p=0.028), and the extent of intensity (p=0.039) when compared to CG. In QoL questionnaire, it was observed that patients with PD showed more negative impact on the QoL compared to CG, as indicated by the total score (p=0.005) with various aspects influencing this result. CONCLUSION: The degree of modification of speech and voice of patients with PD resembles those seen in normal aging process, with the exception of prosody and the habitual frequency, which are related to the greatest negative impact on the QoL of patients with PD. .

OBJETIVO: Comparar a fonoarticulação de um grupo com doença de Parkinson (DP) e um Grupo Controle (GC) de sujeitos neurologicamente sadios, a fim de descobrir se essas características são relacionadas à doença ou ao processo normal de envelhecimento, e investigar o impacto que a disartria acarreta à Qualidade de Vida (QV) desses sujeitos. MÉTODO: Trata-se de um estudo transversal com a participação de 25 sujeitos, sendo 13 pacientes com DP e 12 GC. Todos os participantes foram avaliados quanto à disartria, análise perceptivo-auditiva e acústica, com base no "Protocolo de Avaliação da Disartria", e à QV, utilizando-se o questionário "Vivendo com Disartria". Os dados foram comparados entre os grupos em cada parâmetro. RESULTADOS: Na avaliação da disartria, o grupo com DP apresentou diferenças no parâmetro prosódia (p=0,012), na frequência habitual para os gêneros feminino (p=0,025) e masculino (p=0,028), e na média da extensão de intensidade (p=0,039), quando comparado ao GC. Em relação à QV, observou-se que a disartria apresenta um impacto mais negativo na QV dos pacientes com DP, quando comparados aos sujeitos do GC, conforme observado no escore total (p=0,005) e nos aspectos que influenciaram esse resultado. CONCLUSÕES: O grau de modificação da fonoarticulação dos pacientes com DP assemelha-se aos presentes no processo normal de envelhecimento, com exceção da prosódia e da frequência habitual, que estão relacionadas com o impacto mais negativo na QV dos sujeitos com DP. .

Estimation of phoneme-specific HMM topologies for the automatic recognition of dysarthric speech.

Dysarthria is a frequently occurring motor speech disorder which can be caused by neurological trauma, cerebral palsy, or degenerative neurological diseases. Because dysarthria affects phonation, articulation, and prosody, spoken communication of dysarthric speakers gets seriously restricted, affecting their quality of life and confidence. Assistive technology has led to the development of speech applications to improve the spoken communication of dysarthric speakers. In this field, this paper presents an approach to improve the accuracy of HMM-based speech recognition systems. Because phonatory dysfunction is a main characteristic of dysarthric speech, the phonemes of a dysarthric speaker are affected at different levels. Thus, the approach consists in finding the most suitable type of HMM topology (Bakis, Ergodic) for each phoneme in the speaker's phonetic repertoire. The topology is further refined with a suitable number of states and Gaussian mixture components for acoustic modelling. This represents a difference when compared with studies where a single topology is assumed for all phonemes. Finding the suitable parameters (topology and mixtures components) is performed with a Genetic Algorithm (GA). Experiments with a well-known dysarthric speech database showed statistically significant improvements of the proposed approach when compared with the single topology approach, even for speakers with severe dysarthria.

[Predictability of sentences used in the assessment of speech intelligibility in dysarthria]. / Preditividade das sentenças do protocolo de avaliação da inteligibilidade de fala nas disartrias.

PURPOSE: To analyze the predictability of sentences used in the protocol for the assessment of intelligibility of dysarthric speech. METHODS: A cross-sectional study was conducted in 120 volunteers divided randomly into four groups of 30 individuals.Based on the list of 25 sentences from the protocol, four versions of lists were elaborated. In each version, a different target word was omitted from the sentences. Each group of participants completed a different list version by graphically filling in the blanks with the first word that came to mind, while keeping the sentences coherent. Statistical analyses were carried out to classify sentences according to their predictability, to compare predictability of the words in each sentence, and to compare the different list versions. RESULTS: Three sentences presented high predictability; seven, average predictability; and fifteen, low predictability. Differences in the predictability of target words were found in 84% of the sentences (p ≤ 0.0054). The comparison of list versions revealed that version 1 differed from the others (p ≤ 0.002), and was less predictable. CONCLUSION: Low predictability sentences predominated in the protocol for assessment of speech intelligibility used in this study, suggesting that these sentences can be used reliably for assessing intelligibility. Analysis of intelligibility in sentences based on target words can be used in clinical practice, especially when the predictability of the sentences is known.

