Types Of Dysarthria Research Articles

Increasing Motivation Increases Intelligibility Benefits of Perceptual Training in Dysarthria.

Perceptual training offers a promising, listener-targeted option for improving intelligibility of dysarthric speech. Cognitive resources are required for learning, and theoretical models of listening effort and engagement account for a role of listener motivation in allocation of such resources. Here, we manipulate training instructions to enhance motivation to test the hypothesis that increased motivation increases the intelligibility benefits of perceptual training. Across two data collection sites, which differed with respect to many elements of study design including age of speaker with dysarthria, dysarthria type and severity, type of testing and training stimuli, and participant compensation, 84 neurotypical adults were randomly assigned to one of two training instruction conditions: enhanced instructions or standard instructions. Intelligibility, quantified as percent words correct, was measured before and after training. Listeners who received the enhanced instructions achieved greater intelligibility improvements from training relative to listeners who received the standard instructions. This result was robust across data collection sites and the many differences in methodology. This study provides evidence for the role of motivation in improved understanding of dysarthric speech-increasing motivation increases allocation of cognitive resources to the learning process, resulting in improved mapping of the degraded speech signal. This provides empirical support for theoretical models of listening effort and engagement. Clinically, the results show that a simple addition to the training instructions can elevate learning outcomes.

Effects of Speaking Rate on Variability of Second Formant Frequency Transitions in Dysarthria

Introduction: This study examined the utility of multiple second formant (F2) slope metrics to capture differences in speech production for individuals with dysarthria and healthy controls as a function of speaking rate. In addition, the utility of F2 slope metrics for predicting severity of intelligibility impairment in dysarthria was examined. Methods: Twenty three speakers with Parkinson’s disease and mild to moderate hypokinetic dysarthria (HD), 9 speakers with various neurological diseases and mild to severe ataxic or ataxic-spastic dysarthria (AD), and 26 age-matched healthy control speakers (CON) participated in a sentence repetition task. Sentences were produced at habitual, fast, and slow speaking rate. A variety of metrics were derived from the rising F2 transition portion of the diphthong /ai/. To obtain measures of intelligibility for the two clinical speaker groups, 15 undergraduate SLP students participated in a transcription experiment. Results: Significantly shallower slopes were found for the speakers with HD compared to control speakers. Steeper F2 slopes were associated with increased speaking rate for all groups. Higher variability in F2 slope metrics was found for the speakers with AD compared to the two other speaker groups. For both clinical speaker groups, there was a negative association between intelligibility and F2 slope variability metrics, indicating lower variability in speech production was associated with higher intelligibility. Discussion: F2 slope metrics were sensitive to dysarthria presence, dysarthria type, and speaking rate. The current study provided evidence that the use of F2 slope variability measures has additional value to F2 slope averaged measures for predicting severity of intelligibility impairment in dysarthria.

Improving the intelligibility of dysarthric speech using a time domain pitch synchronous-based approach

Dysarthria is a motor speech impairment that reduces the intelligibility of speech. Observations indicate that for different types of dysarthria, the fundamental frequency, intensity, and speech rate of speech are distinct from those of unimpaired speakers. Therefore, the proposed enhancement technique modifies these parameters so that they fall in the range for unimpaired speakers. The fundamental frequency and speech rate of dysarthric speech are modified using the time domain pitch synchronous overlap and add (TD-PSOLA) algorithm. Then its intensity is modified using the fast Fourier transform (FFT) and inverse fast Fourier transform (IFFT)-based approach. This technique is applied to impaired speech samples of ten dysarthric speakers. After enhancement, the intelligibility of impaired and enhanced dysarthric speech is evaluated. The change in the intelligibility of impaired and enhanced dysarthric speech is evaluated using the rating scale and word count methods. The improvement in intelligibility is significant for speakers whose original intelligibility was poor. In contrast, the improvement in intelligibility was minimal for speakers whose intelligibility was already high. According to the rating scale method, for diverse speakers, the change in intelligibility ranges from 9% to 53%. Whereas, according to the word count method, this change in intelligibility ranges from 0% to 53%.

