Frenchay Dysarthria Assessment Research Articles

A Hierarchical Approach to Efficient Assessment of Functional Intelligibility: The Modular FITI (Functional Importance to Intelligibility) Phrase List

Purpose: Gurevich and Kim (2023a) developed speech stimuli with full phonetic coverage and phonemic balance to comprehensively examine production and perception of consonants. They identify a hierarchy of positional variants with functional importance to intelligibility (FITI). The FITI stimuli are well suited for assessing intelligibility. Multiple studies report that clinicians prefer nonstandard materials (e.g., reading passages, word lists) over formal tools (e.g., Frenchay Dysarthria Assessment–Second Edition [FDA-2]; Enderby & Palmer, 2008), citing time constraints among reasons. Having analyzed the phonetic coverage of the three standard passages (Gurevich & Kim, 2022), the purpose herein is to provide a similar analysis for the FDA-2 and to construct an alternative list of stimuli that achieves strategic coverage of priority intelligibility targets and is adaptable to time constraints. Method: The FDA-2 word list was analyzed in terms of its coverage of the 466 allowable contexts for the 24 English consonants and its coverage of priority FITI targets. A subset of the stimuli from Gurevich and Kim (2023a) was used to construct phrases organized in modules from highest to lowest FITI priority. Results: The full FDA-2 word list covers 35.41% of the allowable 466 contexts, compared to 83.05% by the 308 FITI word list from Gurevich and Kim (2023a). It also underperforms in covering priority FITI targets but does capture some of the hierarchy if all 115 words are used. Fifteen modules were constructed from the 308 FITI words with one to five phrases per module, presented in order of highest to lowest FITI priority. Conclusions: The newly constructed list of phrases has comprehensive phonetic coverage, follows the FITI hierarchy, and is built in autonomous modules. Using the modular FITI phrases to investigate speech is adaptable to time constraints in a manner that prioritizes intelligibility targets.

Speech Intelligibility in Patients with Facial Paralysis.

Background: Patients with facial paralysis often report frustration with communication; however, there are limited data regarding intelligibility deficiencies. Objective: To compare speech intelligibility in patients with severe and non-severe facial paralysis, and in patients with or without synkinesis. Methods: Video and audio data were reviewed retrospectively. Groups were stratified as follows: Group A - severe paralysis (Sunnybrook 0-20) without synkinesis; Group B - non-severe (Sunnybrook >20) paralysis without synkinesis; and Group C - non-severe paralysis with synkinesis. Intelligibility was assessed by lay-people and a speech and language pathologist (SLP) using the Frenchay Dysarthria Assessment Version 2 (FDA-2). A receiver operating characteristic (ROC) curve was used to determine a Sunnybrook cutoff for intelligibility. Results: Eighty cases were reviewed with mean age 55.6, 53.8% female. 25.0% were in Group A, 30.0% Group B, and 45.0% in Group C. Lay-people rated 15.0% and the SLP rated 28.7% as having intelligibility deficiency. An ROC curve demonstrated that patients with Sunnybrook ≤18.5 were more likely to have intelligibility abnormality. Conclusion: Patients with Sunnybrook ≤18.5 are more likely to demonstrate intelligibility deficiency. Clinicians with a more trained ear are more likely to identify intelligibility abnormality compared with lay-people. Those with synkinesis are more intelligible compared with those without it.

Clinical study on tri-tongue acupuncture combined with low-frequency electrical stimulation for treating post-stroke dysarthria.

Few studies have investigated low-frequency electrical stimulation combined with tri-tongue acupuncture for the treatment of post-stroke dysarthria. This randomized clinical study assessed the correlation between the clinical efficacy of low-frequency electrical stimulation combined with tri-tongue acupuncture in patients with post-stroke dysarthria. To investigate the clinical effects of tri-tongue acupuncture combined with low-frequency electrical stimulation for treating post-stroke dysarthria. Ninety patients with post-stroke dysarthria, who were admitted to our hospital from December 2019 to June 2021, were selected and equally divided into two groups (n = 45/group) according to the random number table method. Tri-tongue acupuncture was administered in the control group. The treatment group received both tri-tongue acupuncture and low-frequency electrical stimulation. The clinical efficacy, Western Aphasia Battery (WAB) score, general quality of life inventory (GQOLI-74) score, Frenchay Dysarthria Assessment score, and speech function grades were compared and analyzed between both groups. The overall efficacy in the treatment group was better than that in the control group (P < 0.05). Before treatment, the WAB, Frenchay Dysarthria Assessment, or GQOLI-74 scores (P > 0.05) did not differ between the groups. After therapy, the WAB, Frenchay Dysarthria Assessment, and GQOLI-74 scores in both groups increased significantly (P < 0.05), and the treatment group exhibited a significantly greater increase than that of the controls (P < 0.05). Moreover, the classification of speech function did not differ between the two groups before treatment (P > 0.05), whereas significant improvements were observed in both groups after treatment (P < 0.05). The degree of improvement in the treatment group was greater than that in the control group (P < 0.05). Low-frequency electrical stimulation, in conjunction with tri-tongue acupuncture, exhibits a good clinical effect on post-stroke dysarthria.

Parameterization of voice onset for automatic assessment of Parkinson’s disease

Acoustic analysis of Parkinson’s disease (PD) usually focuses on sustained oscillations of the vocal folds; however, the voice onset (transition from the rest state to a saturation value) is often neglected. In this study, we investigated the parameterization of the voice onset for the objective evaluation of PD. 50 PD patients (25 females) and 50 healthy controls (25 females) performed the sustained phonation of the vowels /ah/, /ih/, and /uh/. Three experts listened to the recordings and assessed the dysarthria level according to a modified version of the Frenchay dysarthria assessment scale (mFDA). We extracted the voice onset automatically, considering the time needed for the amplitude envelope of the acoustic signal to go from 10% up to 90% of the maximum value. Then, we computed filter bank features from the voice onset and pitch, loudness, and perturbation features from the sustained phonation. We performed automatic classification and regression analyses using support vector machines. We obtained a classification accuracy of 89% (AUC: 0.93) when we used feature importance analysis to reduce the feature set. In addition, the regression analysis showed a significant correlation (r: 0.583, p-value &amp;lt; 0.001) between the acoustic features and the mFDA scale. These results show the suitability of the voice onset for objective clinical evaluation of PD.

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.

Speech Characteristics of Patients with Parkinson's Disease-Does Dopaminergic Medications Have a Role?

Objective The present study aimed to investigate the effects of dopaminergic medication on voice, speech motor functions, and motor impairment in patients with Parkinson's disease (PD). Materials and Methods Twenty-five individuals (16 males and 9 females) with PD underwent comprehensive assessment of voice, speech, and motor functions in levodopa medication ON and medication OFF conditions. Age- and gender-matched healthy controls were recruited to compare speech and acoustic parameters. Multi-Dimensional Voice Program (MDVP) from Computerized Speech Laboratory (Model: 4500) was utilized for acoustic analysis of voice and the Voice Handicap Index (VHI) for the self-assessment of vocal function. Frenchay Dysarthria Assessment (FDA-2) and Unified Parkinson's Disease Rating Scale-III (UPDRS III) were used to evaluate speech motor and motor functions, respectively. Statistical Analysis The mean and standard deviation were used as descriptive statistics measures. Raw scores were obtained for FDA-2, DRS, VHI, MDVP parameters, and UPDRS-III in either medication condition. The Wilcoxon signed-rank test was performed to determine the statistical significance of the above measures in both genders across the medication conditions. Spearman's rank correlation coefficient was used to determine the relationship between motor speech function and motor impairment and between VHI and MDVP parameters across both medication conditions. The interrater reliability rating was established using Cohen's kappa. Results An improvement in lip and laryngeal functioning was found in the medication ON over medication OFF state in both males and females with PD. A few frequency and amplitude-related measures improved in the medication-ON state over the medication-OFF state. UPDRS-III scores reduced from the OFF state to the ON state, and no change in dysarthria severity or VHI was found in either gender or medication condition. No correlation was found between speech motor function and motor function or between VHI and acoustic parameters of voice in either medication condition. Conclusions Improvement in motor symptoms with levodopa was predominantly observed when compared with the minor improvements in a few aspects of speech motor function and vocal parameters. The results of this study suggest the need for speech therapy as a nonpharmacological treatment method for speech impairments in PD.

Cross-cultural adaptation into Italian and validation of the Frenchay dysarthria assessment - 2.

A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is currently lacking. To perform a cross-cultural adaptation of the FDA-2 in Italian and to validate the Italian version of the FDA-2. Validation study. Inpatient rehabilitation center. 69 patients with dysarthria and 112 healthy controls. The FDA-2 was translated and cross-culturally adapted to Italian. The validation study was carried out in 4 steps: (1) 42 audio-recorded samples of FDA-2 items from 11 patients with dysarthria were independently assessed by 7 speech and language pathologists for interrater reliability and re-assessed after 6 weeks for intrarater reliability; (2) 11 patients were simultaneously assessed by 3 speech and language therapists for interrater reliability of the whole Italian version of the FDA-2 and re-assessed within 24 hours for test-retest reliability; (3) the Italian version of the FDA-2 was administered to 112 healthy volunteers to gain normative data; (4) 49 patients with different types of dysarthria were assessed using the Italian version of the FDA-2, the Therapy Outcome Measure impairment scale and the Robertson Profile for the validity analysis. Interrater and intrarater reliability ranged from good to excellent (ICC >0.75) except for 3 audio-recorded items. The overall protocol demonstrated excellent (ICC >0.9) inter-rater and test-retest reliability for all the sections and the total score. Normative data were gained for 6 age groups. For the validity analysis, a statistically significant difference was found between dysarthric patients and healthy subjects for all sections and the total score. The FDA-2 significantly correlated to the therapy outcome measure (r=0.75) and the Robertson Profile (r=0.81). The Italian version of the FDA-2 yield satisfactory reliability and validity, comparable to the psychometric properties of the original version. Speech and language pathologists can rely on a valid and reliable tool in Italian for the assessment of dysarthria in both clinical and research practice.

Liuzijue qigong versus traditional breathing training for patients with post-stroke dysarthria complicated by abnormal respiratory control: Results of a single-center randomized controlled trial

Objective: The aim of the study was to investigate whether liuzijue qigong could improve the ability of respiratory control and comprehensive speech in patients with stroke dysarthria. Design: A randomized controlled trial. Setting: The research was carried out in the department of rehabilitation. Participants: Altogether, a total of 98 stroke patients with dysarthria participated in the study. Interventions: Patients were randomly divided into two groups (the experimental group: basic articulation + liuzijue qigong, 48 patients or the control group: basic articulation + traditional breathing training, 50 patients). All therapies were conducted once a day, five times a week for three weeks. Main measures: Primary outcome measure: Speech breathing level of the modified Frenchay Dysarthria Assessment. Secondary outcome measures: the modified Frenchay Dysarthria Assessment, maximum phonation time, maximal counting ability, /s/, /z/, s/z ratio, and the loudness level. All outcome measures were assessed twice (at baseline and after three weeks). Results: At three weeks, There were significant difference between the two groups in the change of speech breathing level (81% vs 66%, P = 0.011), the modified Frenchay Dysarthria Assessment (5.54 (4.68–6.40) vs 3.66 (2.92–4.40), P = 0.001), maximum phonation time (5.55 (4.92–6.18) vs 3.01(2.31–3.71), P < 0.01), maximal counting ability (3.08(2.45–3.71) vs 2.10 (1.53–2.67), P = 0.018), and /s/ (3.08 (2.39–3.78) vs 1.87 (1.23–2.51), P = 0.004), while no significant differences were found in the change of /z/ (3.08 (2.31–3.86) vs 2.10 (1.5–2.64), P = 0.08), s/z ratio (1.26 (0.96–1.55) vs 1.03 (0.97–1.09), P = 0.714), and the change of loudness level (69% vs 60%, P = 0.562). Conclusions: Liuzijue qigong, combined with basic articulation training, could improve the respiratory control ability, as well as the comprehensive speech ability of stroke patients with dysarthria. Trial registration: ChiCTR-INR-16010215.

