Towards an automatic evaluation of the dysarthria level of patients with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a neurological disorder that produces motor and non-motor impairments. The evaluation of motor symptoms is currently performed following the third section of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III); however, only one item of that scale is related to speech impairments. It is necessary to develop a specific scale such that considers those aspects related to speech impairments of the patients. AIMS: (i) To introduce and evaluate the suitability of a modified version of the Frenchay Dysarthria Assessment (m-FDA) scale to quantify the dysarthria level of PD patients; (ii) to objectively model dysarthric speech signals considering four speech dimensions; (iii) to develop a methodology, based on speech processing and machine learning methods, to automatically quantify/predict the dysarthria level of patients with PD. METHODS: The speech recordings are modeled using features extracted from several dimensions of speech: phonation, articulation, prosody, and intelligibility. The dysarthria level is quantified using linear and non-linear regression models. Speaker models based on i-vectors are also explored. RESULTS AND CONCLUSIONS: The m-FDA scale was introduced to assess the dysarthria level of patients with PD. Articulation features extracted from continuous speech signals to create i-vectors were the most accurate to quantify the dysarthria level, with correlations of up to 0.69 between the predicted m-FDA scores and those assigned by the phoniatricians. When the dysarthria levels were estimated considering dedicated speech exercises such as rapid repetition of syllables (DDKs) and read texts, the correlations were 0.64 and 0.57, respectively. In addition, the combination of several feature sets and speech tasks improved the results, which validates the hypothesis about the contribution of information from different tasks and feature sets when assessing dysarthric speech signals. The speaker models seem to be promising to perform individual modeling for monitoring the dysarthria level of PD patients. The proposed approach may help clinicians to make more accurate and timely decisions about the evaluation and therapy associated to the dysarthria level of patients. The proposed approach is a great step towards unobtrusive/ecological evaluations of patients with dysarthric speech without the need of attending medical appointments.

[Speech Ability and Psychological Outcome After Treatment of Oral Cancer]. / Sprechqualität und psychische Beeinträchtigung nach der Therapie von Mundhöhlentumoren.

BACKGROUND: In recent years interactions between surgical treatment of oral carcinoma and incidence of anxiety or depression have become a subject of discussions. This prospective study is a comparison between the extent of loss of speech intelligibility and presence of depressive symptoms or anxiety as a result of oral carcinoma. MATERIAL AND METHODS: One year after surgical therapy for oral carcinoma, 90 patients of an average age of 60±12 years were examined. Their speech intelligibility degree was measured using standardized automatic speech recognition (word recognition rate, WR). Symptoms of anxiety and depression were detected by use of HAD-Scales (HADS). Next to the relationship between WR and HADS other influential variables related to WR and HADS were statistically evaluated. RESULTS: The WR average was 53.2±17.2. Female WR was better than male. The difference between tumor classifications T1 and T4 compared to the WR reached statistical significance. Significant differences were detected between WR and "tumor localization", "graft donor site", "graft morphology", "tongue motility", and "tracheostoma" groups. There was a relationship between tongue motility and graft morphology, graft donor site and tumor localization. HAD-Scores in the mean were elevated: HADS-Total=43.3%, HADS-A=43.3% und HADS-D= 51.1%. WR correlates with HADS-D-Subscale, but not with HADS-A-Subscale. CONCLUSION: Communication disorders as a result of neoplasmic orofacial surgery may be related to extent of the treatment and to affective impairments. This should receive attention in the concept of rehabilitation.

[Validation of an automatic speech analysis in children with isolated cleft palate]. / Validierung einer automatischen Analyse der Sprechproben von Kindern mit isolierter Gaumenspalte.

BACKGROUND: Following surgical repair of cleft lip and palate, hearing and speech and language development are important issues for the continued care of affected childhood and adolescent patients. Therefore, PEAKS (Program for Evaluation and Analysis of all Kinds of Speech Disorders) was developed in order to rate speech intelligibility automatically and reduce the time required for diagnostics. PEAKS is based on a speech recognition system and was extended to incorporate a speaker model. This investigation validated PEAKS for isolated cleft palate. METHODS: From each of the 39 children with isolated cleft palate (3.1-14.5 years), 99 word productions were recorded digitally and analyzed-once "subjectively" by five experts and five nonexperts; once "objectively" using PEAKS. RESULTS: The automatic speech recognition system and the experts arrive at similar results with regard to speech intelligibility. The expert and nonexpert ratings differ significantly from each other. Within the group of nonexperts, a weak interrater reliability demonstrates the uncertainty associated with their ratings. CONCLUSION: PEAKS delivers reliable and representative results with regard to speech intelligibility among children and adolescents with isolated cleft palate. The automatic measurement of speech quality in children and adolescents with isolated cleft palate is possible.

Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic, computer-based speech analysis.

Oral squamous cell carcinoma (OSCC) and its treatment impair speech intelligibility by alteration of the vocal tract. The aim of this study was to identify the factors of oral cancer treatment that influence speech intelligibility by means of an automatic, standardized speech-recognition system. The study group comprised 71 patients (mean age 59.89, range 35-82 years) with OSCC ranging from stage T1 to T4 (TNM staging). Tumours were located on the tongue (n=23), lower alveolar crest (n=27), and floor of the mouth (n=21). Reconstruction was conducted through local tissue plasty or microvascular transplants. Adjuvant radiotherapy was performed in 49 patients. Speech intelligibility was evaluated before, and at 3, 6, and 12 months after tumour resection, and compared to that of a healthy control group (n=40). Postoperatively, significant influences on speech intelligibility were tumour localization (P=0.010) and resection volume (P=0.019). Additionally, adjuvant radiotherapy (P=0.049) influenced intelligibility at 3 months after surgery. At 6 months after surgery, influences were resection volume (P=0.028) and adjuvant radiotherapy (P=0.034). The influence of tumour localization (P=0.001) and adjuvant radiotherapy (P=0.022) persisted after 12 months. Tumour localization, resection volume, and radiotherapy are crucial factors for speech intelligibility. Radiotherapy significantly impaired word recognition rate (WR) values with a progression of the impairment for up to 12 months after surgery.

[Speech intelligibility degree and coping after multimodal therapy of oral squamous carcinoma]. / Sprachverständlichkeit und Krankheitsverarbeitung nach der Therapie von Mundhöhlenkarzinomen.

BACKGROUND: Multimodal treatment of oral cancer can cause speech disorders and diminish speech intelligibility. Speech intelligibility is an essential part of social interaction and therefore important for coping with the disease. The aim of this study was to investigate the influence of speech intelligibility on coping strategies and a standardized questionnaire. PATIENTS AND METHODS: Speech recordings from 76 patients 60.7 ± 11.4 years old (19 women, 57 men) were performed at least 6 months after multimodal treatment of T1-T4 squamous cell carcinoma of the oral cavity and evaluated by automatic speech recognition. Speech intelligibility was quantized as correctly recognized words of a standard text (word recognition rate WR). Coping was evaluated by the Trier Scales of Coping Strategies via questionnaires. RESULTS: Speech intelligibility scores WR rated between 22.2% and 84.3% (mean value 54.2 ± 15.7). Coping strategies vary considerably between the patients and between the scales. WR and the Trier Scales significantly correlate in 3 of the 5 categories (Rumination, Search for Information and Exchange of Experiences). CONCLUSION: Reduced speech intelligibility after multimodal treatment of oral cancer is associated with a change of coping strategy. This includes not only communication-based strategies (Search for Information and Exchange of Experiences) but also intra-psychic processes like rumination.

Automatic, computer-based speech assessment on edentulous patients with and without complete dentures - preliminary results.

Dental rehabilitation of edentulous patients with complete dentures includes not only aesthetics and mastication of food, but also speech quality. It was the aim of this study to introduce and validate a computer-based speech recognition system (ASR) for automatic speech assessment in edentulous patients after dental rehabilitation with complete dentures. To examine the impact of dentures on speech production, the speech outcome of edentulous patients with and without complete dentures was compared. Twenty-eight patients reading a standardized text were recorded twice - with and without their complete dentures in situ. A control group of 40 healthy subjects with natural dentition was recorded under the same conditions. Speech quality was evaluated by means of a polyphone-based ASR according to the percentage of the word accuracy (WA). Speech acceptability assessment by expert listeners and the automatic rating of the WA by the ASR showed a high correlation (corr = 0.71). Word accuracy was significantly reduced in edentulous speakers (55.42 +/- 13.1) compared to the control group's WA (69.79 +/- 10.6). On the other hand, wearing complete dentures significantly increased the WA of the edentulous patients (60.00 +/- 15.6). Speech production quality is significantly reduced after complete loss of teeth. Reconstitution of speech production quality is an important part of dental rehabilitation and can be improved for edentulous patients by means of complete dentures. The ASR has proven to be a useful and easily applicable tool for automatic speech assessment in a standardized way.