Automated Vowel Articulation Analysis in Connected Speech Among Progressive Neurological Diseases, Dysarthria Types, and Dysarthria Severities.

Although articulatory impairment represents distinct speech characteristics in most neurological diseases affecting movement, methods allowing automated assessments of articulation deficits from the connected speech are scarce. This study aimed to design a fully automated method for analyzing dysarthria-related vowel articulation impairment and estimate its sensitivity in a broad range of neurological diseases and various types and severities of dysarthria. Unconstrained monologue and reading passages were acquired from 459 speakers, including 306 healthy controls and 153 neurological patients. The algorithm utilized a formant tracker in combination with a phoneme recognizer and subsequent signal processing analysis. Articulatory undershoot of vowels was presented in a broad spectrum of progressive neurodegenerative diseases, including Parkinson's disease, progressive supranuclear palsy, multiple-system atrophy, Huntington's disease, essential tremor, cerebellar ataxia, multiple sclerosis, and amyotrophic lateral sclerosis, as well as in related dysarthria subtypes including hypokinetic, hyperkinetic, ataxic, spastic, flaccid, and their mixed variants. Formant ratios showed a higher sensitivity to vowel deficits than vowel space area. First formants of corner vowels were significantly lower for multiple-system atrophy than cerebellar ataxia. Second formants of vowels /a/ and /i/ were lower in ataxic compared to spastic dysarthria. Discriminant analysis showed a classification score of up to 41.0% for disease type, 39.3% for dysarthria type, and 49.2% for dysarthria severity. Algorithm accuracy reached an F-score of 0.77. Distinctive vowel articulation alterations reflect underlying pathophysiology in neurological diseases. Objective acoustic analysis of vowel articulation has the potential to provide a universal method to screen motor speech disorders. https://doi.org/10.23641/asha.23681529.

Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence.

This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent rationale for their use is needed. The use of oromotor nonverbal performance to diagnose disease or dysarthria type, versus specific aspects of speech production deficits that contribute to loss of speech intelligibility, is argued to be an important part of the debate. Framing these issues are two models of speech motor control, the Integrative Model (IM) and Task-Dependent Model (TDM), which yield contrasting predictions of the relationship between oromotor nonverbal performance and speech motor control. Theoretical and empirical literature on task specificity in limb, hand, and eye motor control is reviewed to demonstrate its relevance to speech motor control. The IM rejects task specificity in speech motor control, whereas the TDM is defined by it. The theoretical claim of the IM proponents that the TDM requires a special, dedicated neural mechanism for speech production is rejected. Based on theoretical and empirical information, the utility of oromotor nonverbal tasks as a window into speech motor control is questionable.

Influence of noise on perception of different types of dysarthric speech

Disturbances in the central nervous system may lead to changes in the speech muscle system, which impact muscle strength, tone, and coordination as well as movement speed, resulting in different types of dysarthria, each impacting respiration, phonation, articulation, resonance, and prosody differentially. Bilateral upper motor neuron damage leads to spastic dysarthria, cerebellar damage ataxic dysarthria, and damage to basal ganglia hypokinetic dysarthria. In estimating the severity of speech impairment, and measuring speech intelligibility, both reading and spontaneous speech samples are routinely used by speech-language pathologists. However, noise levels in acute and rehabilitation hospitals often exceed the World Health Organization guidelines (Busch-Vishniac et al., 2005) which may impact the clinical outcomes. In this study, 100 graduate student clinicians in Speech-Language Pathology measured speech intelligibility and estimated the severity of speech impairment of speech samples produced by three types of dysarthric speakers: spastic, ataxic, and hypokinetic, in two different noise conditions (quiet, and hospital noise). The differential impact of noise on different types of dysarthria is examined, and its implication on clinical outcomes is discussed.

