The relationship of rate and pause features to the communicative participation of people living with ALS.

INTRODUCTION/AIMS: Many people living with amyotrophic lateral sclerosis (PALS) report restrictions in their day-to-day communication (communicative participation). However, little is known about which speech features contribute to these restrictions. This study evaluated the effects of common speech symptoms in PALS (reduced overall speaking rate, slowed articulation rate, and increased pausing) on communicative participation restrictions. METHODS: Participants completed surveys (the Communicative Participation Item Bank-short form; the self-entry version of the ALS Functional Rating Scale-Revised) and recorded themselves reading the Bamboo Passage aloud using a smartphone app. Rate and pause measures were extracted from the recordings. The association of various demographic, clinical, self-reported, and acoustic speech features with communicative participation was evaluated with bivariate correlations. The contribution of salient rate and pause measures to communicative participation was assessed using multiple linear regression. RESULTS: Fifty seven people living with ALS participated in the study (mean age = 61.1 years). Acoustic and self-report measures of speech and bulbar function were moderately to highly associated with communicative participation (Spearman rho coefficients ranged from rs = 0.48 to rs = 0.77). A regression model including participant age, sex, articulation rate, and percent pause time accounted for 57% of the variance of communicative participation ratings. DISCUSSION: Even though PALS with slowed articulation rate and increased pausing may convey their message clearly, these speech features predict communicative participation restrictions. The identification of quantitative speech features, such as articulation rate and percent pause time, is critical to facilitating early and targeted intervention and for monitoring bulbar decline in ALS.

The effect of rate reduction on signaling prosodic contrasts in dysarthria.

BACKGROUND/AIMS: To understand how reducing speaking rate alters prosodic contrasts in speakers with dysarthria (DYS) and healthy controls (HC). METHODS: Seven male speakers with DYS (mean age = 34.9) and 7 age- and sex-matched HC (mean age = 36.9) produced identical phrases with affirmative (A), contrastive stress (CS) or question (Q) intonation at habitual and slow rate within a naturalistic game. Relative (word-to-word) changes in peak fundamental frequency (F0), intensity, and duration were compared across conditions, groups, and rates. RESULTS: For some contrasts, rate reduction differentially affected the speaking groups, with HC exaggerating and speakers with DYS dampening some prosodic cues. Rate reduction diminished the Q contrast for both groups, with reduced peak F0 differences for HC and reduced word duration differences for HC and with DYS speakers. Slow rate also resulted in decreased lengthening of the final word for all three contrasts, thereby diminishing the Q contrast while exaggerating the CS and A contrasts. CONCLUSION: Although slow rate may improve segmental intelligibility, it may inadvertently dampen prosodic contrasts for some DYS speakers, thereby impacting communication effectiveness and naturalness. Implications for designing interventions that balance trade-offs between prosodic modulation and segmental clarity are discussed.

Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis.

PURPOSE: Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD: Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS: Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS: Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.

Relationship Between Prosody and Intelligibility in Children with Dysarthria.

Exaggerated and redundant prosodic cue use has been noted among adults with dysarthria secondary to cerebral palsy (CP) (Patel, 2004; van Doorn & Sheard, 2001). A possible explanation may be that speakers heighten prosodic contrasts to increase intelligibility. The current work examined whether children with dysarthria due to CP also produce exaggerated prosodic contours and if so, how prosodic cue use in these speakers impacts intelligibility. Acoustic analyses were conducted on a previously collected dataset of 2-7 word utterances produced by fourteen children with CP (7 with dysarthria and 7 without) (Hustad, Gorton & Lee, 2010). The dataset also included sentence-level transcriptions obtained from five listeners per speaker. Word intelligibility scores were derived from these transcripts and used to determine whether prosodic modulation differed for words with high versus low intelligibility. Although mean fundamental frequency (F0) and intensity range were similar across groups, words produced by children with dysarthria were slower and more variable in F0 than the group without dysarthria. Moreover, intelligibility decreased when children with dysarthria increased F0 and duration beyond the range used by children without dysarthria. Thus findings suggest that interventions targeting appropriate prosody may be beneficial in improving intelligibility in children with dysarthria and CP.

Communication and Social Interaction Experiences of Youths With Congenital Motor Speech Disorders.