Assessment of dysarthria with Frenchay dysarthria assessment (FDA-2) in patients with Duchenne muscular dystrophy

Purpose The purpose of this study was to test the psychometric properties of the Japanese version of Frenchay Dysarthria Assessment (FDA-2) and to use this tool to describe the features of speech in patients with Duchenne muscular dystrophy (DMD). Materials and methods The Japanese version of FDA-2 was culturally adapted, and reliability and validity were examined in 22 and 50 patients, respectively. The Japanese version of FDA-2 was administered to 51 patients with DMD. Multiple regression analysis was performed to identify factors related to FDA-2 scores. Results Inter-/intra-rater reliabilities (ICCs) and internal consistency (Cronbach’s α) for total scores were 0.76, 0.97, and 0.94 respectively. For construct validity, two-way ANOVA showed a significant interaction between the disorders and FDA-2 sections (p < 0.05). In DMD patients, the item of tongue at rest was most severely affected, reflecting tongue hypertrophy. Multiple regression analysis identified age, swallowing status, and ventilator use as significantly related. Conclusions The results showed that the Japanese version of FDA-2 has satisfactory reliability and validity. The present study demonstrated the features of dysarthria and related factors in patients with DMD. Implications for rehabilitation In Duchenne muscular dystrophy (DMD), an absent or defective dystrophin protein causes progressive weakness of respiratory and oropharyngeal muscles, both of which are crucial contributors to speech production. This study shows that the Japanese version of FDA-2 has satisfactory reliability and validity compared to original version. The Japanese version of FDA-2 characterizes dysarthria in patients with DMD in this cohort.

The Relationship between Selected Demographic Factors and Speech Organ Dysfunction in Sporadic ALS Patients

Background and objectives: Speech disorders are observed in 30% of newly diagnosed sporadic amyotrophic lateral sclerosis (ALS) patients. Characterized by a dynamic course, dysfunction of articulation has not so far been well understood. The aim of this study was to analyze the influence of demographic factors (sex, age, duration of the disease) and concomitant diseases (degenerative spine disease, depression, hypertension, hypothyroidism, hyperthyroidism, and allergy) on the functioning of speech organs in ALS patients. Materials and Methods: The study group consisted of 65 patients with sporadic ALS. Patients were examined for articulatory functions by means of the Frenchay Dysarthria Assessment (FDA). Results: 68% of the study sample had spinal disorders. Logistic regression analysis showed that a decline in the functioning of lips, soft palate, length of phonation, and voice loudness was more common among men. Patients diagnosed with degenerative spine disease more often suffered from respiratory disorders, while younger patients (<60 years of age) significantly more often had the impairment of the sentence and spontaneous speech functions. Conclusions: The male gender in patients with ALS is associated with an increased risk of deterioration of the phonation length function. Patients under 60 years of age are associated with more often pronouncing sentences disorders and spontaneous speech disorders.

Articulation recovery in ALS patients after lineage-negative adjuvant cell therapy - preliminary report.

Background: Amyotrophic lateral sclerosis (ALS) is one of the most frequently occurring neurodegenerative diseases affecting speech and swallowing. This preliminary study aimed to investigate whether an autologous lineage-negative stem/progenitor cell therapy applied to ALS patients affects the level of selected trophic and proinflammatory factors, and subsequently improves the articulation.Methods: We enrolled 12 patients with sporadic ALS, who underwent autologous bone marrow-derived lineage negative (LIN-) cells administration into cerebrospinal fluid (CSF). We evaluated patients' articulation using the Frenchay Dysarthria Assessment on days 0 and 28 following the LIN- cells administration. Concentrations of various factors (BDNF, NGF, ANGP-2, VEGF, PDGF-AA, PEDF, COMP-FH, CRP, C3, C4) in CSF were quantified by multiplex fluorescent bead-based immunoassays in the samples collected on the day of LIN- cells administration and 28 days later. On top of this, we assessed levels of BDNF and NGF in the patients' plasma on the day of the injection, three, seven days and three months after the treatment.Results: Of the 12 patients who received the LIN- cell therapy 8 showed short-termed improvement in articulatory functions (group I), which was particularly noticeable in better phonation time, lips and soft palate performance, swallowing reflex and voice loudness. Four patients (group II) did not show substantial improvement. CSF concentrations of BDNF, ANGP-2 and PDGF-AA in group I decreased significantly 28 days after LIN- cells administration. The highest concentration levels of BDNF in group II and NGF in both groups in blood plasma were observed on day 3 following the injection.Conclusions: The outcomes of the LIN- cell application in ALS treatment of articulatory organs are promising. The procedure proved to be safe and feasible. A short-lasting trophic effect of autologous LIN- administration could encourage repeated cell's application in order to sustain their beneficial effects, however this approach needs further investigation.

