Motor Speech Impairment Research Articles

Communication impairments in people with progressive supranuclear palsy: A tutorial

Progressive supranuclear palsy (PSP) is a progressive neurological condition, whose main features include supranuclear gaze palsy, frequent falls, bradykinesia, axial rigidity, cognitive decline and communication impairments. Even though communication impairments are early and prominent manifestations, there is a significant lack of research on the nature of these impairments in PSP and the role of speech-language pathologists (SLPs). This tutorial article aims to describe the communication impairments observed in people with PSP; provide clinical guidelines for SLPs when assessing motor speech, language and other communication impairments; and to present facilitation and compensation approaches to treatment for people with PSP. The predominant motor speech impairment is mixed dysarthria, but there is a lack of consensus about the classification of language impairments. The involvement of SLPs in the assessment and treatment of people with PSP should be early, on-going and in collaboration with other health professionals, with the primary focus of maintaining quality of life for these patients and their family members.

Is Language a Factor in the Perception of Foreign Accent Syndrome?

Neurogenic foreign accent syndrome (FAS) is diagnosed when listeners perceive speech associated with motor speech impairments as foreign rather than disordered. Speakers with foreign accent syndrome typically have aphasia. It remains unclear how far language changes might contribute to the perception of foreign accent syndrome independent of accent. Judges with and without training in language analysis rated orthographic transcriptions of speech from people with foreign accent syndrome, speech-language disorder and no foreign accent syndrome, foreign accent without neurological impairment and healthy controls on scales of foreignness, normalness and disorderedness. Control speakers were judged as significantly more normal, less disordered and less foreign than other groups. Foreign accent syndrome speakers' transcriptions consistently profiled most closely to those of foreign speakers and significantly different to speakers with speech-language disorder. On normalness and foreignness ratings there were no significant differences between foreign and foreign accent syndrome speakers. For disorderedness, foreign accent syndrome participants fell midway between foreign speakers and those with speech-language impairment only. Slower rate, more hesitations, pauses within and between utterances influenced judgments, delineating control scripts from others. Word-level syntactic and morphological deviations and reduced syntactic and semantic repertoire linked strongly with foreignness perceptions. Greater disordered ratings related to word fragments, poorly intelligible grammatical structures and inappropriate word selection. Language changes influence foreignness perception. Clinical and theoretical issues are addressed.

Assessment and Treatment of Cognition and Communication Skills in Adults With Acquired Brain Injury via Telepractice: A Systematic Review.

This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in person. The a priori clinical questions were informed by previous research that highlights the importance of considering any functional implications of outcomes, determining disorder- and setting-specific concerns, and measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation of findings. A literature search of multiple databases (e.g., PubMed) was conducted using key words and study inclusion criteria associated with the clinical questions. Ten group studies were accepted that addressed assessment of motor speech, language, and cognitive impairments; assessment of motor speech and language activity limitations/participation restrictions; and treatment of cognitive impairments and activity limitations/participation restrictions. In most cases, equivalence of outcomes was noted across service delivery methods. Limited findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments and interventions precluded robust evaluation of clinical implications for telepractice equivalence and the broader area of telepractice efficacy. Future research is needed that will build upon current knowledge through replication. In addition, further evaluation at the impairment and activity limitation/participation restriction levels is needed.

