Identification of the most significant electrode positions in electromyographic evaluation of swallowing-related movements in humans.

Surface electromyography (sEMG) is a well-established procedure for recording swallowing-related muscle activities. Because the use of a large number of sEMG channels is time consuming and technically sophisticated, the aim of this study was to identify the most significant electrode positions associated with oropharyngeal swallowing activities. Healthy subjects (N = 16) were tested with a total of 42 channels placed in M. masseter, M. orbicularis oris, submental and paralaryngeal regions. Each test subject swallowed 10 ml of water five times. After having identified 16 optimal electrode positions, that is, positions with the strongest signals quantified by the highest integral values, differences to 26 other ones were determined by a Mann-Whitney U test. Kruskal-Wallis H test was utilized for the analysis of differences between single subjects, subject subgroups, and single electrode positions. Factors associated with sEMG signals were examined in a linear regression. Sixteen electrode positions were chosen by a simple ranking of integral values. These positions delivered significantly higher signals than the other 26 positions. Differences between single electrode positions and between test subjects were also significant. Sixteen most significant positions were identified which represent swallowing-related muscle potentials in healthy subjects.

[Modeling developmental aspects of sensorimotor control of speech production]. / Ein neuronales Modell zur sensomotorischen Entwicklung des Sprechens.

BACKGROUND: Detailed knowledge of the neurophysiology of speech acquisition is important for understanding the developmental aspects of speech perception and production and for understanding developmental disorders of speech perception and production. METHOD: A computer implemented neural model of sensorimotor control of speech production was developed. The model is capable of demonstrating the neural functions of different cortical areas during speech production in detail. RESULTS: (i) Two sensory and two motor maps or neural representations and the appertaining neural mappings or projections establish the sensorimotor feedback control system. These maps and mappings are already formed and trained during the prelinguistic phase of speech acquisition. (ii) The feedforward sensorimotor control system comprises the lexical map (representations of sounds, syllables, and words of the first language) and the mappings from lexical to sensory and to motor maps. The training of the appertaining mappings form the linguistic phase of speech acquisition. (iii) Three prelinguistic learning phases--i. e. silent mouthing, quasi stationary vocalic articulation, and realisation of articulatory protogestures--can be defined on the basis of our simulation studies using the computational neural model. These learning phases can be associated with temporal phases of prelinguistic speech acquisition obtained from natural data. CONCLUSIONS: The neural model illuminates the detailed function of specific cortical areas during speech production. In particular it can be shown that developmental disorders of speech production may result from a delayed or incorrect process within one of the prelinguistic learning phases defined by the neural model.

[MRT sequences as a database for a visual articulatory model]. / MRT-Sequenzen als Datenbasis eines visuellen Artikulationsmodells.

Articulatory models can be used in phoniatrics for the visualisation of speech disorders, and can thus be used in teaching, the counselling of patients and their relatives, and in speech therapy. The articulatory model developed here was based on static MRI data of sustained sounds. MRI sequences are now being used to further refine the model with respect to speech movements. Medio-sagittal MRI sections were recorded for 12 consonants in the symmetrical context of the three point vowels [i:], [a:] and [u:] for this corpus. The recording-rate was eight images/s. The data show a strong influence of the vocalic context on the articulatory target-positions of all consonants. A method for the reduction of the MRI data for subsequent qualitative and quantitative analyses is presented.

Vocal cord palsy resulting from spontaneous carotid dissection.

OBJECTIVES/HYPOTHESIS: Vocal cord palsy has a variety of causes, such as malignant tumors of the thyroid, lung, or upper mediastinum, aortic aneurysm, surgery of the thyroid, and infectious diseases. STUDY DESIGN: Case report. METHODS: A 43-year-old biologist had a holocephalic headache and right-sided neck pain for 1 day. Five days later, he developed paralysis of the right-side vocal cord. In addition, an angiotensin converting enzyme (ACE) inhibitor was administered because the patient had high systolic and diastolic blood pressures, which were formerly not known to the patient. Five days after admission, a temporary sensorimotor hemiparesis occurred. RESULTS: Neurological examination revealed, in addition to the known paralysis of the right-side vocal cord, right-side palatoplegia, right-side hypoglossal nerve palsy, and mild dysphagia. Duplex sonography showed evidence of lumen narrowing of the right-side internal carotid artery caused by an hypoechogenic mural hematoma. Magnetic resonance imaging (0.5 T, Philips Gyroscan) revealed a circumscribed dissection of the right-side internal carotid artery from the carotid bifurcation to the petrosal segment. The diffusion-weighted magnetic resonance imaging scan of the brain also demonstrated multiple embolic ischemic lesions in the right hemisphere. CONCLUSION: Internal carotid artery dissection must be included in the differential diagnosis of lower cranial nerve palsy and should be assessed by duplex ultrasonography and magnetic resonance imaging.

[Sector-related grey scale analysis of video ultrasound recorded tongue movements in swallowing]. / Sektorbezogene Grauwertanalyse videosonographisch aufgezeichneter Zungenbewegungen beim Schlucken.

Diseases of the oral cavity, floor of the mouth, and nervous system can be accompanied by disturbances in tongue movement during swallowing. These disturbances can be diagnosed by videosonography whereby the examiner has to evaluate extensive video documentation of lingual motion. It was the aim of this study to facilitate this evaluation by the application of a reproducible computer-assisted quantitative analysis procedure. Video sequences of 56 healthy adults and 19 patients with dysphagias of different etiologies were analysed. A numerical estimation of swallowing movements was carried out in abstraction from the structures imaged (bolus, air, muscles of the tongue, floor of the mouth, hyoid, etc.). Intensity changes of the pixels within previously defined radial image sectors were quantified in relationship to time and depicted as sector curves. The healthy adults demonstrated a characteristic pattern of two motion maxima that appeared within almost all sector curves. These maxima represented bolus transport movements and the reset movement of the tongue. Patients with diseases of the tongue or neuromuscular changes caused by disturbances of the central nervous system showed pathological deviations on videosonography. These appeared as local or general reductions in movement, slow speed motions, repetitive swallowing or unsorted additional movements of the tongue during swallowing.

Three-dimensional phonetographic assessment of voice performance in professional and non-professional speakers.

For the assessment of voice performance, three-dimensional (3D) phonetograms were constructed using mean values of vocal pitch, vocal intensity, and phonation time. They were built up for groups of professional and non-professional male and female speakers. The 3D phonetograms of the professional and non-professional groups were projected into one another for the female as well as for the male speakers to facilitate comparison of the professional and non-professional groups. In addition, pitch-related cross-sections of the 3D phonetograms were created. These cross-sections plotted as sequences are useful to evaluate changes in vocal dynamics and phonation time in relation to the course of vocal pitch. In this contribution, it could be demonstrated that the 3D phonetograms of the non-professional groups were completely enclosed by those of the professional groups who developed a greater vocal capacity. Furthermore, the cross-section sequences of the professional groups were obviously longer and broader than those of the non-professional groups. Details of group-specific differences with respect to the examined voice parameters are discussed.

[Computer-assisted 3D phonetography]. / Computergestützte 3D-Phonetographie.

Profiles of fundamental frequency sound pressure levels and voice duration are measured separately in clinical practice. It was the aim of the present study to combine the two examinations, in order to estimate the relationship between pitch, sound pressure level and voice duration and to develop a new computer-assisted graph. A three-dimensional (3D) wireframe phonogram was constructed based on SPL profiles to obtain a general view of the parameters recorded. We have termed this "phonetography". Variable further projections were selected for the analysis of different aspects of parametric relationships. The results in 21 healthy volunteers and 4 patients with hyperfunctional dysphonias demonstrated that there were three typical figures of the 3D phonograms produced, depending on the relationship between voice duration when soft ("piano") compared to loud ("forte"). In one-third of the healthy volunteers, the values of the piano voice duration were greater than those of forte for almost all pitches examined. In two-thirds of the healthy subjects the values of forte voice duration were partly greater, as were those of piano voice duration. All of the patients showed voice duration values greater for forte than for piano. The results of the study demonstrate that the 3D phonogram is a useful tool for obtaining new insights into various relationships of voice parameters.

[MRI examination of laryngeal height during vowel singing]. / Kernspintomographische Untersuchung der Kehlkopfstellungen beim Singen von Vokalen.

Larynx height positions were determined in 12 singing students and singers with magnetic resonance imaging. The examinations were carried out during the singing of 9 different pitch and loudness combinations of the vowels /a/, /u/ and /i/. It could be demonstrated that vertical larynx position differences were smaller in professional singers than in students. In 10 of 12 examined volunteers a correlation between raised larynx position and high pitch singing or between lowered larynx position and low pitch singing could be observed in at least one of the examined vowels. Loudness-dependent and vowel-dependent differences of larynx height position could not be identified.

[Solitary hearing and equilibrium damage after vaccinations]. / Solitäre Hör- und Gleichgewichtsschäden nach Impfungen.

Solitary impairments of hearing and equilibrium after vaccinations are rarely seen. They are usually connected with damage to the central nervous system, thus being combined with further neurological symptoms. In German and English literature 9 cases of isolated statoacoustic nerve lesions due to vaccinations could be found. They are summarized and their similarities and differences are discussed. Information relevant for the evaluation of possible causal relations between vaccinations and solitary 8th cranial nerve disorders is emphasized. Questions concerning the incidence, etiology and differential diagnosis of functional cochleovestibular impairments are highlighted.

[Unilateral recurrent nerve paralysis in suspected Lyme borreliosis]. / Einseitige Rekurrensparese bei Verdacht auf Lyme-Borreliose.

Cranial nerve palsy can often be observed in Borrelia burgdorferi infection. A dysphonic patient with a long lasting left-sided recurrent nerve palsy was treated with ceftriaxone, an antibiotic drug for the therapy of Lyme borreliosis. On the 7th day of application the paretic vocal fold showed recovering movements up to regular vocal fold function and normal stroboscopic results. Clinical and serologic constellations and their therapeutical implications are discussed.

[Functionally determined area changes in the oro-pharyngo-laryngeal vocal tract of singers as shown by magnetic resonance tomography]. / Funktionsbedingte Flächenänderungen des oro-pharyngo-laryngealen Vokaltraktes bei Sängern in der Magnetresonanztomographie.

The oro-pharyngeal-laryngeal resonating spaces were studied in 12 singers at varying stages of their training by means of medio-sagittal MRI images, and the results were compared. The singers were requested to sing /a/ /u/ and /i/ at various pitches and with increasing loudness. The total oro-pharyngo-laryngeal areas were integrated by means of the MRI sections. The relationship between the oro-pharyngeal and pharyngo-laryngeal areas was determined, as well as their ratio to total area. With increasing volume there was increase in the area of the oro-pharyngeal component with no change in the pharyngo-laryngeal component. The relationship of the partial areas depends on the extent of training of the singer.

[Applications of the "Speech Viewer II" in voice training in vocal cord paralysis]. / Einsatzmöglichkeiten des "Speech Viewer II" zum Stimmtraining bei Stimmlippenparesen.

Referring to traditional therapeutical concepts of vocal fold paralysis a microphone-controlled computer programme was used for voice treatment in 13 patients with unilateral vocal fold paralysis. 6 of these patients were female, 7 were male. The age ranged from 18 to 72 years (mean: 50 years). The etiology of the paralysis was distributed as follows: post strumectomy (4 cases), post operation of the aortic arch (3 cases), post mediastinoscopy (1 case), post operation of the cervical vertebrae (1 case). 2 cases are not decided yet, 2 are probably idiopathic. The vocal fold dysfunction lasted between 24 hours and 8 years before our first examination, less than 4 weeks in 11 cases. With 1 exception (intermediate) the vocal fold position was classified as paramedian. 8 patients suffered from left, and 5 patients from right vocal fold paralysis. The voice treatment took place with a microphone-controlled speech viewer including an audio capture and playback adapter. 7 of the 15 training modules of the computer programme were chosen to be useful for voice training. Those modules can be differentiated in physical-technical modules showing voice spectra or pitch scales and in object-related modules showing images such as landscapes, animals and others. These programme-specific modules (monitor exercises) were primarily built to train the following voice qualities separately: loudness, pitch, voicing, voice onset, fundamental frequency, sustained phonation etc. Modifying certain therapeutic instructions (see Tables 1 and 2) the monitor exercises were used to improve the coordination of different voice parameters, thus resembling physiological speech.(ABSTRACT TRUNCATED AT 250 WORDS)

[The phasic imaging of velopharyngeal sphincter movements]. / Die Phasendarstellung velopharyngealer Sphinkterbewegungen.

The velopharyngeal function while swallowing water was studied on a healthy volunteer patient with velopharyngeal closure and on a patient with velopharyngeal insufficiency. This patient suffers from open hypernasality as a result of shortened velum. Both subjects underwent nasoendoscopy with a flexible fiber glass optical device while swallowing water and while articulating the plosive consonant /k/. Velopharyngeal function was documented by means of videotaping and then the single video images were placed together along a time scale to form a new temporal image. This image makes possible a quick and comprehensive differentiation between physiological and disturbed motion patterns as demonstrated in this study using velopharyngeal function as the example. The videotaping in lapse time of such disordered movements can provide indicators of the therapeutical steps to be taken.

[NMR examination of Polish speech sounds]. / Badanie obwodowego narzadu mowy przy wymowie glosek polskich za pomoca jadrowego rezonansu magnetycznego (NMR).

Polish phonemas were examined using MRI Snapshot-FLASH-technique. Functional images of the articulators were obtained.

[Sonographic imaging of internal jugular venous blood flow in juvenile hyperfunctional dysphonia]. / Badanie sonograficzne szybkosci przeplywu krwi w zyle szyjnej wewnetrznej w hyperfunkcjonalnej dysfonii dzieciecej.

Relative blood flow velocity peaks of the internal jugular vein were examined by simultaneous Doppler and B-mode sonography in 4 boys with hyperfunctional dysphonia. During phonation patients showed remarkably greater reduction of relative blood flow velocity peaks than a normal speaker.