PURPOSE: The purpose of this study was to explore the communication and social interaction experiences of adolescents with congenital motor speech disorders due to cerebral palsy or Down syndrome, with the aim of identifying clinical and research needs to support the development and implementation of speech-language interventions. METHOD: Five male youths (ages 14-18 years) with congenital motor speech disorders and one of their parents participated in face-to-face, semistructured interviews designed to understand communication and social experiences in daily life. Interviews were audio-recorded and orthographically transcribed offline. Content was coded according to topic areas emerging in the data. Themes were developed to illustrate the most salient and representative aspects of participants' experiences according to the phenomenological tradition that recognizes that participants are experts in their "lived experience." RESULTS: Participants described the youths' day-to-day communication experiences, including facilitators and barriers to successful social interactions. Thematic analysis revealed three main themes: (a) strong core relationships amidst sparse, superficial interactions in daily life; (b) the complicated picture of why; and (c) how speech-language pathologists can help. CONCLUSIONS: Participants reported that the impact of congenital motor speech disorders on social interactions and experiences became more apparent in adolescence than in earlier childhood. Addressing communication challenges to meet the unique social demands of this period requires tailored interventions that target multiple contributing factors beyond speech impairment, such as social communication skills, negative communication partner attitudes, and participation opportunities. Shifting practice toward a life participation approach to communication intervention stands to substantially improve the long-term social outcomes of adolescents with motor speech disorders.

Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies.

BACKGROUND: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients' cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. OBJECTIVE: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. METHODS: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan-Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. RESULTS: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77% (17/22) in study 1, 59% (29/49) in study 2, and 96% (22/23) in study 3. After 3 months, passively collected location data were collected for 95% (21/22), 86% (42/49), and 100% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75%). CONCLUSIONS: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients' progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. TRIAL REGISTRATION: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711.

Rate of speech decline in individuals with amyotrophic lateral sclerosis.

Although speech declines rapidly in some individuals with amyotrophic lateral sclerosis (ALS), longitudinal changes in speech have rarely been characterized. The study objectives were to model the rate of decline in speaking rate and speech intelligibility as a function of disease onset site, sex, and age at onset in 166 individuals with ALS; and estimate time to speech loss from symptom onset. We also examined the association between clinical (speaking rate/intelligibility) measures and patient-reported measures of ALS progression (ALSFRS-R). Speech measures declined faster in the bulbar-onset group than in the spinal-onset group. The rate of decline was not significantly affected by sex and age. Functional speech was still maintained at 60 months since disease onset for most patients with spinal onset. However, the time to speech loss was 23 months based on speaking rate < 120 (w/m) and 32 months based on speech intelligibility < 85% in individuals with ALS-bulbar onset. Speech measures were more responsive to functional decline than were the patient-reported measures. The findings of this study will inform future work directed toward improving speech prognosis in ALS, which is critical for determining the appropriate timing of interventions, providing appropriate counseling for patients, and evaluating functional changes during clinical trials.

An exploratory study of student, speech-language pathologist and emergency worker impressions of speakers with dysarthria.

PURPOSE: To explore the influence of listener profession on impressions of speakers with dysarthria with varying intelligibility using semantic differential scales. Method: Three listener groups (undergraduate students, emergency workers, speech-language pathologists (SLPs); n = 38) rated non-speech attributes of six adults with dysarthria that ranged from low to high speech intelligibility. Participants rated 22 bipolar adjective pairs and listening effort on visual analogue scales. Following factor analysis of the semantic differential scales, listener impression and effort ratings were compared across listening groups and speaker intelligibility. RESULT: Repeated measures ANOVA revealed that neither impressions nor effort ratings differed across listener groups. However, impressions significantly decreased and listening effort significantly increased with reduced intelligibility. Analysis of the semantic differential scale items revealed two factors (Capability, Personality) that predicted 52% of the variance. Listener impressions were significantly higher for Personality than Capability. Conclusion: Preliminary findings suggest that speakers with dysarthria with reduced intelligibility are at risk to be negatively judged, particularly on their physical and mental capability. This study demonstrates the promise of employing semantic differential scales to investigate listener impressions and therefore the daily communication experiences of speakers with dysarthria. SLPs should consider patient experience of negative impressions when designing treatment.

Co-Occurrence of Hypernasality and Voice Impairment in Amyotrophic Lateral Sclerosis: Acoustic Quantification.