Effect of Acupuncture Intervention and Manipulation Types on Poststroke Dysarthria: A Systematic Review and Meta-Analysis.

This study aimed to evaluate the effect of acupuncture intervention and manipulation types on poststroke dysarthria. Electronic database, including PubMed, CENTRAL, Scopus, RISS, and CNKI, were searched for randomized controlled trials (RCT), treating dysarthria using acupuncture, speech-language therapy (SLT), and general management (GM), published before April 2019. The number, distribution, intensity, depth, and repetition of acupuncture and bleeding therapy on the sublingual veins were considered as manipulation types. Risk of bias of the included trials was evaluated, and their efficacy was assessed using risk ratio (RR) and the standard mean differences in the Frenchay Dysarthria Assessment and Speech Function Grading, with 95% confidence intervals (CIs).Fifteen RCT trials involving 1453 patients were isolated. Electroacupuncture plus SLT and manual acupuncture plus SLT were more effective than SLT only, respectively (RR = 1.520, 95% CI [1.183–1.952], RR = 1.380, 95% CI [1.281–1.488]). The clinical efficacy of acupuncture plus GM was higher than that of GM alone (RR = 1.165, 95% CI [1.050–1.293]). Meta-ANOVA showed that none of the manipulation types increased the clinical efficacy of acupuncture on dysarthria. The methodological quality was low. In conclusion, our study suggests that the effect of acupuncture on poststroke dysarthria may be maximized when manual acupuncture or electroacupuncture is combined with SLT, irrespective of manipulation types.

French adaptation of the “Frenchay Dysarthria Assessment 2” speech intelligibility test

ObjectivesSpeech intelligibility can be defined as “the degree to which a speaker's intended message is recovered by a listener”. Loss of intelligibility is one of the most frequent complaints in patients suffering from speech disorder, impairing communication. Measurement of intelligibility is therefore an important parameter in follow-up. We developed a French version of the “Frenchay Dysarthria Assessment, 2nd edition” (FDA-2), an intelligibility test recognized internationally in its English version. The present study details the construction of the test and its preliminary validation. Materials and methodsWe first compiled a set of words and phrases in French, based on the criteria defined in FDA-2. In a second step, we validated the test in healthy subjects in normal and noisy conditions, to check sensitivity to speech signal degradation. ResultsThe test proved valid and sensitive, as scores were significantly lower for noise-degraded stimuli. ConclusionThis French-language intelligibility test can be used to evaluate speech disorder: for example, in dysarthria, head and neck cancer or after cochlear implantation.

Comparative assessment and monitoring of deterioration of articulatory organs using subjective and objective tools among patients with amyotrophic lateral sclerosis

BackgroundAmyotrophic lateral sclerosis (ALS) is a fatal degenerative disease of a rapid course. In 25% of ALS sufferers, speech disorders occur as prodromal symptoms of the disease. Impaired communication affects physical health and has a negative impact on mental and emotional condition. In this study, we assessed which domains of speech are particularly affected in ALS. Subsequently, we estimated possible correlations between the ALS patients’ subjective perception of their speech quality and an objective assessment of the speech organs carried out by an expert.MethodsThe study group consisted of 63 patients with sporadic ALS. The patients were examined for articulatory functions by means of Voice Handicap Index (VHI) and the Frenchay Dysarthria Assessment (FDA).ResultsOn the basis of the VHI scores, the entire cohort was divided into 2 groups: group I (40 subjects) with mild speech impairment, and group II (23 subjects) displaying moderate and profound speech deficits. In an early phase of ALS, changes were typically reported in the tongue, lips and soft palate. The FDA and VHI-based measurements revealed a high, positive correlation between the objective and subjective evaluation of articulation quality.ConclusionsDeterioration of the articulatory organs resulted in the reduction of social, physical and emotional functioning. The highly positive correlation between the VHI and FDA scales seems to indicate that the VHI questionnaire may be a reliable, self-contained tool for monitoring the course and progression of speech disorders in ALS.Trial registrationNCT02193893.

