Automating the analysis of eye movement for different neurodegenerative disorders.

The clinical observation and assessment of extra-ocular movements is common practice in assessing neurodegenerative disorders but remains observer-dependent. In the present study, we propose an algorithm that can automatically identify saccades, fixation, smooth pursuit, and blinks using a non-invasive eye tracker. Subsequently, response-to-stimuli-derived interpretable features were elicited that objectively and quantitatively assess patient behaviors. The cohort analysis encompasses persons with mild cognitive impairment (MCI), Alzheimer's disease (AD), Parkinson's disease (PD), Parkinson's disease mimics (PDM), and controls (CTRL). Overall, results suggested that the AD/MCI and PD groups had significantly different saccade and pursuit characteristics compared to CTRL when the target moved faster or covered a larger visual angle during smooth pursuit. These two groups also displayed more omitted antisaccades and longer average antisaccade latency than CTRL. When reading a text passage silently, people with AD/MCI had more fixations. During visual exploration, people with PD demonstrated a more variable saccade duration than other groups. In the prosaccade task, the PD group showed a significantly smaller average hypometria gain and accuracy, with the most statistical significance and highest AUC scores of features studied. The minimum saccade gain was a PD-specific feature different from CTRL and PDM. These features, as oculographic biomarkers, can be potentially leveraged in distinguishing different types of NDs, yielding more objective and precise protocols to diagnose and monitor disease progression.

Interpretable speech features vs. DNN embeddings: What to use in the automatic assessment of Parkinson's disease in multi-lingual scenarios.

Speech-based approaches for assessing Parkinson's Disease (PD) often rely on feature extraction for automatic classification or detection. While many studies prioritize accuracy by using non-interpretable embeddings from Deep Neural Networks, this work aims to explore the predictive capabilities and language robustness of both feature types in a systematic fashion. As interpretable features, prosodic, linguistic, and cognitive descriptors were adopted, while x-vectors, Wav2Vec 2.0, HuBERT, and TRILLsson representations were used as non-interpretable features. Mono-lingual, multi-lingual, and cross-lingual machine learning experiments were conducted leveraging six data sets comprising speech recordings from various languages: American English, Castilian Spanish, Colombian Spanish, Italian, German, and Czech. For interpretable feature-based models, the mean of the best F1-scores obtained from each language was 81% in mono-lingual, 81% in multi-lingual, and 71% in cross-lingual experiments. For non-interpretable feature-based models, instead, they were 85% in mono-lingual, 88% in multi-lingual, and 79% in cross-lingual experiments. Firstly, models based on non-interpretable features outperformed interpretable ones, especially in cross-lingual experiments. Specifically, TRILLsson provided the most stable and accurate results across tasks and data sets. Conversely, the two types of features adopted showed some level of language robustness in multi-lingual and cross-lingual experiments. Overall, these results suggest that interpretable feature-based models can be used by clinicians to evaluate the deterioration of the speech of patients with PD, while non-interpretable feature-based models can be leveraged to achieve higher detection accuracy.

Multilingual evaluation of interpretable biomarkers to represent language and speech patterns in Parkinson's disease.

Motor impairments are only one aspect of Parkinson's disease (PD), which also include cognitive and linguistic impairments. Speech-derived interpretable biomarkers may help clinicians diagnose PD at earlier stages and monitor the disorder's evolution over time. This study focuses on the multilingual evaluation of a composite array of biomarkers that facilitate PD evaluation from speech. Hypokinetic dysarthria, a motor speech disorder associated with PD, has been extensively analyzed in previously published studies on automatic PD evaluation, with a relative lack of inquiry into language and task variability. In this study, we explore certain acoustic, linguistic, and cognitive information encoded within the speech of several cohorts with PD. A total of 24 biomarkers were analyzed from American English, Italian, Castilian Spanish, Colombian Spanish, German, and Czech by conducting a statistical analysis to evaluate which biomarkers best differentiate people with PD from healthy participants. The study leverages conceptual robustness as a criterion in which a biomarker behaves the same, independent of the language. Hence, we propose a set of speech-based biomarkers that can effectively help evaluate PD while being language-independent. In short, the best acoustic and cognitive biomarkers permitting discrimination between experimental groups across languages were fundamental frequency standard deviation, pause time, pause percentage, silence duration, and speech rhythm standard deviation. Linguistic biomarkers representing the length of the narratives and the number of nouns and auxiliaries also provided discrimination between groups. Altogether, in addition to being significant, these biomarkers satisfied the robustness requirements.

Effect of Functional Endoscopic Sinus Surgery on Voice and Speech Recognition.

OBJECTIVE: Functional Endoscopic Sinus Surgery (FESS) is the surgery of choice for nasal polyposis and chronic rhinosinusitis. The aim of our study is to assess the influence of this surgery in the acoustic parameters of voice, and their implications in the systems of identification or verification of the speaker through the speech. MATERIAL AND METHODS: A prospective study was performed between January 2017 and June 2017 including two groups of patients: those undergoing FESS, and a control group. Demographic data and GRBAS assessment were statistically analyzed. In addition, a recording of patients' voices was made with a subsequent acoustic analysis and automatic identification of the speaker through machine learning systems, establishing the equal error rate. Samples were taken before surgery, 2 weeks after surgery and 3 months later. RESULTS: After FESS, a significant difference was observed in Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS). Besides, acoustic analysis showed a significance decrease in fundamental frequency (F0), when compared with the control group. For the automatic identification of the speaker through computer systems, we found that the equal error rate is higher in the FESS group. CONCLUSIONS: Results suggest that FESS produce a decrease of F0 and changes in the vocal tract that derive in an increase in the error of recognition of the speaker in FESS patients.

Artificial Intelligence Applied to Chest X-Ray Images for the Automatic Detection of COVID-19. A Thoughtful Evaluation Approach.

Current standard protocols used in the clinic for diagnosing COVID-19 include molecular or antigen tests, generally complemented by a plain chest X-Ray. The combined analysis aims to reduce the significant number of false negatives of these tests and provide complementary evidence about the presence and severity of the disease. However, the procedure is not free of errors, and the interpretation of the chest X-Ray is only restricted to radiologists due to its complexity. With the long term goal to provide new evidence for the diagnosis, this paper presents an evaluation of different methods based on a deep neural network. These are the first steps to develop an automatic COVID-19 diagnosis tool using chest X-Ray images to differentiate between controls, pneumonia, or COVID-19 groups. The paper describes the process followed to train a Convolutional Neural Network with a dataset of more than 79, 500 X-Ray images compiled from different sources, including more than 8, 500 COVID-19 examples. Three different experiments following three preprocessing schemes are carried out to evaluate and compare the developed models. The aim is to evaluate how preprocessing the data affects the results and improves its explainability. Likewise, a critical analysis of different variability issues that might compromise the system and its effects is performed. With the employed methodology, a 91.5% classification accuracy is obtained, with an 87.4% average recall for the worst but most explainable experiment, which requires a previous automatic segmentation of the lung region.

Phonetic relevance and phonemic grouping of speech in the automatic detection of Parkinson's Disease.

Literature documents the impact of Parkinson's Disease (PD) on speech but no study has analyzed in detail the importance of the distinct phonemic groups for the automatic identification of the disease. This study presents new approaches that are evaluated in three different corpora containing speakers suffering from PD with two main objectives: to investigate the influence of the different phonemic groups in the detection of PD and to propose more accurate detection schemes employing speech. The proposed methodology uses GMM-UBM classifiers combined with a technique introduced in this paper called phonemic grouping, that permits observation of the differences in accuracy depending on the manner of articulation. Cross-validation results reach accuracies between 85% and 94% with AUC ranging from 0.91 to 0.98, while cross-corpora trials yield accuracies between 75% and 82% with AUC between 0.84 and 0.95, depending on the corpus. This is the first work analyzing the generalization properties of the proposed approaches employing cross-corpora trials and reaching high accuracies. Among the different phonemic groups, results suggest that plosives, vowels and fricatives are the most relevant acoustic segments for the detection of PD with the proposed schemes. In addition, the use of text-dependent utterances leads to more consistent and accurate models.

Effect of Septoplasty On Voice Performance: Nasalance and Acoustic Study.

BACKGROUND: Septoplasty is a surgical technique for the correction of the nasal septum that may alter the vocal tract. The aim of our study is to assess whether this technique modifies nasalance and acoustic parameters, and their clinical implications in voice perception. METHODOLOGY: A prospective study was performed between January 2017 and June 2017 including 2 groups of patients: those undergoing septoplasty, and a control group. Subjective nasality questionnaire, objective nasalance with nasometer, and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) assessment were statistically analysed. In addition, a recording of patients' voices was made with a subsequent acoustic analysis. Samples were taken: pre-surgically, 2 weeks after surgery and after 3 months. RESULTS: After septoplasty, a significant difference was observed in GRBAS, nasality questionnaire and nasometer nasalance, when compared with the control group. As for the acoustic analysis, no differences were observed in most parameters (F0, Jitter, Shimmer, HNR, NHR, Formants F1-F3), except for the antiF3 antiformant, which showed significant changes in all the vowels studied. CONCLUSIONS: Septoplasty can produce changes in the vocal tract, with an increase in initial nasalance but with subsequent normalization. Besides, minor changes were found in the acoustic analysis but with no clinical relevance.