Preditividade das sentenças do protocolo de avaliação da inteligibilidade de fala nas disartrias / Predictability of sentences used in the assessment of speech intelligibility in dysarthria

OBJETIVO: Analisar a preditividade das sentenças utilizadas no protocolo de avaliação da inteligibilidade da fala nas disartrias. MÉTODOS: Foi realizado um estudo transversal com 120 voluntários divididos, aleatoriamente, em quatro grupos de 30 indivíduos. A partir da lista de 25 frases do protocolo, foram elaboradas quatro versões de listas. Em cada uma delas, uma palavra-alvo diferente foi omitida das sentenças. Cada grupo de participantes completou uma versão da lista preenchendo graficamente as lacunas com a primeira palavra que lhes viesse à mente, de modo que cada sentença ficasse coerente. Foram realizadas análises estatísticas para classificar as frases quanto a sua preditividade, comparar a preditividade das palavras em cada sentença e comparar as versões da lista. RESULTADOS: Três sentenças apresentaram alta preditividade; sete, média preditividade; e 15, baixa preditividade. Foram encontradas diferenças de preditividade entre as palavras-alvo em 84 por cento das frases (p<;0,0054). Comparando as versões da lista, constatou-se que a versão 1 diferiu das demais (p<;0,002), mostrando-se menos previsível. CONCLUSÃO: No protocolo de avaliação da inteligibilidade da fala empregado neste estudo há predomínio de sentenças de baixa preditividade, sugerindo que estas podem ser empregadas de maneira confiável na avaliação da inteligibilidade. A análise da inteligibilidade em sentenças por palavras-alvo deve ser usada clinicamente, especialmente quando se conhece a preditividade das sentenças.

PURPOSE: To analyze the predictability of sentences used in the protocol for the assessment of intelligibility of dysarthric speech. METHODS: A cross-sectional study was conducted in 120 volunteers divided randomly into four groups of 30 individuals.Based on the list of 25 sentences from the protocol, four versions of lists were elaborated. In each version, a different target word was omitted from the sentences. Each group of participants completed a different list version by graphically filling in the blanks with the first word that came to mind, while keeping the sentences coherent. Statistical analyses were carried out to classify sentences according to their predictability, to compare predictability of the words in each sentence, and to compare the different list versions. RESULTS: Three sentences presented high predictability; seven, average predictability; and fifteen, low predictability. Differences in the predictability of target words were found in 84 percent of the sentences (p<;0.0054). The comparison of list versions revealed that version 1 differed from the others (p<;0.002), and was less predictable. CONCLUSION: Low predictability sentences predominated in the protocol for assessment of speech intelligibility used in this study, suggesting that these sentences can be used reliably for assessing intelligibility. Analysis of intelligibility in sentences based on target words can be used in clinical practice, especially when the predictability of the sentences is known.

Phonarticulatory diadochokinesis in young and elderly individuals.

The phonoarticulatory diadochokinesis test has been recommended to evaluate neurological disorders. It is a speech task that consists of the ability to repeat at high speed a segment of speech. The purpose of this research is to analyze the diadochokinesia rate of adults from two distinct age groups. 23 young adults and 23 elderly people, both sexes participated in this study. Each participant produced the /pa/, /ta/, /ka/ syllables, the vowel /a/ and the /pataka/ sequence, as fast and as long as they could with habitual pitch and loudness. The speech samples were analyzed by using the voice and speech analysis software Visi-Pitch III/Sona-Speech, KayElemetrics. Both groups presented with reduced diadochokinesia rate as the speech production became more complex. The young adults group presented with higher diadochokinesia rate in adults in all speech tasks while the elderly adults group had a worse intensity control.

Phonarticulatory diadochokinesis in young and elderly individuals / Diadococinesia fonoarticulatória em jovens e idosos

The phonoarticulatory diadochokinesis test has been recommended to evaluate neurological disorders. It is a speech task that consists of the ability to repeat at high speed a segment of speech. The purpose of this research is to analyze the diadochokinesia rate of adults from two distinct age groups. 23 young aice and speech analysis software Visi-Pitch III/Sona-Speech, KayElemetrics. Both groups presented with reduced diadochokinesia rate as the speech production became more complex. The young adults group presented with higher diadochokinesia rate in adults and 23 elderly people, both sexes participated in this study. Each participant produced the /pa/, /ta/, /ka/ syllables, the vowel /a/ and the /pataka/ sequence, as fast and as long as they could with habitual pitch and loudness. The speech samples were analyzed by using the voll speech tasks while the elderly adults group had a worse intensity control.