Distinct phenotypes of stimulation-induced dysarthria represent different cortical networks in STN-DBS

BackgroundDeep brain stimulation of the subthalamic nucleus is an effective treatment of Parkinson's disease, yet it is often associated with a general deterioration of speech intelligibility. Clustering the phenotypes of dysarthria has been proposed as a strategy to tackle these stimulation-induced speech problems. MethodsIn this study, we examine a cohort of 24 patients to test the real-life application of the proposed clustering and attempt to attribute the clusters to specific brain networks with two different approaches of connectivity analysis. ResultsBoth our data-driven and hypothesis-driven approaches revealed strong connections of variants of stimulation-induced dysarthria to brain regions that are known actors of motor speech control. We showed a strong connection between the spastic dysarthria type and the precentral gyrus and supplementary motor area, prompting a possible disruption of corticobulbar fibers. The connection between the strained voice dysarthria and more frontal areas hints toward a deeper disruption of the motor programming of speech production. ConclusionsThese results provide insights into the mechanism of stimulation-induced dysarthria in deep brain stimulation of the subthalamic nucleus and may guide reprogramming attempts for individual Parkinson's patients based on pathophysiological understanding of the affected networks.

Rate Modulation Abilities in Acquired Motor Speech Disorders.

The purpose of this study was to describe, compare, and understand speech modulation capabilities of patients with varying motor speech disorders (MSDs) in a paradigm in which patients made highly cued attempts to speak faster or slower. Twenty-nine patients, 12 with apraxia of speech (AOS; four phonetic and eight prosodic subtype), eight with dysarthria (six hypokinetic and two spastic subtype), and nine patients without any neurogenic MSD completed a standard motor speech evaluation where they were asked to repeat words and sentences, which served as their "natural" speaking rate. They were then asked to repeat lower complexity (counting 1-5; repeating "cat" and "catnip" 3 times each) and higher complexity stimuli (repeating "catastrophe" and "stethoscope" 3 times each and "My physician wrote out a prescription" once) as fast/slow as possible. Word durations and interword intervals were measured. Linear mixed-effects models were used to assess differences related to MSD subtype and stimuli complexity on bidirectional rate modulation capacity as indexed by word duration and interword interval. Articulatory accuracy was also judged and compared. Patients with prosodic AOS demonstrated a reduced ability to go faster; while they performed similarly to patients with spastic dysarthria when counting, patients with spastic dysarthria were able to increase rate similar to controls during sentence repetition; patients with prosodic AOS could not and made increased articulatory errors attempting to increase rate. AOS patients made more articulatory errors relative to other groups, regardless of condition; however, their percentage of errors reduced with an intentionally slowed speaking rate. The findings suggest comparative rate modulation abilities in conjunction with their impact on articulatory accuracy may support differential diagnosis between healthy and abnormal speech and among subtypes of MSDs (i.e., type of dysarthria or AOS). Findings need to be validated in a larger, more representative cohort encompassing several types of MSDs. https://doi.org/10.23641/asha.22044632.

Quality of communication and quality of life of people with aphasia and dysarthria after stroke

Introduction. Aphasia and dysarthria are permanent consequences of stroke in many patients. These disorders significantly disrupt the person?s functioning in everyday life. The aim of this paper is to examine the quality of communication and quality of life in patients with aphasia and dysarthria. Material and Methods. The clinical group included 25 patients with aphasia and 20 patients with dysarthria due to stroke. The control group included 15 post-stroke people without speech and language disorders and 15 neurologically healthy subjects. The Quality of Communication Life Scale was used to assess the quality of communication. This scale provides information about the impact of speech and language disorders on individuals? ability to communicate and quality of life in general. The scale consists of 18 items scored from 1 to 5. Results. Patients with aphasia and dysarthria have a significantly lower quality of communication compared to stroke survivors with preserved speech and language functions and neurologically healthy subjects. The severity of the language and speech disorder proved to be a significant factor in determining the quality of communication. Namely, patients with more severe forms of aphasia and dysarthria scored significantly lower on the Quality of Communication Life Scale compared to the patients with milder forms. It was also shown that patients with flaccid dysarthria have the worst quality of communication compared to the patients with other types of dysarthria. Conclusion. Aphasia and dysarthria following a stroke significantly impair the quality of communication and quality of life of the affected persons.

