Outcomes of a Community of Practice on Quebec Speech Language Pathologists' Voice Assessment Practices and Professional Identity

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.

En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.

The impacts of aging on the comprehension of affective prosody: A systematic review.

Recent clinical reports have suggested a possible decline in the ability to understand emotions in speech (affective prosody comprehension) with aging. The present study aims to further examine the differences in performance between older and younger adults in terms of affective prosody comprehension. Following a recent cognitive model dividing affective prosody comprehension into perceptual and lexico-semantic components, a cognitive approach targeting these components was adopted. The influence of emotions' valence and category on aging performance was also investigated. A systematic review of the literature was carried out using six databases. Twenty-one articles, presenting 25 experiments, were included. All experiments analyzed affective prosody comprehension performance of older versus younger adults. The results confirmed that older adults' performance in identifying emotions in speech was reduced compared to younger adults. The results also brought out the fact that affective prosody comprehension abilities could be modulated by the emotion category but not by the emotional valence. Various theories account for this difference in performance, namely auditory perception, brain aging, and socioemotional selectivity theory suggesting that older people tend to neglect negative emotions. However, the explanation of the underlying deficits of the affective prosody decline is still limited.

Affective prosody disorders in adults with neurological conditions: A scoping review.

BACKGROUND: Individuals with affective-prosodic deficits have difficulty understanding or expressing emotions and attitudes through prosody. Affective prosody disorders can occur in multiple neurological conditions, but the limited knowledge about the clinical groups prone to deficits complicates their identification in clinical settings. Additionally, the nature of the disturbance underlying affective prosody disorder observed in different neurological conditions remains poorly understood. AIMS: To bridge these knowledge gaps and provide relevant information to speech-language pathologists for the management of affective prosody disorders, this study provides an overview of research findings on affective-prosodic deficits in adults with neurological conditions by answering two questions: (1) Which clinical groups present with acquired affective prosodic impairments following brain damage? (2) Which aspects of affective prosody comprehension and production are negatively affected in these neurological conditions? METHODS & PROCEDURES: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A literature search was undertaken in five electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL and Linguistics, and Language Behavior Abstracts) to identify primary studies reporting affective prosody disorders in adults with neurological impairments. We extracted data on clinical groups and characterised their deficits based on the assessment task used. OUTCOMES & RESULTS: The review of 98 studies identified affective-prosodic deficits in 17 neurological conditions. The task paradigms typically used in affective prosody research (discrimination, recognition, cross-modal integration, production on request, imitation and spontaneous production) do not target the processes underlying affective prosody comprehension and production. Therefore, based on the current state of knowledge, it is not possible to establish the level of processing at which impairment occurs in clinical groups. Nevertheless, deficits in the comprehension of affective prosody are observed in 14 clinical groups (mainly recognition deficits) and deficits in the production of affective prosody (either on request or spontaneously) in 10 clinical groups. Neurological conditions and types of deficits that have not been investigated in many studies are highlighted. CONCLUSIONS & IMPLICATIONS: The aim of this scoping review was to provide an overview on acquired affective prosody disorders and to identify gaps in knowledge that warrant further investigation. Deficits in the comprehension or production of affective prosody are common to numerous clinical groups with various neurological conditions. However, the underlying cause of affective prosody disorders across them is still unknown. Future studies should implement standardised assessment methods with specific tasks based on a cognitive model to identify the underlying deficits of affective prosody disorders. WHAT THIS PAPER ADDS: What is already known on the subject What is already known on the subjectAffective prosody is used to share emotions and attitudes through speech and plays a fundamental role in communication and social interactions. Affective prosody disorders can occur in various neurological conditions, but the limited knowledge about the clinical groups prone to affective-prosodic deficits and about the characteristics of different phenotypes of affective prosody disorders complicates their identification in clinical settings. Distinct abilities underlying the comprehension and production of affective prosody can be selectively impaired by brain damage, but the nature of the disturbance underlying affective prosody disorders in different neurological conditions remains unclear. What this study adds Affective-prosodic deficits are reported in 17 neurological conditions, despite being recognised as a core feature of the clinical profile in only a few of them. The assessment tasks typically used in affective prosody research do not provide accurate information about the specific neurocognitive processes impaired in the comprehension or production of affective prosody. Future studies should implement assessment methods based on a cognitive approach to identify underlying deficits. The assessment of cognitive/executive dysfunctions, motor speech impairment and aphasia might be important for distinguishing primary affective prosodic dysfunctions from those secondarily impacting affective prosody. What are the potential clinical implications of this study? Raising awareness about the possible presence of affective-prosodic disorders in numerous clinical groups will facilitate their recognition by speech-language pathologists and, consequently, their management in clinical settings. A comprehensive assessment covering multiple affective-prosodic skills could highlight specific aspects of affective prosody that warrant clinical intervention.

A Comparison of Healthy and Disordered Voices Using Multi-Dimensional Voice Program, Praat, and TF32.

PURPOSE: Instrumental voice assessment plays a critical role in identifying vocal issues and for documenting treatment outcomes. The reported voice data, however, are sensitive to the algorithm used by each acoustic analysis software program (AASP) to analyze the corresponding waveform. In the present study, five acoustic measures were compared across healthy speakers and speakers with dysphonia for three AASPs commonly used in research, education, and clinical practice: Multidimensional Voice Program (MDVP) by Computerized Speech Lab, Praat, and TF32. MATERIALS AND METHODS: Sustained vowel phonations for the quantal vowels /ɑ/, /i/, and /u/ were analyzed for 80 speakers with organic dysphonia and 60 age- and sex-matched healthy controls. Descriptive, inferential, and correlation data are reported for mean fundamental frequency (mean F0), standard deviation of fundamental frequency (SD F0), short-term perturbation measures of jitter and shimmer, and harmonic-to-noise ratio (HNR). RESULTS: The present study replicated previous findings of interprogram differences for healthy speakers, with MDVP consistently yielding higher values than Praat and TF32 for SD F0, jitter, and shimmer and lower values for HNR. Similar, but magnified patterns of results were observed for speakers with dysphonia. CONCLUSION: The variation observed across programs calls into question the validity in comparing voice outcomes reported by one AASP to those previously obtained by another, particularly for acoustic signals with aperiodic components that are commonly present in disordered voices. It is advised that waveforms be visually inspected prior to conducting acoustic analysis, and that voice outcomes not be combined or compared across AASPs.

Speech rate increase in primary progressive apraxia of speech and its cost on articulatory accuracy.

Impaired articulation (e.g., articulatory accuracy) and prosody (e.g., slow speech rate) are considered primary diagnostic criterions for apraxia of speech both in neurodegenerative and post-stroke contexts. The primary aim of this study was to investigate the ability of participants with primary progressive apraxia of speech (PPAOS), a neurodegenerative disease characterised by initially isolated progressive apraxia of speech, to increase speech rate and the interaction between articulatory accuracy and speech rate. The secondary aim was to investigate the effect of syllable frequency and structure on this interaction. Four speakers with PPAOS, and four sex- and age-matched healthy speakers (HS) read eight two-syllable words embedded two times in a ten-syllable carrier phrase. Syllable frequency and structure were manipulated for the first syllable of the target words and controlled for the second syllable. All sentences were produced at three different target speech rates (conditions): habitual, regular (five syllables/second), and fast (seven syllables/second). Prosodic measures for target words and sentences were computed based on acoustic analysis of speech rate. Articulatory measures for words and sentences were rated based on a perceptual assessment of articulatory accuracy. Results show slower speech rate and reduced articulatory accuracy in speakers with PPAOS compared to HS. Results suggest that speakers with PPAOS also have limited ability to increase their speech rate. Finally, results suggest that articulatory complexity influences speech rate but that the cost of speech rate increase on articulatory accuracy varies greatly across speakers with PPAOS and is not necessarily related to the extent of the increase when measured in a highly structured sentence production task. Theoretical and clinical implications of these findings are discussed.

The Impact of Clear Speech on the Perceptual and Acoustic Properties of Fricative-Vowel Sequences in Speakers With Dysarthria.