A prova de diadococinesia fonoarticulatória tem sido recomendada para transtornos neurológicos, sendo uma tarefa de fala que consiste na habilidade de realizar rápidas repetições de segmentos de fala. O objetivo deste estudo é analisar a velocidade de diadococinesia em sujeitos adultos em dois grupos etários distintos. Participaram 23 adultos jovens e 23 idosos, de ambos os sexos. Cada indivíduo emitiu as sílabas /pa/, /ta/, /ka/, a vogal /a/ e a seqüência /pataka/, o mais rapidamente e durante o maior tempo possível, em sua freqüência e intensidade habituais. Estas emissões foram analisadas no programa computadorizado de análise de voz e fala Visi-Pitch III/Sona-Speech, da KayElemetrics. Ambos os grupos apresentaram redução da velocidade diadococinética à medida que as emissões foram mais complexas. O grupo mais jovem apresentou velocidade diadococinética maior em todas as emissões enquanto o grupo de idosos teve pior controle de intensidade.

Anartria o apraxia del habla progresiva / Progressive anarthria or speech apraxia

Two cases of progressive anarthria are reported; we remark their close but distinct relation with speech apraxia. Both of them were older female, with a progressive loss of speech, bilateral paresis of lower face, tongue and palatal muscles. They also had mild pyramidal signs and a fronto-subcortical cognitive deterioration. Brain TC and MRI were within normal limits. One of them had a possible progressive supranuclear palsy, the other one a possible corticobasal degeneration. The analysis of similar cases reports let us to conclude than there are several pathologies that can cause a progressive pseudobulbar palsy. The final diagnosis must be by postmortem examination of the brain.

Se presentan dos casos de anartria progresiva, discutiendo la relación o el diagnóstico diferencial con la apraxia del habla progresiva. En ambos casos se trataba de mujeres mayores de 65 años con un cuadro de pérdida progresiva del lenguaje oral, con diparesia facial, lingual y velar, deterioro cognitivo de tipo frontal y discretos signos piramidales. Las imágenes cerebrales estructurales fueron normales. Uno de ellos pudo corresponder a una parálisis supranuclear progresiva, la otra a una degeneración corticobasal. Se analiza la literatura, llegando a la conclusión de que existen una serie de cuadros que pueden presentarse con un síndrome pseudobulbar progresivo. El diagnóstico definitivo debiera ser patológico.

[Dysarthria: a speech rate study]. / Disartria: estudo da velocidade de fala.

BACKGROUND: speech rate in dysarthric patients. AIM: to obtain an objective measure of the speech rate of dysarthric patients during the reading of a standardized text and during spontaneous speech. METHOD: eleven subjects, with ages ranging from 18 to 69 years, were studied. For each dysarthric patient, 3 normal individuals of the same gender and age were evaluated, composing the control group. The speech samples were collected based on a reading of a standardized text and on a two minute conversation. Speech rate was analyzed in terms of words per minute. RESULTS: the analysis of the results demonstrated that in both situations of speech, the dysarthric group presented a statistically significant slower speech rate than the control group. CONCLUSION: the values of speech rate obtained in this study do not agree with other studies carried out in the English language.

Disartria: estudo da velocidade de fala / Dysarthria: a speech rate study

Objetivo: verificar a velocidade de fala na leitura de texto padronizado e na fala espontânea de indivíduos com disartria. Método: foram estudados 11 indivíduos com disartria, na faixa etária de 18 a 69 anos. Para cada indivíduo avaliado, foram avaliados 3 indivíduos normais, do mesmo sexo e idade, que formaram o grupo-controle. As amostras das falas constaram da leitura de texto padronizado e de dois minutos de conversação. O cálculo da velocidade foi feito em palavras por minuto. Resultados: a análise dos resultados obtidos permitiu concluir que nas duas diferentes situações de fala, o grupo com disartria apresentou uma velocidade de fala estatisticamente menor que o grupo controle.Os valores encontrados diferiram dos valores de referência descritos em trabalhos com a velocidade de fala na Língua Inglesa.

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.

Las disartrias / Dysarthrias

Se plantea que las disartrias constituyen un frecuente e importante capítulo en medicina, no obstante, la literatura médica sobre ella no es todo lo extensa que su alcance requiere, aun en textos clásicos de neurología y otras especialidades. Este tema pretende una actualización sobre las mismas que esté a la altura de los acontecimientos actuales, y desde el punto de vista práctico permita clasificación adecuada, así como un enfoque fisicopatológico preciso. Plantea además el tratamiento de las mismas, de lo que se adolece por completo en los estudios considerados, desde el punto de vista logofoniátrico(AU)