Presence Of Dysarthria Research Articles

Dysarthria and dysphagia in patients with mitochondrial diseases

BackgroundInformation about dysarthria and dysphagia in mitochondrial diseases (MD) is scarce. However, this knowledge is needed to identify speech and swallowing problems early, to monitor the disease course, and to develop and offer optimal treatment and support. This study therefore aims to examine the prevalence and severity of dysarthria and dysphagia in patients with MD and its relation to clinical phenotype and disease severity. Secondary aim is to determine clinically relevant outcome measures for natural history studies and clinical trials. MethodsThis retrospective cross-sectional medical record study includes adults (age ≥ 18 years) diagnosed with genetically confirmed MD who participated in a multidisciplinary admission within the Radboud center for mitochondrial medicine between January 2015 and April 2023. Dysarthria and dysphagia were examined by administering the Radboud dysarthria assessment, swallowing speed, dysphagia limit, test of mastication and swallowing solids (TOMASS), and 6-min mastication test (6MMT). The disease severity was assessed using the Newcastle mitochondrial disease scale for adults (NMDAS). ResultsThe study included 224 patients with MD with a median age of 42 years of whom 37.5% were male. The pooled prevalence of dysarthria was 33.8% and of dysphagia 35%. Patients with MD showed a negative deviation from the norm on swallowing speed, TOMASS (total time) and the 6MMT. Furthermore, a significant moderate relation was found between the presence of dysarthria and the clinical phenotypes. There was a statistically significant difference in total time on the TOMASS between the clinical phenotypes. