Speech Production Deficits Research Articles

Aging deficits in naturalistic speech production and monitoring revealed through reading aloud.

The current study investigated how aging affects production and self-correction of errors in connected speech elicited via a read aloud task. Thirty-five cognitively healthy older and 56 younger participants read aloud 6 paragraphs in each of three conditions increasing in difficulty: (a) normal, (b) nouns-swapped (in which nouns were shuffled across pairs of sentences in each paragraph), and (c) exchange (in which adjacent words in every two sentences were reversed in order). Reading times and errors increased with task difficulty, but self-correction rates were lowest in the nouns-swapped condition. Older participants read aloud more slowly, and after controlling for aging-related advantages in vocabulary knowledge, produced more speech errors (especially in the normal condition), and self-corrected errors less often than younger participants. Exploratory analysis of error types revealed that aging increased the rate of function word substitution errors (saying the instead of a), whereas younger participants omitted content words more often than did older participants. This pattern of aging deficits reveals powerful effects of vocabulary knowledge on speech production and suggests aging speakers can compensate for aging-related decline in control over speech production with their higher vocabulary knowledge and careful attention to speech planning in more difficult speaking conditions. These results suggest a model of speech production in which planning of speech is relatively automatic, whereas monitoring and self-correction are more attention-demanding, in turn leaving speech production relatively intact in aging. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits.

Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this article, we discuss the nature of speech production errors in children with dyslexia, including those who have a history of speech sound disorder and those who do not, to familiarize speech-language pathologists with speech production-specific risk factors that may help predict or identify dyslexia in young children. In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.

Supplemental Material for Aging Deficits in Naturalistic Speech Production and Monitoring Revealed Through Reading Aloud

Supplemental Material for Aging Deficits in Naturalistic Speech Production and Monitoring Revealed Through Reading Aloud

Automatic Screening to Detect 'At Risk' Child Speech Samples using a Clinical Group Verification framework.

Pediatric speech sound disorders (SSD) encompass a wide range of speech production deficits that can interfere with children's educational growth, social engagement and employment opportunities. Early detection of SSDs can facilitate timely intervention and minimize the potential for life-long adverse effects, but distinguishing between typical and atypical speech production in preschoolers is challenging due to developmental and individual variability in speech acquisition. In this study we apply Gaussian Mixture Models to speech samples from 3- to 6-year-old children, recorded by parents using an iOS app. Speech-language pathologists previously classified the samples as positive ('at risk' speech, warranting a referral for a speech-language evaluation) or negative ('no risk' speech). In a series of exploratory analyses, novel distance measures and group scoring techniques are developed which show good subject-level prediction accuracy. Our results provide evidence that it may be feasible to use Speech Processing and Speaker Verification techniques to model and screen speech samples from children for possible speech sound disorders.

Relative contributions of lesion location and lesion size to predictions of varied language deficits in post-stroke aphasia.

Despite the widespread use of lesion-symptom mapping (LSM) techniques to study associations between location of brain damage and language deficits, the prediction of language deficits from lesion location remains a substantial challenge. The present study examined several factors which may impact lesion-symptom prediction by (1) testing the relative predictive advantage of general language deficit scores compared to composite scores that capture specific deficit types, (2) isolating the relative contribution of lesion location compared to lesion size, and (3) comparing standard voxel-based lesion-symptom mapping (VLSM) with a multivariate method (sparse canonical correlation analysis, SCCAN). Analyses were conducted on data from 128 participants who completed a detailed battery of psycholinguistic tests and underwent structural neuroimaging (MRI or CT) to determine lesion location. For both VLSM and SCCAN, overall aphasia severity (Western Aphasia Battery Aphasia Quotient) and object naming deficits were primarily predicted by lesion size, whereas deficits in Speech Production and Speech Recognition were better predicted by a combination of lesion size and location. The implementation of both VLSM and SCCAN raises important considerations regarding controlling for lesion size in lesion-symptom mapping analyses. These findings suggest that lesion-symptom prediction is more accurate for deficits within neurally-localized cognitive systems when both lesion size and location are considered compared to broad functional deficits, which can be predicted by overall lesion size alone.