Разработка вспомогательного инструмента для объективизации логопедической диагностики «Шкалы оценки вида дизартрии» и оценка ее чувствительности и специфичности

The purpose — to create a tool for objectifying the type of dysarthria, which would be simple, easy of use, and efficient in assessing the patient’s condition dynamics depending on the treatment received. Material and methods. The authors’ scale for dysarthria type assessment was used. A total of 88 people with diagnosis of post-stroke dysarthria were assessed in 2021 to 2023 at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia in Krasnoyarsk. Results. Sensitivity, specificity, positive predictive value and negative predictive value were assessed for each subscale characterizing a specific type of dysarthria. The results indicate that all subscales (bulbar, pseudobulbar, cerebellar and extrapyramidal) have high sensitivity (90% minimum) and high specificity (85% minimum). Conclusions. The possibility of using this scale as an additional effective method of objectifying the diagnosis for patients with post-stroke dysarthria in the standard activity of a medical speech therapist was confirmed.

Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review.

Numerous disabling motor and non-motor symptoms occur during Parkinson's disease (PD), including speech disorders, often referred to as hypokinetic dysarthria. PD is the most common cause of this type of dysarthria. About 90% of PD patients experience hypokinetic dysarthria, which is exacerbated as the disease progresses and makes it very difficult for other people to understand the person with PD. This disorder is characterized by a monotonous speech pattern, reduced and monotonous loudness, decreased stress, a breathy or hoarse voice quality, an increase in speech rate, rapid repetition of phonemes, and impreciseness in consonant production. However, patients may also have sensory symptoms including inaccurate perceptions of their own loudness and decreased awareness of speech problems. Hypokinetic dysarthria in PD may not only result from dopamine degeneration in the nigrostriatal pathway but also from disturbances in the motor and somatosensory systems. All speech components, such as phonation, articulation, respiration, resonance, and prosody should be assessed carefully in PD patients with hypokinetic dysarthria. Taking medical history, an oral motor assessment, a perceptual evaluation of speech characteristics, intelligibility, efficiency, and participation in communication all need to be a part of the assessment. The tasks of maximum phonation time, diadochokinetic rate, reading sentences, words, and passages, describing pictures, and spontaneous speech are used to assess the features of speech components and intelligibility. The evaluation should include physiological, acoustic, or imaging modalities as well. Speech therapy is typically the main treatment of speech problems in PD. The management of PD-related hypokinetic dysarthria basically focuses on speaker-oriented and communication-oriented strategies. In addition to these strategies, Augmentative Alternative Communication (AAC) should be considered in patients with severe dysarthria. Loudness, intelligibility, and sound perception may all significantly improve with the Lee Silverman Voice Therapy LOUD (LSVT LOUD) program which is an evidence-based program. The beneficial effect of pharmacological and surgical treatment approaches has not been proven in improving speech. Deep brain stimulation may carry the risk of the deterioration of speech as the illness progresses.

Investigating the Impact of Speech Compression on the Acoustics of Dysarthric Speech.