Purpose Studies have reported that clear speech has the potential to influence suprasegmental and segmental aspects of speech, in both healthy and dysarthric speakers. While the impact of clear speech has been studied on the articulation of individual segments, few studies have investigated its effects on coarticulation with multisegment sequences such as fricative-vowel. Objectives The goals of this study are to investigate, in healthy and dysarthric speech, the impact of clear speech on (a) the perception of anticipatory vowel coarticulation in fricatives and (b) the acoustic characteristics of this effect. Method Ten speakers with dysarthria secondary to idiopathic Parkinson's disease were recruited as well as 10 age- and sex-matched healthy speakers. A sentence reading task was performed in natural and clear speaking conditions. The sentences contained words with the initial fricatives /s/ and /ʃ/ preceded by /ə/ and followed by the vowels /i/, /y/, /u/, or /a/. For the perceptual measurements, five listeners were recruited and were asked to predict the upcoming word by listening only to the isolated fricative. Acoustic analyses consisted of spectral moment analysis (M1-M4) on averaged time series. Results Perceptual findings report that identification rates were improved with clear speech for the speakers with dysarthria, but only for the fricative-/i/ sequences. Error pattern analysis indicates that this improvement is associated with an increase in the roundness parameter (lip spreading) identification. Acoustic results are unclear for M1 and M3 but suggest that M2 and M4 differentiation between the rounded versus unrounded vowel contexts is increased with clear speech for the speakers with dysarthria. Discussion Taken together, these findings suggest that clear speech may improve lip coordination in dysarthric speakers with Parkinson's disease. However, the impact of clear speech on the acoustic measures of fricative spectral moments is somewhat limited. This suggests that these metrics, when taken individually, do not capture the entire complexity of fricative-vowel coarticulation.

A Preliminary Look Into the Clinical Evolution of Motor Speech Characteristics in Primary Progressive Apraxia of Speech in Québec French.

Purpose This study aimed to track changes in acoustical and perceptual features of motor speech in patients with phonetic and prosodic primary progressive apraxia of speech (PPAOS) in Québec French over an 18-month period. Method A prospective multiple-case series with multiple testing periods, including four participants with a diagnosis of PPAOS, was conducted. Participants were 0.5-4 years postonset of disease at baseline. They underwent comprehensive motor speech and language assessments and cognitive screening every 6 months for up to 18 months. Acoustical and perceptual analyses of motor speech were conducted. Results Results showed a considerable impairment in motor speech abilities for patients with PPAOS at all time points and a significant decrease in performance for almost all articulatory and prosodic measures over time. Passage reading and diadochokinesis seemed particularly promising for the tracking of changes in PPAOS motor speech characteristics and PPAOS classification. Quantifying length of speech runs made it possible to distinguish phonetic from prosodic PPAOS. Finally, the patients who evolved to phonetic PPAOS developed aphasia, and the two with prosodic PPAOS showed greater motor symptoms such as unequivocal dysarthria. Conclusion This study extends the growing literature on PPAOS and its subtypes by describing specific changes in articulatory and prosodic abilities over a period of at least 6 months, which are important for the diagnosis and management of PPAOS.

Progressive apraxia of speech in Quebec French speakers: A case series.

BACKGROUND: The term progressive apraxia of speech (PAOS) is used to describe speakers presenting with isolated or dominant apraxia of speech in the context of a neurodegenerative syndrome, including primary progressive apraxia of speech (PPAOS) and dominant progressive apraxia of speech (DAOS), respectively. Its motor speech profile has been increasingly explored in the last decade, but description remains vague and very English oriented, although the effect of speakers' language on motor speech phenotypes is increasingly recognized. Although some studies suggest that speakers presenting with isolated PAOS (PPAOS) versus dominant PAOS with concomitant aphasia (DAOS) should be differentiated, distinct characteristics of the two presentations are unclear. Furthermore, a careful description of their clinical presentation in languages other than English is required. AIMS: To describe the motor speech characteristics of Quebec French-speaking participants with prominent PAOS and to explore the communication profile of those presenting more specifically with isolated PAOS (PPAOS), and with dominant PAOS and concomitant aphasia (DAOS). METHODS & PROCEDURES: A thorough effort to recruit all speakers presenting with PAOS in the larger population areas of the province of Quebec was conducted over a 3-year span. A total of nine participants with PAOS (pwPAOS; PPAOS = 5, DAOS = 4) underwent a comprehensive language and motor speech assessment, and a cognitive screening. Their performance was compared with 30 matched healthy controls. OUTCOMES & RESULTS: As a group, pwPAOS differed from healthy speakers on all acoustic and perceptual measures. The PPAOS and PAOS subgroups were similar on several measures, but participants from the PPAOS subgroup tended to perform better on articulatory measures and maximum speech rate tasks. CONCLUSIONS & IMPLICATIONS: This study provides an in-depth analysis of motor speech characteristics of PAOS in Quebec French speakers and adds further evidence for the differentiation of PPAOS and DAOS. Combining simple perceptual and acoustic analyses represent a promising approach to distinguish the two variants and identify treatment targets. What this paper adds What is already known on this subject Progressive apraxia of speech (PAOS) is a neurodegenerative syndrome characterized by progressive and initially isolated or dominant apraxia of speech (primary progressive apraxia of speech [PPAOS] and dominant progressive apraxia of speech [DAOS], respectively). Studies mostly report articulatory and prosodic deficits in PAOS, but concomitant deficits such as dysarthria and executive dysfunction are also reported. The description of motor speech skills in PAOS remains vague and English-oriented. Studies suggest that speakers presenting with isolated PAOS vs dominant PAOS with concomitant aphasia should be differentiated, but distinct characteristics of the two presentations are unclear. What this study adds to existing knowledge To the best of the authors' knowledge, this study is the first to report transversal data of Quebec-French participants with PPAOS and DAOS. Moreover, this study is a first step towards identifying potential characteristics that could facilitate the diagnosis of PPAOS and DAOS in Quebec French. It makes a significant contribution to our understanding of progressive apraxia of speech in different cultural languages. What are the potential or actual clinical implications of this work? This study also initiates the search for sensitive tasks for the diagnosis of those speakers (which is an important process), in addition to identifying the core characteristics of PAOS, DAOS, and PPAOS in the development of an assessment battery for this population.