Encephalopathy with status epilepticus during sleep: Unusual EEG patterns

PurposeTo retrospectively analyze the electroclinical characteristics, etiology, treatment, and prognosis of patients with epileptic encephalopathy with status epilepticus during sleep (ESES) with unusual EEG features and to corroborate if this series of patients is part of the ESES syndrome. MethodCharts of 17 patients with typical clinical manifestations of the ESES syndrome with focal ESES of non-REM sleep at onset and during the focal ESES phase, or bilateral synchronic and asynchronic ESES with a symmetric or asymmetric morphology, continuous or subcontinuous and sometimes multifocal paroxysms with or without slow-wave activity during slow sleep seen between 2000 and 2012 were analyzed. ResultsMean patient follow-up from onset was 7.5 years. An idiopathic cause was found in seven patients, a structural cause in eight, and etiology was unknown in the remaining two. The median age at onset of the unusual ESES syndrome was 7 years. During the ESES phase, 15 children developed new seizure types, negative myoclonus was observed in seven patients, positive myoclonus in five, and absences in nine. Six patients had motor impairment, two had auditory verbal agnosia, and two had motor speech impairment. Attention deficit hyperactivity disorder was observed in four, aggressiveness in six, memory deficit in two, and impaired temporospatial orientation in four.The patients with focal ESES in the frontal region showed behavioral disturbances and/or motor deterioration, and in those with temporo-occipital involvement the dominant clinical manifestations were language and/or behavioral disturbances. ConclusionOur patients with typical clinical manifestations of ESES syndrome but with unusual EEG patterns may be variants of this syndrome.

Predicting speech intelligibility with a multiple speech subsystems approach in children with cerebral palsy.

Speech acoustic characteristics of children with cerebral palsy (CP) were examined with a multiple speech subsystems approach; speech intelligibility was evaluated using a prediction model in which acoustic measures were selected to represent three speech subsystems. Nine acoustic variables reflecting different subsystems, and speech intelligibility, were measured in 22 children with CP. These children included 13 with a clinical diagnosis of dysarthria (speech motor impairment [SMI] group) and 9 judged to be free of dysarthria (no SMI [NSMI] group). Data from children with CP were compared to data from age-matched typically developing children. Multiple acoustic variables reflecting the articulatory subsystem were different in the SMI group, compared to the NSMI and typically developing groups. A significant speech intelligibility prediction model was obtained with all variables entered into the model (adjusted R2 = .801). The articulatory subsystem showed the most substantial independent contribution (58%) to speech intelligibility. Incremental R2 analyses revealed that any single variable explained less than 9% of speech intelligibility variability. Children in the SMI group had articulatory subsystem problems as indexed by acoustic measures. As in the adult literature, the articulatory subsystem makes the primary contribution to speech intelligibility variance in dysarthria, with minimal or no contribution from other systems.

Motor speech impairment, activity, and participation in children with cerebral palsy

The present study used a population-based sample of children with cerebral palsy (CP) to estimate the prevalence of motor speech impairment and its association with activity and participation. A sample of 79 Victorian children aged 4 years 11 months to 6 years 5 months was recruited through the Victorian CP Register. The presence of motor speech impairment was recorded using the Viking Speech Scale (VSS). Activity and participation outcomes included speech intelligibility (the National Technical Institute for the Deaf rating scale, NTID), the Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS). A parent completed rating scale was used to examine the association between motor speech impairment and participation. Ninety per cent (71/79) of children demonstrated a motor speech impairment. Strong associations were found between the VSS and NTID (< .001), CFCS (< .001), and FCCS levels (<.001). VSS levels III–IV were significantly associated with restrictions in home, school, and community-based participation as perceived by parents. Although some diversity in activity and participation outcomes was observed within specific VSS levels, the results of this study suggested that children with mild motor speech impairments are more likely to demonstrate superior activity and participation outcomes compared to children with moderate or severe deficits.

Characteristics and occurrence of speech impairment in Huntington’s disease: possible influence of antipsychotic medication

Although motor speech impairment is a common manifestation of Huntington's disease (HD), its description remains limited. The aim of the current study was therefore to estimate the occurrence and characteristics of speech disorder in HD and to explore the influence of antipsychotic medication on speech performance. Speech samples, including reading passage and monologue, were acquired from 40 individuals diagnosed with HD and 40 age- and sex-matched healthy controls. Objective acoustic analyses were used to evaluate key aspects of speech including vowel articulation, intensity, pitch and timing. A predictive model was constructed to detect the occurrence and most prominent patterns of speech dysfunction in HD. We revealed that 93% of HD patients manifest some degree of speech impairment. Decreased number of pauses, slower articulation rate, imprecise vowel articulation and excess intensity variations were found to be the most salient patterns of speech dysfunction in HD. We further demonstrated that antipsychotic medication may induce excessive loudness and pitch variations perceptually resembling excess patterns of word stress, and may also accentuate general problems with speech timing. Additionally, antipsychotics induced a slight improvement of vowel articulation. Specific speech alterations observed in HD patients indicate that speech production may reflect the pathophysiology of the disease as well as treatment effects, and may therefore be considered a valuable marker of functional disability in HD.