Acoustic analysis plays an important role in the assessment of dysarthria. Out of a public health necessity, telepractice has become increasingly adopted as the modality in which clinical care is given. While there are differences in software among telepractice platforms, they all use some form of speech compression to preserve bandwidth, with the most common algorithm being the Opus codec. Opus has been optimized for compression of speech from the general (mostly healthy) population. As a result, for speech-language pathologists, this begs the question: is the remotely transmitted speech signal a faithful representation of dysarthric speech? Existing high-fidelity audio recordings from 20 speakers of various dysarthria types were encoded at three different bit rates defined within Opus to simulate different internet bandwidth conditions. Acoustic measures of articulation, voice, and prosody were extracted, and mixed-effect models were used to evaluate the impact of bandwidth conditions on the measures. Significant differences in cepstral peak prominence, degree of voice breaks, jitter, vowel space area, pitch, and vowel space area were observed after Opus processing, providing insight into the types of acoustic measures that are susceptible to speech compression algorithms.

Motor speech effects in subthalamic deep brain stimulation for Parkinson's disease.

A motor speech disorder or dysarthria commonly arises in patients with Parkinson's disease (PD). The impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on motor speech and the potential of intraoperative motor speech testing to predict outcomes are unknown. This study examined 1) the types and prevalence of motor speech changes observed with STN DBS and their relation to the preoperative condition, 2) the ability of intraoperative testing to predict postoperative changes in motor speech, and 3) the spatial relationship between stimulation sites producing maximal motor improvement, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and maximal motor speech deterioration. Comprehensive preoperative, intraoperative, and postoperative motor speech/dysarthria evaluations were performed in consecutive patients with advanced idiopathic PD who underwent STN DBS surgery in the period from 2011 to 2016. Preoperative type of dysarthria and overall dysarthria severity rating along with intraoperative motor speech testing results were evaluated as predictors of postoperative change. Atlas-independent, fully individualized field modeling was used to identify stimulation sites associated with maximal MDS-UPDRS motor improvement and motor speech deterioration. Forty-three patients with PD treated with STN DBS were prospectively studied. Improved MDS-UPDRS motor scores and worsened dysarthria were demonstrated by a subset of patients (16/43). Preoperative dysarthria characteristics did not predict postoperative deterioration. Intraoperative assessment of motor speech strongly predicted postoperative outcomes (OR 4.4, p = 0.02). Sites of maximal MDS-UPDRS motor improvement and worsened dysarthria were distinct. Worsened dysarthria was associated with capsular stimulation, anterior and ventral to the site of maximal MDS-UPDRS motor improvement. The predictive reliability of intraoperative motor speech testing, together with the identification of distinct stimulation sites for motor speech impairment and improved MDS-UPDRS motor function, raise the possibility that DBS lead repositioning or reprogramming could reduce adverse effects on motor speech without impacting MDS-UPDRS motor outcomes in patients undergoing STN DBS.

Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version.

'Dysarthria' is a group of motor speech disorders resulting from a disturbance in neuromuscular control. Most individuals with dysarthria cope with communicative restrictions due to speech impairments and reduced intelligibility. Thus, language-sensitive measurements of intelligibility are important in dysarthria neurological assessment. The Frenchay Dysarthria Assessment, 2nd edition (FDA-2), is a validated tool for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. The current study conducted a careful culture- and linguistic-sensitive adaption of the two intelligibility subtests of the FDA-2 to Hebrew (words and sentences) and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (acquired dysarthria, n = 15; and developmental dysarthria, n = 19). Analysis indicated that the new subtests were found to be specific and sensitive, valid and reliable, as scores significantly differ between healthy older adults and adults with dysarthria, correlated with other subjective measures of intelligibility, and showed high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers, thus may be an important addition to the speech-language pathologist's toolbox, for clinical work as well as for research purposes. WHAT THIS PAPER ADDS: What is already known on the subject 'Dysarthria' is a group of disorders reflecting impairments in the strength, speed and precision of movements required for adequate control of the various speech subsystems. Reduced speech intelligibility is one of the main consequences of all dysarthria subtypes, irrespective of their underlying cause. Indeed, most individuals with dysarthria cope with communicative restrictions due to speech impairments. Thus, language-sensitive measurements of intelligibility are important in dysarthria assessment. The FDA-2's words and sentences subtests present standardized and validated tools for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. What this paper adds to existing knowledge The lack of assessment tools in Hebrew poses challenges to clinical evaluation as well as research purposes. The current study conducted a careful culture- and linguistic-sensitive adaption of the FDA-2 intelligibility subtests to Hebrew and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (adults with acquired dysarthria, n = 15; and young adults with developmental dysarthria, n = 19). What are the potential or actual clinical implications of this work? Analyses indicated that the new word and sentence subtests are specific, sensitive, valid and reliable. Namely, (1) they successfully differentiate between healthy individuals and individuals with dysarthria; (2) they correlate with other subjective measures of intelligibility; and (3) they show high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers. Thus, they may be an important addition to the speech-language pathologist's toolbox, for clinical and research purposes. The methods described here can be emulated for the adaptation of speech assessment tools to other languages.