Cross-Cultural Adaptation and Validation of the Voice Handicap Index in the Quebec French Population (VHI-QF).

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) is a widely recognized, self-administered questionnaire, designed to evaluate patients' perception of voice-related disability. It takes into consideration the physical, functional and emotional impacts of dysphonia. The VHI has been translated and validated in many languages, including European French. The purpose of our study is to translate, adapt and validate a new version of the VHI in Quebec French. METHODS: The original VHI was translated into Quebec French (QF) by forward and backward translations by four professional translators, including a speech-language pathologist. The content validity of the resulting VHI-QF was examined in focus groups with six patients and seven speech-language pathologists. Another sample of 154 patients with voice disorders and 150 healthy controls allowed evaluation of the new questionnaire's convergent and discriminant validity, and internal consistency. Satisfaction toward the questionnaire was also evaluated for all patients, as well Test-retest reliability and responsiveness for a sub-sample. RESULTS: The VHI-QF showed a moderate correlation with dysphonia severity level, indicating adequate convergent validity. Both total and subscale scores also exhibited adequate ability to discriminate between patients and controls (discriminant validity), high internal consistency, and good test-retest reliability. The analysis of pre- and post-treatment VHI-QF scores revealed adequate responsiveness to voice treatment. Patients were overall satisfied with the questionnaire. CONCLUSION: The VHI-QF is a valid, reliable and clinically useful self-reported tool to evaluate the severity and change of voice disorders in Quebec French population. Therefore this questionnaire can be used in clinical and research contexts.

Age-related deficits in speech production: From phonological planning to motor implementation.

Speaking is one of the most complex motor actions that humans can perform, requiring the coordination between linguistic, cognitive, affective and sensorimotor systems. Perhaps counter-intuitively, it is also one of the easiest acts that humans perform, on a daily basis, from a very early age till the end of life, without even thinking about it. With age, however, spoken language production undergoes significant changes, with potential impacts on interpersonal communication and social participation. Unfortunately, the neurobiological mechanisms involved are unclear, which impedes efforts towards the development of clinical interventions, differential diagnosis strategies and even prevention strategies for this population. In the present study, we examined age differences in speech production using a simple diadochokinetic rates task in which phonological and sequential complexity were manipulated. 85 cognitively healthy adults (20-93 years) were recruited from the general population. Cognitive level, hearing and depression symptoms were measured. Participants produced short and long sequences of simple and complex syllables aloud as quickly, steadily and accurately as possible. Performance was assessed in terms of articulation rate, articulation rate stability and accuracy. Results show that, controlling for cognition, hearing and depression, articulation rate stability and accuracy declined significantly with age. The phonological manipulation had more impact on performance than the sequential manipulation. These findings were interpreted as reflecting age-related central disruptions at the level of phonological and motor planning, which provides important new cues into underlying neurobiological mechanisms.