Clinical and MRI correlates of disease progression in a case of nonfluent/agrammatic variant of primary progressive aphasia due to progranulin (GRN) Cys157LysfsX97 mutation

Little is known about the longitudinal changes of brain damage in patients with sporadic nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA) and in progranulin (GRN) mutation carriers. This study reports the clinical and MRI longitudinal data of a patient with nfvPPA carrying GRN Cys157LysfsX97 mutation (GRN+). Voxel-based morphometry, tensor-based morphometry and diffusion tensor MRI were applied to evaluate gray matter (GM) and white matter (WM) changes over three years. The prominent clinical feature was motor speech impairment associated with only mild agrammatism. MRI demonstrated a progressive and severe GM atrophy of inferior fronto–insular–temporo–parietal regions with focal damage to frontotemporal and frontoparietal WM connections. This is the first report of longitudinal MRI data in a nfvPPA- GRN+ patient and this report offers new insights into the pathophysiology of the disease.

Impact of sentence length and phonetic complexity on intelligibility of 5-year-old children with cerebral palsy

Reduced speech intelligibility is a barrier to effective communication for many children with cerebral palsy (CP). Many variables may impact intelligibility, yet little research attention has sought to quantify these variables. This study examined the influence of sentence characteristics on intelligibility in two groups of children with CP (those with and without dysarthria) and typically-developing children. Questions addressed effects of sentence length on transcription intelligibility among groups; effects of phonetic complexity on intelligibility; and differences in the relationship between sentence characteristics and intelligibility across individual children with dysarthria. Speech samples varying in length from 2–7 words were elicited from 16 children with CP (mean age 59.6 months) and eight typically-developing children (mean age = 59.8 months). One hundred and nineteen naïve listeners made orthographic transcriptions of the children's sentence productions. Sentence length and phonetic complexity affected intelligibility for all groups of children, but had a greater impact on intelligibility for children with dysarthria than those without speech motor impairment. Variable relationships between sentence characteristics and intelligibility were found across individual children with dysarthria. Results suggest that reducing both the length and phonetic complexity of utterances may enhance intelligibility for children with dysarthria. However, there may be important individual differences in the impact of one or both types of sentence characteristics. This highlights the importance of considering individual speech motor profiles when deciding on treatment strategies.

Impaired motor speech performance in Huntington’s disease

Dysarthria is a common symptom of Huntington's disease and has been reported, besides other features, to be characterized by alterations of speech rate and regularity. However, data on the specific pattern of motor speech impairment and their relationship to other motor and neuropsychological symptoms are sparse. Therefore, the aim of the present study was to describe and objectively analyse different speech parameters with special emphasis on the aspect of speech timing of connected speech and non-speech verbal utterances. 21 patients with manifest Huntington's disease and 21 age- and gender-matched healthy controls had to perform a reading task and several syllable repetition tasks. Computerized acoustic analysis of different variables for the measurement of speech rate and regularity generated a typical pattern of impaired motor speech performance with a reduction of speech rate, an increase of pauses and a marked disability to steadily repeat single syllables. Abnormalities of speech parameters were more pronounced in the subgroup of patients with Huntington's disease receiving antidopaminergic medication, but were also present in the drug-naïve patients. Speech rate related to connected speech and parameters of syllable repetition showed correlations to overall motor impairment, capacity of tapping in a quantitative motor assessment and some score of cognitive function. After these preliminary data, further investigations on patients in different stages of disease are warranted to survey if the analysis of speech and non-speech verbal utterances might be a helpful additional tool for the monitoring of functional disability in Huntington's disease.