Orofacial Muscle Strength across the Dysarthrias.

This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure generation (Pmax) by the tongue, lips, and cheeks represented strength. Pmax was lower for speakers with mixed spastic–flaccid dysarthria for all tongue and lip measures, as well as for speakers with flaccid or spastic dysarthria for anterior tongue elevation and lip compression. Anterior tongue elevation and cheek compression tended to be lower than normal for the hypokinetic group. Pmax did not differ significantly between controls and speakers with ataxic dysarthria on any measure. Correlations were generally weak between dysarthria severity and orofacial weakness but were stronger in the dysarthria groups with more prominent orofacial weakness. The results generally support predictions that orofacial weakness accompanies flaccid and/or spastic dysarthria but not ataxic dysarthria. The findings support including type of dysarthria as a variable of interest when examining orofacial weakness in motor speech disorders.

Relationships between maximum tongue pressure and second formant transition in speakers with different types of dysarthria.

The effects of muscle weakness on speech are currently not fully known. We investigated the relationships between maximum tongue pressure and second formant transition in adults with different types of dysarthria. It focused on the slope in the second formant transition because it reflects the tongue velocity during articulation. Sixty-three Japanese speakers with dysarthria (median age, 68 years; interquartile range, 58-77 years; 44 men and 19 women) admitted to acute and convalescent hospitals were included. Thirty neurologically normal speakers aged 19-85 years (median age, 22 years; interquartile range, 21.0-23.8 years; 14 men and 16 women) were also included. The relationship between the maximum tongue pressure and speech function was evaluated using correlation analysis in the dysarthria group. Speech intelligibility, the oral diadochokinesis rate, and the second formant slope were based on the impaired speech index. More than half of the speakers had mild to moderate dysarthria. Speakers with dysarthria showed significantly lower maximum tongue pressure, speech intelligibility, oral diadochokinesis rate, and second formant slope than neurologically normal speakers. Only the second formant slope was significantly correlated with the maximum tongue pressure (r = 0.368, p = 0.003). The relationship between the second formant slope and maximum tongue pressure showed a similar correlation in the analysis of subgroups divided by sex. The oral diadochokinesis rate, which is related to the speed of articulation, is affected by voice on/off, mandibular opening/closing, and range of motion. In contrast, the second formant slope was less affected by these factors. These results suggest that the maximum isometric tongue strength is associated with tongue movement speed during articulation.

Translation and validation of communicative quality of life in the dysarthric speaker questionnaire in telugu

Purpose: Several tools are available to assess the quality of life for speech, language, voice, and swallowing disorders in Indian languages. However, limited tools are present to assess the quality of life of dysarthria. So, the present study aims to translate and validate the Quality of Life in the Dysarthric Speaker (QoL-DyS) questionnaire into the Telugu language.Methods: A total of 30 different types of dysarthria and 30 age-matched controls participated in the present study. The QoL-DyS tool was trans-adapted in the Telugu language using a standardized procedure and administered to the participants. The internal consistency, test-retest reliability, construct validity, scale statistics, and item statistics were computed.Results: The present study revealed that the developed tool has good (i.e., 0.81) overall internal consistency and excellent (i.e., 0.92) test-retest reliability. The significant difference (i.e., <i>p</i><0.05) was found between the experimental and control group.Conclusions: From the present study, we can conclude that the Telugu QOL-DyS is a reliable tool. It is applicable in clinical practice for the self-assessment of the quality of life in dysarthric speakers. Hence, the Telugu QOL-DyS is recommended in clinical practice, and there is a need to develop QoL-DyS in other Indian languages.