Changes detected in swallowing function in Friedreich ataxia over 12 months

Friedreich ataxia (FRDA) is a multisystem neurodegenerative disorder and the most common hereditary ataxia. Dysphagia (swallowing impairment) is present in 98% of individuals with FRDA and is characterized by lingual and pharyngeal dysfunction (manifesting in impaired bolus preparation and transfer, and post-swallow residue in the mouth and pharynx), delayed swallow initiation, and entry of material into the airway (penetration/aspiration). Dysphagia severity correlates with disease severity and duration however no longitudinal studies describe changes in function in FRDA. The aim of this study was to investigate the progression of dysphagia in FRDA over one year. Fifty-nine individuals with FRDA and confirmed dysphagia were recruited and 23 of them underwent a second assessment 12 months later. Assessments of swallowing related quality of life, oral motor function (Frenchay Dysarthria Assessment 2nd Ed [FDA-2]) and functional swallowing via videofluoroscopy were conducted. Trials of thin liquid, puree and biscuit were interpreted using the Bethlehem Assessment Scale and the Penetration-Aspiration Scale by two blinded raters. Data from the videofluoroscopy revealed a decline in tongue function, pharyngeal clearance and cricopharyngeal function on solid food. However, severity of penetration/aspiration did not increase. Swallowing-related quality of life and oral-motor function remained stable. A decline in function was observed at three anatomical sites considered important for safe and effective swallowing (tongue, pharyngeal, and cricopharyngeal). However, these deficits did not translate into any meaningful functional decline in swallowing related health over 12 months for individuals with FRDA.

Influence of Lineage-Negative Stem Cell Therapy on Articulatory Functions in ALS Patients.

Introduction Amyotrophic lateral sclerosis (ALS) is a fatal, neurodegenerative disease, leading to loss of muscle strength and motor control. Impaired speech and swallowing lower the quality of life and consequently may induce acute respiratory failure. Bone marrow-derived stem and progenitor cells (SPCs) may be a valuable source of trophic factors. In this study, we assessed whether adjuvant cellular therapy could affect the levels of selected neurotrophins and proinflammatory factors in the cerebrospinal fluid (CSF) and subsequently prevent the deterioration of articulation. Materials and Methods The study group consisted of 32 patients with sporadic ALS who underwent autologous lineage-negative (Lin−) stem cell intrathecal administration to the spinal canal. Lin− cells were aspirated from the bone marrow and isolated using immunomagnetic beads and a lineage cell depletion kit. Patients were examined for articulatory functions by means of the Voice Handicap Index (VHI) questionnaire and Frenchay Dysarthria Assessment (FDA). In parallel, we carried out the analysis of selected trophic and proinflammatory factors in CSF utilizing multiplex fluorescent bead-based immunoassays. Results Of the 32 patients who received the Lin− progenitor cell therapy, 6 (group I) showed improvement in articulatory functions, 23 remained stable (group II), and 3 deteriorated (group III) on the 28th day. The improvement was particularly noticeable in a better cough reflex, laryngeal time, and dribble reflex. A statistically significant lower level of brain-derived neurotrophic factor (BDNF) was observed on day 0 in group I compared to group II. The CSF concentrations of C-reactive protein (CRP) in group I significantly decreased 7 days after Lin− SPC transplantation. On the contrary, a significant increase in the tumor necrosis factor receptor (TNF-R) level was confirmed among patients from group I with improvement of dribble and coughing reflex, tongue movements, and respiration on the 7th day, as well as on day 28 including dribble reflex solely. Conclusions An application of Lin− stem cells could potentate the beneficial humoral effect. The prevention of deterioration of articulatory functions in ALS patients after applying adjuvant Lin− stem cell therapy seems to be promising. Although the procedure is safe and feasible, it requires further in-depth studies.