Technology-aided recreation and communication opportunities for post-coma persons affected by lack of speech and extensive motor impairment

This study assessed technology-aided intervention programs for two post-coma men who had re-acquired consciousness, but were unable to engage in personally or socially relevant occupations, given their lack of functional speech and their extensive motor disabilities. The microswitches used for accessing the program contents consisted of (a) a pressure sensor fixed in the palm of the first man's hand that could be activated with a small hand closure movement, and (b) an optic sensor fixed under the chin of the second man that could be activated by mouth opening movements. The programs' content consisted of recreation and communication options, which involved activating music, videos, and basic requests, sending and receiving (listening to) text messages, and placing phone calls. The results showed that the men (a) used the technology-aided programs successfully to manage the recreation and communication options available and (b) showed consistent preference for the sessions with the technology-aided program over other daily events. Family and staff members interviewed about the participants' programs (seven members for each participant) thought that the participants enjoyed the intervention sessions with the programs and that the programs had beneficial effects for them. Implications of the findings are discussed.

Re-establishing Broca’s initial findings

The importance of the left inferior pre-frontal cortex (LIPC) for speech production was first popularized by Paul Broca, providing a cornerstone of behavioral neurology and laying the foundation for future research examining brain-behavior relationships. Although Broca’s findings were rigorously challenged, comprehensive contradictory evidence was not published until 130years later. This evidence suggested that damage to left anterior insula was actually the best predictor of motor speech impairment. Using high-resolution structural magnetic resonance imaging (MRI) in patients with chronic stroke, we reveal that LIPC involvement more accurately predicts acquired motor speech impairment than insula damage. Perfusion-weighted MRI provides complementary evidence, highlighting how damage to left inferior pre-frontal gyrus often includes insula involvement, and vice versa. Our findings suggest that Broca’s initial conclusions associating acquired motor speech impairment with LIPC damage remain valid nearly 150years after his initial report on this issue.

Phonological and Motor Errors in Individuals With Acquired Sound Production Impairment

This study aimed to compare sound production errors arising due to phonological processing impairment with errors arising due to motor speech impairment. Two speakers with similar clinical profiles who produced similar consonant cluster simplification errors were examined using a repetition task. We compared both overall accuracy and acoustic details of hundreds of productions with target consonant clusters to tokens with singletons. Changes in accuracy over the course of the study were also compared. In target words with consonant cluster simplification, the individual whose errors reflected phonological impairment produced articulatory timing consistent with singleton onsets. These productions improved when resyllabification was possible, but error rates were not affected by exposure. In contrast, the individual with motoric-based errors produced simplifications that contained the articulatory timing associated with clusters. Accuracy was not affected by the ability to resyllabify, but it did significantly improve following repeated production. Our findings reveal clear differences between errors arising in phonological processing and in motor planning that reflect the underlying systems. The changes over the course of the study suggest that error types with different sources are responsive to different intervention strategies.

The effect of portable DAF usage in daily life on the speech intelligibility of dysarthrias

Dysarthria is a neurologic motor speech impairment due to a pathological change of nerve and muscle system. Several rehabilitation methods of speaking rate control have been widely used to improve speech intelligibility for mild dysarthria. Nevertheless, speech intelligibility of the dysarthric patients show almost no improvement outside of a clinic. Delayed auditory feedback(DAF)is one of the speaking rate control methods. Recently a small portable DAF device has been developed, which enables dysarthric patients to use it in their daily life. In this study, wearing a portable DAF, two dysarthric patients conducted a 20-minute practice per day for three months. In the practice, they instructed to prolong vowel length in DAF usage. Intelligibility tests for single-word utterance and for reading aloud a long sentence were conducted before and after the practices. As a result, the single-word intelligibility score increased from 84.0% to 90.6% in case1, and from 68.3% to 89.7% in case2. Additionally, vowel space in the F1-F2 space in case2 enlarged. Both the performance of long sentence reading and free conversation will be presented in the meeting. These results suggest that a portable DAF effectiveness in daily use. This work was supported by JSPS KAKENHI 10424889.