Recurrence of embolism post intravenous thrombolysis on an asymptomatic bilateral carotid stenosis

Atherosclerosis is the most common cause of stroke and patients with stroke due to large-vessel atherosclerosis are at the highest risk of recurrent stroke. Carotid endarterectomy (CEA) is a secondary prevention method for reducing the risk of stroke, but endovascular therapy has developed rapidly in recent years. The long-term therapeutic efficacy of endovascular stenting for carotid artery stenosis has been shown not to be inferior to CEA. We present the case of a 61-year-old female, smoker, dyslipidemic, hypertensive, therapeutically neglected, who suddenly developed right hemiplegia accompanied by central facial palsy and motor aphasia. The inclusion criteria allowed the initiation of intravenous thrombolytic therapy. At 2 and 24 hours after thrombolysis the evolution was favorable with the almost complete recovery of motor and speech production deficits. At 48 hours after thrombolysis, the patient experienced rapid decompensation and worsening, with recurrence of hemiplegia on the same side and motor aphasia. Cervical echoDoppler and cerebro-cervical CT angiography (CTA) revealed a complete right internal carotid artery (ICA) and quantified the degree of left ICA stenosis asymptomatic up to that time. The case was a challenge in terms of subsequent secondary prevention. Although most studies dealt with endarterectomy as a treatment for tight carotid stenosis, in the here reported case this was not possible, so we had to resort to angioplasty with placement of a self-expandable stent in the left ICA.

Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts.

Donepezil (DP), a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014). Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia). A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day) which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy) during 8 weeks (Endpoint 1). Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR) during 3 months (Endpoint 2). Language evaluations, diffusion weighted imaging (DWI), and voxel-based morphometry (VBM) were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these tracts. In conclusion, cholinergic potentiation alone and combined with a model-based aphasia therapy improved language deficits by promoting structural plastic changes in right white matter tracts.

Reassessing Aphasic Classifications with Community Detection Analysis

Reassessing Aphasic Classifications with Community Detection Analysis

Cortical sensitivity to spoken acoustic variability in persons with aphasia: an MEG study

Cortical sensitivity to spoken acoustic variability in persons with aphasia: an MEG study

The Relationship Between Speech Production and Speech Perception Deficits in Parkinson's Disease.

This study investigated the possible relationship between hypokinetic speech production and speech intensity perception in patients with Parkinson's disease (PD). Participants included 14 patients with idiopathic PD and 14 matched healthy controls (HCs) with normal hearing and cognition. First, speech production was objectified through a standardized speech intelligibility assessment, acoustic analysis, and speech intensity measurements. Second, an overall estimation task and an intensity estimation task were addressed to evaluate overall speech perception and speech intensity perception, respectively. Finally, correlation analysis was performed between the speech characteristics of the overall estimation task and the corresponding acoustic analysis. The interaction between speech production and speech intensity perception was investigated by an intensity imitation task. Acoustic analysis and speech intensity measurements demonstrated significant differences in speech production between patients with PD and the HCs. A different pattern in the auditory perception of speech and speech intensity was found in the PD group. Auditory perceptual deficits may influence speech production in patients with PD. The present results suggest a disturbed auditory perception related to an automatic monitoring deficit in PD.

When There’s More to the Story

When There’s More to the Story

Interrelations between cognitive dysfunction and motor symptoms of Parkinson's disease: behavioral and neural studies.

Parkinson's disease (PD) is characterized by a range of motor symptoms. Besides the cardinal symptoms (tremor, bradykinesia/akinesia, and rigidity), PD patients also show other motor deficits, including gait disturbance, speech deficits, and impaired handwriting. However, along with these key motor symptoms, PD patients also experience cognitive deficits in attention, executive function, working memory, and learning. Recent evidence suggests that these motor and cognitive deficits of PD are not completely dissociable, as aspects of cognitive dysfunction can impact motor performance in PD. In this article, we provide a review of behavioral and neural studies on the associations between motor symptoms and cognitive deficits in PD, specifically akinesia/bradykinesia, tremor, gait, handwriting, precision grip, and speech production. This review paves the way for providing a framework for understanding how treatment of cognitive dysfunction, for example cognitive rehabilitation programs, may in turn influence the motor symptoms of PD.