Corrigendum: Voice Pathology Detection Using Modulation Spectrum-Optimized Metrics.

[This corrects the article on p. 1 in vol. 4, PMID: 26835449.].

Voice Pathology Detection Using Modulation Spectrum-Optimized Metrics.

There exist many acoustic parameters employed for pathological assessment tasks, which have served as tools for clinicians to distinguish between normophonic and pathological voices. However, many of these parameters require an appropriate tuning in order to maximize its efficiency. In this work, a group of new and already proposed modulation spectrum (MS) metrics are optimized considering different time and frequency ranges pursuing the maximization of efficiency for the detection of pathological voices. The optimization of the metrics is performed simultaneously in two different voice databases in order to identify what tuning ranges produce a better generalization. The experiments were cross-validated so as to ensure the validity of the results. A third database is used to test the optimized metrics. In spite of some differences, results indicate that the behavior of the metrics in the optimization process follows similar tendencies for the tuning databases, confirming the generalization capabilities of the proposed MS metrics. In addition, the tuning process reveals which bands of the modulation spectra have relevant information for each metric, which has a physical interpretation respecting the phonatory system. Efficiency values up to 90.6% are obtained in one tuning database, while in the other, the maximum efficiency reaches 71.1%. Obtained results also evidence a separability between normophonic and pathological states using the proposed metrics, which can be exploited for voice pathology detection or assessment.

Modulation Spectra Morphological Parameters: A New Method to Assess Voice Pathologies according to the GRBAS Scale.

Disordered voices are frequently assessed by speech pathologists using perceptual evaluations. This might lead to problems caused by the subjective nature of the process and due to the influence of external factors which compromise the quality of the assessment. In order to increase the reliability of the evaluations, the design of automatic evaluation systems is desirable. With that in mind, this paper presents an automatic system which assesses the Grade and Roughness level of the speech according to the GRBAS perceptual scale. Two parameterization methods are used: one based on the classic Mel-Frequency Cepstral Coefficients, which has already been used successfully in previous works, and other derived from modulation spectra. For the latter, a new group of parameters has been proposed, named Modulation Spectra Morphological Parameters: MSC, DRB, LMR, MSH, MSW, CIL, PALA, and RALA. In methodology, PCA and LDA are employed to reduce the dimensionality of feature space, and GMM classifiers to evaluate the ability of the proposed features on distinguishing the different levels. Efficiencies of 81.6% and 84.7% are obtained for Grade and Roughness, respectively, using modulation spectra parameters, while MFCCs performed 80.5% and 77.7%. The obtained results suggest the usefulness of the proposed Modulation Spectra Morphological Parameters for automatic evaluation of Grade and Roughness in the speech.

An automatic method to detect and track the glottal gap from high speed videoendoscopic images.

BACKGROUND: The image-based analysis of the vocal folds vibration plays an important role in the diagnosis of voice disorders. The analysis is based not only on the direct observation of the video sequences, but also in an objective characterization of the phonation process by means of features extracted from the recorded images. However, such analysis is based on a previous accurate identification of the glottal gap, which is the most challenging step for a further automatic assessment of the vocal folds vibration. METHODS: In this work, a complete framework to automatically segment and track the glottal area (or glottal gap) is proposed. The algorithm identifies a region of interest that is adapted along time, and combine active contours and watershed transform for the final delineation of the glottis and also an automatic procedure for synthesize different videokymograms is proposed. RESULTS: Thanks to the ROI implementation, our technique is robust to the camera shifting and also the objective test proved the effectiveness and performance of the approach in the most challenging scenarios that it is when exist an inappropriate closure of the vocal folds. CONCLUSIONS: The novelties of the proposed algorithm relies on the used of temporal information for identify an adaptive ROI and the use of watershed merging combined with active contours for the glottis delimitation. Additionally, an automatic procedure for synthesize multiline VKG by the identification of the glottal main axis is developed.