À propos d’un cas clinique : William, une histoire pleine de paroles

Language has something to do with oral motricity. This clinical report is a 10-year follow-up of a child with dyskinesia and language impairment. The developmental abnormalities are interpreted in regard to the motor speech impairment.

Increased rCBV in status epilepticus

Dear Sirs,The estimated relative cerebral blood volume (rCBV) is asemiquantitative parameter that correlates with tissue vas-cularisation. High-grade gliomas are characterised by anincreased macrovasculature and microvasculature, andtherefore associated with an increased rCBV [1]. In neuro-oncology, high rCBV is used to distinguish tumoral fromnon-tumoral increase in lesion size, e.g, pseudoprogressionand radiation necrosis from real tumour progression.However, in high-grade glioma an increase in rCBVwithout tumour progression can also be observed in (non-convulsive) status epilepticus, as we will describe below.A 45-year-old woman was admitted to our hospitalbecause of a complete paresis of the right arm and motorspeech impairment. Thirteen years before she had beentreated for an anaplastic oligodendroglioma of the lefttemporal lobe with surgery followed by radiotherapy(59.4 Gy) and chemotherapy (6 cycles of procarbazine,CCNU, vincristin). Every 6 months a magnetic resonanceimaging (MRI) scan of the brain was performed showing apost-surgery cyst and local subtle enhancement, whichremained stable over this period (Fig. 1a). Dynamic sus-ceptibility contrast (DSC) perfusion-weighted MR imaging[T2*w gradient echo echo-planar imaging with repetitiontime of 2,000 ms; 60 phases; contrast bolus injection after10 phases at 5 ml/s of 12 ml of Gadovist 1.0 (BayerSchering Pharma) followed by 20 ml 0.9% NaCl; preloadbolus of 3 ml of Gadovist 1.0 (Bayer Schering Pharma)5 min prior to DSC perfusion imaging] performed5 months before admission showed rCBV ratios of 1.09(insular L) and 1.18 (occipital L) (Fig. 1d). One weekbefore admission, she had woken up with a headache, aparesis of her right arm and an increased speech impair-ment. In the following days her headache subsided and herparesis was fluctuating. On admission she showed a mixedaphasia, right hemianopia and a complete paresis of herright arm. An electroencephalogram (EEG) showed clearepileptic discharges located left centroparietal withoutclinical corresponding symptoms. A MRI scan of the brainshowed cortical swelling with extensive cortical enhance-ment of the left temporal lobe (Fig. 1b), and perfusion-weighted imaging showed rCBV ratios of 2.24 (insular L)and 1.64 (occipital L) (Fig. 1e), suggesting tumour pro-gression. The patient was treated with anti-epileptic drugsfollowed by an improvement of clinical symptoms. Arepeat MRI made 2 months later showed a decrease ofenhancement (Fig. 1c) and of rCBV ratios (1.07 insular Land 0.78 occipital L) (Fig. 1f) to near-baseline values,indicating the increase in contrast enhancement and rCBVwas not due to tumour progression.

Thinking about better speech: Mental practice for stroke-induced motor speech impairments

Background: Mental practice (MP) is a mind–body technique in which physical movements are cognitively rehearsed. It has shown efficacy in reducing the severity of a number of neurological impairments. Aims: In the present review we highlight recent developments in MP research, and the basis for MP use after stroke-induced motor speech disorders. Main Contribution: In this review we (a) propose a novel conceptual model regarding the development of learned non-use in people with motor speech impairments; (b) review the rationale and efficacy of MP for reducing the severity of stroke-induced impairments; (c) review evidence demonstrating muscular and neural activations during and following MP use; (d) review evidence showing that MP increases skill acquisition, use, and function in stroke; (e) review literature regarding neuroplasticity after stroke, including MP-induced neuroplasticity and the neural substrates underlying motor and language reacquisition; and (f) based on the above, review the rationale and clinical application of MP for stroke-induced motor speech impairments. Conclusions: Support for MP use includes decades of MP neurobiological and behavioural efficacy data in a number of populations. Most recently these data have expanded to the application of MP in neurological populations. Given increasingly demanding managed care environments, efficacious strategies that can be easily administered are needed. We also encounter clinicians who aspire to use MP, but their protocols do not contain several of the elements shown to be fundamental to effective MP implementation. Given shortfalls of some conventional aphasia and motor speech rehabilitative techniques, and uncertainty regarding optimal MP implementation, this paper introduces the neurophysiological bases for MP, the evidence for MP use in stroke rehabilitation, and discusses its applications and considerations in patients with stroke-induced motor speech impairments.