PURPOSE: Hypernasality and atypical voice characteristics are common features of dysarthric speech due to amyotrophic lateral sclerosis (ALS). Existing acoustic measures have been developed to primarily target either hypernasality or voice impairment, and the effects of co-occurring hypernasality-voice problems on these measures are unknown. This report explores (a) the extent to which acoustic measures are affected by concurrent perceptually identified hypernasality and voice impairment due to ALS and (b) candidate acoustic measures of early indicators of hypernasality and voice impairment in the presence of multisystem involvement in individuals with ALS. METHOD: Two expert listeners rated severity of hypernasality and voice impairment in sentences produced by individuals with ALS (n = 27). The samples were stratified based on perceptual ratings: voice/hypernasality asymptomatic, predominantly hypernasal, predominantly voice impairment, and mixed (co-occurring hypernasality and voice impairment). Groups were compared using established acoustic measures of hypernasality (one-third octave analysis) and voice (cepstral/spectral analysis) impairment. RESULTS: The one-third octave analysis differentiated all groups; the cepstral peak prominence differentiated all groups except asymptomatic versus mixed, whereas the low-to-high spectral ratio did not differ among groups. Additionally, one-third octave analyses demonstrated promising speech diagnostic potential. CONCLUSIONS: The results highlight the need to consider the validity of measures in the context of multisubsystem involvement. Our preliminary findings further suggest that the one-third octave analysis may be an optimal approach to quantify hypernasality and voice abnormalities in the presence of multisystem speech impairment. Future evaluation of the diagnostic accuracy of the one-third octave analysis is warranted.

The Impact of Contrastive Stress on Vowel Acoustics and Intelligibility in Dysarthria.

Purpose: To compare vowel acoustics and intelligibility in words produced with and without contrastive stress by speakers with spastic (mixed-spastic) dysarthria secondary to cerebral palsy (DYSCP) and healthy controls (HCs). Method: Fifteen participants (9 men, 6 women; age M = 42 years) with DYSCP and 15 HCs (9 men, 6 women; age M = 36 years) produced sentences containing target words with and without contrastive stress. Forty-five healthy listeners (age M = 25 years) completed a vowel identification task of DYSCP productions. Vowel acoustics were compared across stress conditions and groups using 1st (F1) and 2nd (F2) formant measures. Perceptual intelligibility was compared across stress conditions and dysarthria severity. Results: F1 and F2 significantly increased in stressed words for both groups, although the degree of change differed. Mean Euclidian distance between vowels also increased with stress. The relative probability of vowels falling within the target F1 × F2 space was greater for HCs but did not differ with stress. Stress production resulted in greater listener vowel identification accuracy for speakers with mild dysarthria. Conclusions: Contrastive stress affected vowel formants for both groups. Perceptual results suggest that some speakers with dysarthria may benefit from a contrastive stress strategy to improve vowel intelligibility.

Respiratory kinematics during vocalization and nonspeech respiration in children from 9 to 48 months.

The development of respiratory drive for vocalization was studied by observing chest wall kinematics longitudinally in 4 typically developing children from the age of 9 to 48 months. Measurements of the relative contribution of rib cage and abdominal movement during vocalization (i.e., babbling and true words) and rest breathing were obtained every 3 months using respiratory plethysmography (Respitrace). Extending earlier findings in 15-month-olds, 2 methods of analysis of rib cage and abdominal movement were used: (a). a dynamic index of the strength of coupling between the rib cage and abdomen, and (b). a classification scheme describing the moment-by-moment changes in each of the 2 components (C. A. Moore, T. J. Caulfield, and J. R. Green, 2001). The developmental course of relative chest wall kinematics differed between vocalization and rest breathing. The coupling of rib cage and abdomen during vocalization weakened significantly with development, whereas it remained consistently strong for rest breathing throughout the observed period. The developmental changes in frequency of occurrence of relative moment-by-moment changes varied across movement type. The results support previous findings that speech breathing is distinct from rest breathing based on the relative contributions of the rib cage and abdomen. Longitudinal changes are likely responsive to anatomic development, including changes to rib cage shape and compliance.

Indirect estimates of jaw muscle tension in children with suspected hypertonia, children with suspected hypotonia, and matched controls.

PURPOSE: In this study, the authors compared indirect estimates of jaw-muscle tension in children with suspected muscle-tone abnormalities with age- and gender-matched controls. METHOD: Jaw movement and muscle activation were measured in children (ages 3 years, 11 months, to 10 years) with suspected muscle-tone abnormalities (Down syndrome or spastic cerebral palsy; n = 10) and controls (n = 11). Two measures were used to infer jaw tension: a kinematic index of mass-normalized stiffness and electromechanical delay (EMD). The kinematic index used video-based kinematics to obtain the slope of the peak velocity-displacement relationship. The EMD was derived from the interval between the onset of suprahyoid muscle activity and the onset of jaw depression. RESULTS: Neither measure differentiated the groups. The kinematic index revealed differences between stressed and unstressed syllables in 3-syllable productions by the participants with cerebral palsy and controls, but not in 2-syllable productions by the participants with Down syndrome and controls. CONCLUSION: This preliminary investigation included the novel application of 2 measures to infer the jaw-muscle tension of children with suspected tone abnormalities. Although the results do not support the hypothesis that suspected muscle-tone abnormalities affect jaw movement sufficiently to influence speech production, considerations for interpreting the findings include methodological limitations and possible compensatory muscle coactivation.