Perception drives production across sensory modalities: A network for sensorimotor integration of visual speech

Sensory information is critical for movement control, both for defining the targets of actions and providing feedback during planning or ongoing movements. This holds for speech motor control as well, where both auditory and somatosensory information have been shown to play a key role. Recent clinical research demonstrates that individuals with severe speech production deficits can show a dramatic improvement in fluency during online mimicking of an audiovisual speech signal suggesting the existence of a visuomotor pathway for speech motor control. Here we used fMRI in healthy individuals to identify this new visuomotor circuit for speech production. Participants were asked to perceive and covertly rehearse nonsense syllable sequences presented auditorily, visually, or audiovisually. The motor act of rehearsal, which is prima facie the same whether or not it is cued with a visible talker, produced different patterns of sensorimotor activation when cued by visual or audiovisual speech (relative to auditory speech). In particular, a network of brain regions including the left posterior middle temporal gyrus and several frontoparietal sensorimotor areas activated more strongly during rehearsal cued by a visible talker versus rehearsal cued by auditory speech alone. Some of these brain regions responded exclusively to rehearsal cued by visual or audiovisual speech. This result has significant implications for models of speech motor control, for the treatment of speech output disorders, and for models of the role of speech gesture imitation in development.

Speech Perception and Working Memory in Children with Residual Speech Errors: A Case Study Analysis.

Some children with residual deficits in speech production also display characteristics of dyslexia; however, the causes of these disorders--in isolation or comorbidly--remain unknown. Presently, the role of phonological representations is an important construct for considering how the underlying system of phonology functions. In particular, two related skills--speech perception and phonological working memory--may provide insight into the nature of phonological representations. This study provides an exploratory investigation into the profiles of three 9-year-old children: one with residual speech errors, one with residual speech errors and dyslexia, and one who demonstrated typical, age-appropriate speech sound production and reading skills. We provide an in-depth examination of their relative abilities in the areas of speech perception, phonological working memory, vocabulary, and word reading. Based on these preliminary explorations, we suggest implications for the assessment and treatment of children with residual speech errors and/or dyslexia.

The role of candidate‐gene CNTNAP2 in childhood apraxia of speech and specific language impairment

Childhood apraxia of speech (CAS) is a debilitating pediatric speech disorder characterized by varying symptom profiles, comorbid deficits, and limited response to intervention. Specific Language Impairment (SLI) is an inherited pediatric language disorder characterized by delayed and/or disordered oral language skills including impaired semantics, syntax, and discourse. To date, the genes associated with CAS and SLI are not fully characterized. In the current study, we evaluated behavioral and genetic profiles of seven children with CAS and eight children with SLI, while ensuring all children were free of comorbid impairments. Deletions within CNTNAP2 were found in two children with CAS but not in any of the children with SLI. These children exhibited average to high performance on language and word reading assessments in spite of poor articulation scores. These findings suggest that genetic variation within CNTNAP2 may be related to speech production deficits.

Decoding speech perception from single cell activity in humans

Deciphering the content of continuous speech is a challenging task performed daily by the human brain. Here, we tested whether activity of single cells in auditory cortex could be used to support such a task. We recorded neural activity from auditory cortex of two neurosurgical patients while presented with a short video segment containing speech. Population spiking activity (~20 cells per patient) allowed detection of word onset and decoding the identity of perceived words with significantly high accuracy levels. Oscillation phase of local field potentials (8–12Hz) also allowed decoding word identity although with lower accuracy levels. Our results provide evidence that the spiking activity of a relatively small population of cells in human primary auditory cortex contains significant information for classification of words in ongoing speech. Given previous evidence for overlapping neural representation during speech perception and production, this may have implications for developing brain–machine interfaces for patients with deficits in speech production.

Dominant Frontotemporal Dementia Mutations in 140 Cases of Primary Progressive Aphasia and Speech Apraxia

Background: Mutations in three genes [chromosome 9 open-reading-frame 72 (C9ORF72); microtubule-associated protein tau (MAPT) and progranulin (GRN)] account for the vast majority of familial, and a proportion of sporadic, frontotemporal dementia (FTD) cases. Progressive apraxia of speech (PAOS) is a type of FTD characterized by speech production deficits without a known cause. Methods: We therefore assessed for genetic mutations in C9ORF72, MAPT and GRN in 40 prospectively recruited PAOS patients. For comparison, we also assessed these mutations in 100 patients with primary progressive aphasia (PPA), including logopenic PPA (n = 54), nonfluent/agrammatic PPA (n = 17), semantic PPA (n = 16), and unclassifiable PPA (n = 13). Results: The mean age at onset of PAOS patients was 66.7 years (± 9.3); 50% were women. Ten patients (25%) had ≥1 first-degree relative with a neurodegenerative disease. No mutations were found in any PAOS patient. In comparison, 36% of the PPA patients had a family history and 5 (5%) had a genetic mutation detected: MAPT (n = 0), GRN (n = 3) and C9ORF72 (n = 2). Conclusions: Although limited by an overrepresentation of logopenic PPA, which frequently predicts Alzheimer's disease pathology, this study suggests that mutations in the three genes most commonly associated with FTD are not associated with PAOS and are not commonly associated with PPA.