Anxiety-depressive disorders in patients with dysarthria against the background of organic brain damage

IntroductionThe presence of acquired speech disorders of varying evidence can cause maladjustment and job loss. Often there is no adequate psychological and psychotherapeutic assistance for these patients, which hinders the process of recovery and reintegration into the social environment.ObjectivesTo study the level of anxiety and depression in patients with dysarthria who have undergone various types of cerebrovascular accidents. To give practical recommendations regarding the correction of these conditions.MethodsTo assess the level of anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was used as the most convenient for application in clinical practice.ResultsThe study involved 42 people in the age group 45-60 years old with the consequences of cerebrovascular accident in the form of various types of dysarthria and without severe movement disorders. All participants had a university degree and a confirmed stroke of anamnesis. According to the data obtained, 45% of patients had symptoms of depression, 52% – anxiety. It should be clarified that specific weight of men with manifestations of depression and anxiety was higher (65% and 56%, respectively). The beginning of active antidepressant therapy in a hospital setting showed a positive subjective effect from such influences – in 38% of patients.ConclusionsThe use of modern methods for assessing the level of anxiety and depression in patients with speech disorders should become an obligatory stage of diagnostic measures. Psychological assistance and pharmacological correction not only helps patients to adapt to new social conditions, but also promotes prevention the progression of depressive manifestations.DisclosureNo significant relationships.

Dysarthria following acute ischemic stroke: Prospective evaluation of characteristics, type and severity

Dysarthria is a common symptom following stroke and represents an important cause of functional impairment in stroke patients. A better characterization of dysarthria could facilitate differential diagnosis and optimize healthcare service distribution. To determine the speech characteristics, dysarthria type and severity in the acute phase following ischemic stroke in a comprehensive stroke centre. First-ever ischemic stroke patients consecutively admitted to the Stroke Unit of Ghent University Hospital were included in this prospective clinical study between March 2018 and October 2019. All participants admitted to the Stroke Unit were screened for dysarthria by a speech-language pathologist within 72 h after admission. When dysarthria was identified, speech characteristics were evaluated via auditory-perceptual assessment and objective measurement of acoustic parameters. Dysarthria type was determined based on the Mayo Classification System. Severity of impairment was scored at function and activity level using the Radboud Dysarthria Assessment and the evaluation of speech intelligibility at sentence level using the Dutch Speech Intelligibility Assessment. In addition, dysarthria recovery was separately evaluated in all participants using the National Institutes of Health Stroke Scale (NIHSS) at hospital admission, day 3 ± 2 and day 7. A total of 67 out of 151 participants (44%; mean age = 69 years; SD = 13; 28 females) were diagnosed with dysarthria in the acute phase following stroke. Standardized assessments were possible in 72% (48/67) of participants. Imprecise articulation of consonants, harsh voice quality and audible inspiration were the most frequent observed speech characteristics. The acoustic parameters maximum phonation time and maximum loudness deviated most from normative values. Unilateral upper motor neuron (UUMN) was the main dysarthria type present in 52% (25/48) of participants. A total of 58% (28/48) and 71% (34/48) of participants had no/minimal/mild difficulties at the functional and activity levels, respectively. Speech intelligibility was mildly impaired (median = 91%; IQR = 73-97). According to the NIHSS, sub-item speech score at hospital admission, 46% (70/151) of participants had dysarthria, of which half recovered completely from their dysarthria within 1 week after stroke symptom onset. UUMN was the dominant dysarthria type, and the majority of participants had a mild dysarthria. Half the participants showed complete recovery within 1 week following symptom onset. The observed speech characteristics mainly reflect impairments in the subsystem's articulation, phonation and respiration. Objective measurements of acoustic parameters corroborate these findings. Future research should focus on longitudinal assessment to investigate recovery of symptoms and the long-term impact of dysarthria on social participation. What this paper adds What is already known on the subject There are few data concerning the presentation of dysarthria following acute ischemic stroke. Moreover, previous research did not include objective measurements of speech characteristics and dysarthria severity. There was a need to determine prospectively speech characteristics, dysarthria type and severity in a stroke population using standardized assessments. What this paper adds to existing knowledge The findings of this study show a high prevalence of dysarthria following acute ischemic stroke. This study confirms previous findings that the speech of dysarthric patients following acute ischemic stroke was mostly characterized by imprecise articulation of consonants, a harsh voice quality and audible inspiration. The results of the objective measures confirm these findings. We added evidence that UUMN is the most prevalent dysarthria type in a stroke population, and that the majority of participants had mild dysarthria. A high rate of dysarthria recovery was seen in the first week following symptom onset. What are the potential or actual clinical implications of this work? The findings of this study contribute to the limited research performed regarding post-stroke dysarthria. The results can help optimize the distribution of healthcare resources. The majority of participants have a mild dysarthria, making the identification of the specific needs of this group an important area of concern. The evaluation of impaired speech subsystems and characteristics, especially supplemented with objective measures of acoustic parameters, and the classification of the type and severity of dysarthria can be helpful to monitor early progress in the acute phase post-stroke.