Prospective Investigation of Incidence and Co-Occurrence of Dysphagia, Dysarthria, and Aphasia Following Ischemic Stroke.

Purpose The high incidence of swallowing and communication disorders following stroke is well documented. However, many of these studies have used retrospective chart reviews to make estimates of incidence and co-occurrence. The current study prospectively examined the incidence and co-occurrence of dysphagia, dysarthria, and aphasia following a 1st occurrence of ischemic stroke at an academic medical center hospital. Method One hundred patients who experienced their 1st ischemic stroke were recruited for participation in this study. All participants received a clinical swallowing evaluation to assess for dysphagia, administration of the Frenchay Dysarthria Assessment-Second Edition ( Enderby & Palmer, 2008 ) and Western Aphasia Battery-Revised ( Kertesz, 2006 ) to screen for the presence of dysarthria and aphasia, respectively. Results Incidence rates of dysphagia, dysarthria, and aphasia were 32%, 26%, and 16%, respectively. Forty-seven percent of participants had at least 1 of these disorders, 28% had 2 of these disorders, and 4% had all 3. Although the incidence rates in this study were smaller in magnitude than incidence rates in previous research, the pattern of results is broadly similar (i.e., dysphagia had the highest incidence rate, followed by dysarthria and, lastly, aphasia). Conclusions This prospective study yielded slightly lower incidence rates than have been previously obtained from retrospective chart reviews. The high incidence and co-occurrence of devastating swallowing and communication disorders post-ischemic stroke provides clear motivation for speech-language pathology involvement in the early phase of stroke rehabilitation.

Towards an automatic evaluation of the dysarthria level of patients with Parkinson's disease

BackgroundParkinson's disease (PD) is a neurological disorder that produces motor and non-motor impairments. The evaluation of motor symptoms is currently performed following the third section of the Movement Disorder Society – Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III); however, only one item of that scale is related to speech impairments. It is necessary to develop a specific scale such that considers those aspects related to speech impairments of the patients. Aims(i) To introduce and evaluate the suitability of a modified version of the Frenchay Dysarthria Assessment (m-FDA) scale to quantify the dysarthria level of PD patients; (ii) to objectively model dysarthric speech signals considering four speech dimensions; (iii) to develop a methodology, based on speech processing and machine learning methods, to automatically quantify/predict the dysarthria level of patients with PD. MethodsThe speech recordings are modeled using features extracted from several dimensions of speech: phonation, articulation, prosody, and intelligibility. The dysarthria level is quantified using linear and non-linear regression models. Speaker models based on i-vectors are also explored. Results and conclusionsThe m-FDA scale was introduced to assess the dysarthria level of patients with PD. Articulation features extracted from continuous speech signals to create i-vectors were the most accurate to quantify the dysarthria level, with correlations of up to 0.69 between the predicted m-FDA scores and those assigned by the phoniatricians. When the dysarthria levels were estimated considering dedicated speech exercises such as rapid repetition of syllables (DDKs) and read texts, the correlations were 0.64 and 0.57, respectively. In addition, the combination of several feature sets and speech tasks improved the results, which validates the hypothesis about the contribution of information from different tasks and feature sets when assessing dysarthric speech signals. The speaker models seem to be promising to perform individual modeling for monitoring the dysarthria level of PD patients. The proposed approach may help clinicians to make more accurate and timely decisions about the evaluation and therapy associated to the dysarthria level of patients. The proposed approach is a great step towards unobtrusive/ecological evaluations of patients with dysarthric speech without the need of attending medical appointments.

Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial

BackgroundStroke-induced dysarthria is caused by muscle weakness, sacral or muscular dystonia, and incoordination of the articulatory organ formed by organic lesions caused by cerebral vascular obstruction or sudden bursting of blood vessels in the brain, which may cause abnormal breathing patterns, pronunciation, resonance, rhythm, and unclear articulation.The Six Character Formula, or Liuzijue qigong (LQG), is an essential part of Chinese traditional exercises and focuses on breathing–speech synchronization. The purpose of the present study was to compare the effects of LQG with traditional breathing training (combined with basic articulation training in both groups) in patients with post-stroke dysarthria.Methods/designThe proposed study will be a single-center randomized controlled trial. A total of 100 patients, with a modified Frenchay Dysarthria Assessment (FDA) dysarthria assessment score < 27 and with a FDA speech breathing level ≥ b will be randomly divided into study (LQG, n = 50) and control (conventional breathing training, n = 50) groups. Basic articulation training will be conducted once a day, five times a week for 3 weeks. Data collection will be conducted at baseline, 1 week, and 2 weeks post-treatment initiation and after completion of the treatment (3 weeks). Comprehensive analyses will be conducted to measure and compare any differences in speech breathing dysfunction levels, comprehensive evaluation of dysarthria, maximum phonation time (MPT), maximal counting ability, signal-noise (S/Z) ratio, and loudness scales between the study and control groups.DiscussionThis trial will provide evidence about the effectiveness of LQG for improvement of speech breathing function and speech ability in patients with post-stroke dysarthria complicated with abnormal breathing.Trial registrationChinese Clinical Trial Registry, ChiCTR-INR-16010215. Registered 21 December 2016.

Speaker models for monitoring Parkinson’s disease progression considering different communication channels and acoustic conditions

Symptoms of Parkinson’s disease vary from patient to patient. Additionally, the progression of those symptoms also differs among patients. Most of the studies on the analysis of speech of people with Parkinson’s disease do not consider such an individual variation. This paper presents a methodology for the automatic and individual monitoring of speech disorders developed by PD patients. The neurological state and dysarthria level of the patients are evaluated. The proposed system is based on individual speaker models which are created for each patient. Two different models are evaluated, the classical GMM–UBM and the i–vectors approach. These two methods are compared with respect to a baseline found with a traditional Support Vector Regressor. Different speech aspects (phonation, articulation, and prosody) are considered to model recordings of spontaneous speech and a read text. A multi-aspect coefficient is proposed with the aim of incorporating information from all of these speech aspects into a single measure. Two different scenarios are considered to assess a set with seven PD patients: (1) the longitudinal test set which consists of speech recordings captured in five recording sessions distributed from 2012 to 2016, and (2) the at-home test set which consists of speech recordings captured in the home of the same seven patients during 4 months (one day per month, four times per day). The UBM is trained with the recordings of 100 speakers (50 with Parkinson’s disease and 50 healthy speakers) captured with controlled acoustic conditions and a professional audio-setting. With the aim of evaluating the suitability of the proposed approaches and the possibility of extending this kind of systems to remotely assess the speech of the patients, a total of five different communication channels (sound-proof booth, Skype®, Hangouts®, mobile phone, and land-line) are considered to train and test the system. Due to the reduced number of recording sessions in the longitudinal test set, the experiments that involved this set are evaluated with the Pearson’s correlation. The experiments with the at-home test set are evaluated with the Spearman’s correlation. The results estimating the dysarthria level of the patients in the at-home test set indicate a correlation of 0.55 with a modified version of the Frenchay Dysarthria Assessment scale when the GMM-UBM model is applied upon the Skype® recordings. The results in the longitudinal test set indicate a correlation of 0.77 using a model based on i-vectors with recordings captured in the sound-proof-booth. The evaluation of the neurological state of the patients in the longitudinal test set shows correlations of up to 0.55 with the Movement Disorder Society - Unified Parkinson’s Disease Rating Scale also using models based on i-vectors created with Skype® recordings. These results suggest that the i–vector approach is suitable when the acoustic conditions among recording sessions differ (longitudinal test set). The GMM-UBM approach seems to be more suitable when the acoustic conditions do not change a lot among recording sessions (at-home test set). Particularly, the best results were obtained with the Skype® calls, which can be explained due to several preprocessing stages that this codec applies to the audio signals. In general, the results suggest that the proposed approaches are suitable for tele-monitoring the dysarthria level and the neurological state of PD patients.