L'apport critique de l'évaluation de la communication dans le diagnostic précoce de l'apraxie primaire progressive de la parole.

Primary progressive apraxia of speech (PPAoS) is a neurodegenerative syndrome characterized by speech apraxia at its onset; as it progresses, it often evolves into total mutism. Even though this syndrome is increasingly recognized, its early differential diagnostic is still complex. The objective of this study was to illustrate why a fine evaluation of speech and language is essential for the differential diagnosis of PPAoS. This longitudinal case study presents the progression of a PPAoS patient over a period of 5 years. Periodic neurological and speech-language assessments were carried out to follow the progression of neurological, memory, language and speech symptoms. The different diagnostic labels established over time were also reported. The evolution of the patient's communication profile was characterized by a preservation of language components and episodic memory, in parallel with a progressive deterioration of speech which gradually reduced intelligibility, and was associated with signs of spasticity, resulting in a complete anarthria. This case study sheds light upon the evolution of a patient with PPAoS. A better understanding of the clinical profile and progression of PPAoS is necessary in order to improve early diagnosis and adequate care for these patients.

Vocalic transitions as markers of speech acoustic changes with STN-DBS in Parkinson's Disease.

PURPOSE: Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) effectively treats cardinal symptoms of idiopathic Parkinson's disease (PD) that cannot be satisfactorily managed with medication. Research is equivocal regarding speech changes associated with STN-DBS. This study investigated the impact of STN-DBS on vocalic transitions and the relationship to intelligibility. METHODS: Eight Quebec-French speakers with PD and eight healthy controls participated. The slope of the second formant frequency (F2 slope) for glides was obtained. Locus equations (LEs) were calculated to capture vocalic transitions in consonant-vowel sequences. A visual analog scale was used to obtain judgments of intelligibility. Measures for the PD group were obtained both On and Off stimulation. RESULTS: F2 slopes and LEs differed among groups, but there were no systematic differences for On versus Off STN-DBS. On an individual level, participants with PD exhibited heterogeneous changes with DBS stimulation. Intelligibility was significantly correlated with F2 slope. CONCLUSION: F2 slope appears to be sensitive to articulatory impairment in PD and could be used in clinical settings to distinguish these speakers from healthy controls. However, acoustic metrics failed to identify systematic change with STN-DBS. The heterogeneity of results, as well as the clinical relevance of acoustic metrics are discussed.

Consonant Acoustics in Parkinson's Disease and Multiple Sclerosis: Comparison of Clear and Loud Speaking Conditions.

PURPOSE: The impact of clear speech or an increased vocal intensity on consonant spectra was investigated for speakers with mild dysarthria secondary to multiple sclerosis or Parkinson's disease and healthy controls. METHOD: Sentences were read in habitual, clear, and loud conditions. Spectral moment coefficients were obtained for word-initial and word-medial /s/, /ʃ/, /t/, and /k/. Global production differences among conditions were confirmed with measures of vocal intensity and articulation rate. RESULTS: Static or slice-in-time first moments (M1) for loud differed most frequently from habitual, but neither loud nor clear enhanced M1 contrast for consonant pairs. In several instances, the clear and loud conditions yielded stable or nonvarying fricative M1 time histories. Spectral contrast was reduced for word-medial versus word-initial consonant pairs. CONCLUSION: The finding that the loud and especially clear condition yielded fairly subtle changes in consonant spectra suggests these global techniques may minimally enhance consonant segmental production or contrast in mild dysarthria. The robust effect of word position on consonant spectra indicates that this variable deserves consideration in future studies. Future research also is needed to investigate how or whether consonant production bears on the improved intelligibility previously reported for these global dysarthria treatment techniques.

Language disturbances after non-thalamic subcortical stroke: a review of the literature.