Intellectual abilities, language comprehension, speech, and motor function in children with spinal muscular atrophy type 1

BackgroundSpinal muscular atrophy (SMA) is a chronic, neuromuscular disease characterized by degeneration of spinal cord motor neurons, resulting in progressive muscular atrophy and weakness. SMA1 is the most severe form characterized by significant bulbar, respiratory, and motor dysfunction. SMA1 prevents children from speaking a clearly understandable and fluent language, with their communication being mainly characterized by eye movements, guttural sounds, and anarthria (type 1a); severe dysarthria (type 1b); and nasal voice and dyslalia (type 1c).The aim of this study was to analyze for the first time cognitive functions, language comprehension, and speech in natural history SMA1 children according to age and subtypes, to develop cognitive and language benchmarks that provide outcomes for the clinical medication trials that are changing SMA1 course/trajectory.MethodsThis is a retrospective study including 22 children with SMA1 (10 affected by subtype 1a-1b: AB and 12 by 1c: C) aged 3–11 years in clinical stable condition with a coded way to communicate “yes” and “no”. Data from the following assessments have been retrieved from patient charts: one-dimensional Raven test (RCPM), to evaluate cognitive development (IQ); ALS Severity Score (ALSSS) to evaluate speech disturbances; Brown Bellugy modified for Italian standards (TCGB) to evaluate language comprehension; and Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) to assess motor functioning.ResultsSMA 1AB and 1C children were similar in age, with the former characterized by lower CHOP-INTEND scores compared to the latter. All 22 children had collaborated to RCPM and their median IQ was 120 with no difference (p = 0.945) between AB and C. Global median score of the speech domain of the ALSSS was 5; however, it was 2 in AB children, being significantly lower than C (6.5, p < 0.001).TCGB test had been completed by 13 children, with morphosyntactic comprehension being in the normal range (50). Although ALSSS did not correlate with both IQ and TCGB, it had a strong (p < 0.001) correlation with CHOP-INTEND described by an exponential rise to maximum.ConclusionsAlthough speech and motor function were severely compromised, children with SMA1 showed general intelligence and language comprehension in the normal range. Speech impairment was strictly related to global motor impairment.