The influence of psycholinguistic variables on articulatory errors in naming in progressive motor speech degeneration

We describe an analysis of speech errors on a confrontation naming task in a man with progressive speech degeneration of 10-year duration from Pick’s disease. C.S. had a progressive non-fluent aphasia together with a motor speech impairment and early assessment indicated some naming impairments. There was also an absence of significant phonological or semantic impairment. In order to examine naming difficulties and the factors that influence his speech production errors, we selected 210 words varying in frequency, age of acquisition (AoA), imageability, phonemic length and syllable length and conducted a logistic regression analysis on a range of speech production error types (phone omissions, additions, substitutions, response delays, overall errors). No significant naming errors due to lexical access were found. The only significant predictor of speech articulation errors was phonemic length, with none of the other lexical variables influencing speech production error. The only error type predicted was phone omissions. Results suggest that C.S.’s speech and naming errors indicate compromised speech programming/planning rather than lexical selection and we conclude that this pattern of findings is indicative of problems with motor speech production.

Treatment of Language, Motor Speech Impairments, and Dysphagia

Language, speech, cognitive-associated communication deficits, and dysphagia are common following acquired brain injury (stroke, traumatic brain injury, and others). Treatment of these disorders can be divided into restorative, compensatory, and supportive approaches. Although therapy must be individualized for each person, components of all three approaches are necessary to maximize an individual's recovery. This article provides a general overview of traditional as well as state-of-the-art treatment for aphasia, cognitive-linguistic impairments, dysarthria, apraxia, and dysphagia.

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression across speech subsystems, and for addressing the critical need for sensitive outcome measures for ongoing experimental treatment trials. To address this need, we are obtaining longitudinal profiles of bulbar impairment in 100 individuals based on a comprehensive instrumentation-based assessment that yield objective measures. Using instrumental approaches to quantify speech-related behaviors is very important in a field that has primarily relied on subjective, auditory-perceptual forms of speech assessment1. Our assessment protocol measures performance across all of the speech subsystems, which include respiratory, phonatory (laryngeal), resonatory (velopharyngeal), and articulatory. The articulatory subsystem is divided into the facial components (jaw and lip), and the tongue. Prior research has suggested that each speech subsystem responds differently to neurological diseases such as ALS. The current protocol is designed to test the performance of each speech subsystem as independently from other subsystems as possible. The speech subsystems are evaluated in the context of more global changes to speech performance. These speech system level variables include speaking rate and intelligibility of speech.The protocol requires specialized instrumentation, and commercial and custom software. The respiratory, phonatory, and resonatory subsystems are evaluated using pressure-flow (aerodynamic) and acoustic methods. The articulatory subsystem is assessed using 3D motion tracking techniques. The objective measures that are used to quantify bulbar impairment have been well established in the speech literature and show sensitivity to changes in bulbar function with disease progression. The result of the assessment is a comprehensive, across-subsystem performance profile for each participant. The profile, when compared to the same measures obtained from healthy controls, is used for diagnostic purposes. Currently, we are testing the sensitivity and specificity of these measures for diagnosis of ALS and for predicting the rate of disease progression. In the long term, the more refined endophenotype of bulbar ALS derived from this work is expected to strengthen future efforts to identify the genetic loci of ALS and improve diagnostic and treatment specificity of the disease as a whole. The objective assessment that is demonstrated in this video may be used to assess a broad range of speech motor impairments, including those related to stroke, traumatic brain injury, multiple sclerosis, and Parkinson disease.