Language disorders following subcortical non-thalamic stroke show great variability across literature and a well-defined profile in these aphasic disturbances is yet to be established. The lack of recent and consistent literature on the subject complicates the management of subcortical aphasia. The aim of this study is to review the literature describing oral language disturbances following subcortical non-thalamic stoke affecting the basal ganglia and the surrounding white matter. A review of the literature of three databases (PubMed, PsycNet and LLBA), identifying research articles from 1997 to 2015, was completed. The quality of the selected studies was assessed using the Checklist for the assessment of methodological quality. Twenty-two articles met criteria for review and oral language assessment data were extracted for 114 subjects. The results suggest a predominance of deficits in more complex and demanding language levels (ex. discourse, syntax) and in language production (vs comprehension). Rapid recovery is expected, especially for lexical-semantic and receptive deficits. These findings show the importance of a complete oral language evaluation after subcortical stoke and provide recent data relative to expected deficits and recovery to guide clinicians in the management of these patients. They also suggest that a descriptive approach of the deficits may be more efficient and accurate than the use of a traditional classification of aphasia.

Articulatory Changes in Vowel Production following STN DBS and Levodopa Intake in Parkinson's Disease.

Purpose. To investigate the impact of deep brain stimulation of the subthalamic nucleus (STN DBS) and levodopa intake on vowel articulation in dysarthric speakers with Parkinson's disease (PD). Methods. Vowel articulation was assessed in seven Quebec French speakers diagnosed with idiopathic PD who underwent STN DBS. Assessments were conducted on- and off-medication, first prior to surgery and then 1 year later. All recordings were made on-stimulation. Vowel articulation was measured using acoustic vowel space and formant centralization ratio. Results. Compared to the period before surgery, vowel articulation was reduced after surgery when patients were off-medication, while it was better on-medication. The impact of levodopa intake on vowel articulation changed with STN DBS: before surgery, levodopa impaired articulation, while it no longer had a negative effect after surgery. Conclusions. These results indicate that while STN DBS could lead to a direct deterioration in articulation, it may indirectly improve it by reducing the levodopa dose required to manage motor symptoms. These findings suggest that, with respect to speech production, STN DBS and levodopa intake cannot be investigated separately because the two are intrinsically linked. Along with motor symptoms, speech production should be considered when optimizing therapeutic management of patients with PD.

Corrigendum to "Changes in Vowel Articulation with Subthalamic Nucleus Deep Brain Stimulation in Dysarthric Speakers with Parkinson's Disease".

[This corrects the article DOI: 10.1155/2014/487035.].

Changes in vowel articulation with subthalamic nucleus deep brain stimulation in dysarthric speakers with Parkinson's disease.

Purpose. To investigate changes in vowel articulation with the electrical deep brain stimulation (DBS) of the subthalamic nucleus (STN) in dysarthric speakers with Parkinson's disease (PD). Methods. Eight Quebec-French speakers diagnosed with idiopathic PD who had undergone STN DBS were evaluated ON-stimulation and OFF-stimulation (1 hour after DBS was turned off). Vowel articulation was compared ON-simulation versus OFF-stimulation using acoustic vowel space and formant centralization ratio, calculated with the first (F1) and second formant (F2) of the vowels /i/, /u/, and /a/. The impact of the preceding consonant context on articulation, which represents a measure of coarticulation, was also analyzed as a function of the stimulation state. Results. Maximum vowel articulation increased during ON-stimulation. Analyses also indicate that vowel articulation was modulated by the consonant context but this relationship did not change with STN DBS. Conclusions. Results suggest that STN DBS may improve articulation in dysarthric speakers with PD, in terms of range of movement. Optimization of the electrical parameters for each patient is important and may lead to improvement in speech fine motor control. However, the impact on overall speech intelligibility may still be small. Clinical considerations are discussed and new research avenues are suggested.

Two French-speaking cases of foreign accent syndrome: an acoustic-phonetic analysis.

Foreign accent syndrome (FAS) is an acquired neurologic disorder in which an individual suddenly and unintentionally speaks with an accent which is perceived as being different from his/her usual accent. This study presents an acoustic-phonetic description of two Quebec French-speaking cases. The first speaker presents a perceived accent shift to Acadian French (French spoken in the easternmost provinces of Canada), whereas the second acquired an accent identified as Germanic. Speech seems affected by constraints on the coordination of articulatory gestures, expressed by distortions in the production of segments. These distortions do not necessarily result from changes in suprasegmental settings (slow speech rate and isochronous syllable pattern were observed) but may cause the disappearance of markers used for Quebec French accent recognition. Reported speech characteristics are comparable to those of speakers with apraxia of speech (AOS) but symptoms are relatively mild and somewhat similar to the speech of foreign speakers. For this reason, the position that FAS may be a mild form or subtype of AOS, as maintained by other authors, should be seriously considered.