The relation of object naming and other visual speech production tasks: a large scale voxel-based morphometric study.

We report a lesion–symptom mapping analysis of visual speech production deficits in a large group (280) of stroke patients at the sub-acute stage (<120 days post-stroke). Performance on object naming was evaluated alongside three other tests of visual speech production, namely sentence production to a picture, sentence reading and nonword reading. A principal component analysis was performed on all these tests' scores and revealed a ‘shared’ component that loaded across all the visual speech production tasks and a ‘unique’ component that isolated object naming from the other three tasks. Regions for the shared component were observed in the left fronto-temporal cortices, fusiform gyrus and bilateral visual cortices. Lesions in these regions linked to both poor object naming and impairment in general visual–speech production. On the other hand, the unique naming component was potentially associated with the bilateral anterior temporal poles, hippocampus and cerebellar areas. This is in line with the models proposing that object naming relies on a left-lateralised language dominant system that interacts with a bilateral anterior temporal network. Neuropsychological deficits in object naming can reflect both the increased demands specific to the task and the more general difficulties in language processing.

Massed sentence repetition training can augment and speed up recovery of speech production deficits in patients with chronic conduction aphasia receiving donepezil treatment

Background: In the past two decades, single-case studies evaluated the effect of massed repetition training to improve speech production and short-term memory deficits in conduction aphasia (CA). Improvements were reported in treated language and memory domains with modest generalisation of gains to spontaneous speech or auditory comprehension. Although these results are encouraging, sentence repetition training has not been compared with distributed speech-language therapy, and no studies have examined the role of pharmacological interventions to enhance gains promoted by these behavioural interventions in CA.Aims: The effects of massed sentence repetition therapy (MSRT) were compared to those of distributed speech-language therapy (DSLT) in measures of verbal output, short-term memory and repetition in patients with chronic post-stroke CA receiving treatment with the cholinesterase inhibitor donepezil (DP).Methods and Procedures: Three patients with chronic CA aphasia associated to large left perisylvian infarctions participated in a 28-week open-label study combining DP with DSLT or MSRT. A within-patient design, with baselines across behaviours and a washout period was used. Patients were treated with DP (10 mg/day) combined first with DSLT (16 weeks, 40 hours) and after a washout period (4 weeks) with MSRT (8 weeks, 40 hours). Language functions were assessed with the Western Aphasia Battery and experimental repetition tasks prior to and after DSLT and MSRT.Outcomes and Results: Both interventions improved performance in speech production tasks, but better improvements were found with DP-MSRT than with DP-DSLT. Larger treatment effects were found for DP-MSRT in comparison with baselines and DP-DSLT in repetition of word pairs and triplets, and novel and experimental sentences with generalisation of gains to aphasia severity, connected speech and non-treated control sentences.Conclusions: Combined interventions with DP and two different aphasia therapies (DSLT and MSRT) significantly improved speech production deficits in CA, but DP-MSRT augmented and speeded up most benefits provided by DP-DSLT.

A functional deficit in the sensorimotor interface component as revealed by oral reading in Thai conduction aphasia

The contemporary view is that a disruption in phonological encoding underlies the speech production deficit in conduction aphasia. We therefore expect to observe a commonality in phonological errors regardless of task - speaking, reading, or writing. A case report is presented of an oral reading task performed by a Thai conduction aphasic with evidence of localized damage in the left temporoparietal zone. He was instructed to read aloud selections from elementary school materials printed in Thai script at his own pace. A phonological analysis of substitution errors revealed that syllable-initial consonants were more vulnerable to disruption than vowels or tones. Tonal errors were seen to be a secondary consequence of a substitution error involving the syllable-initial consonant. His impaired performance is interpreted as evidence in support of a sensorimotor interface system that converts phonological representations derived from visual orthographic input into articulatory motor representations for speech output.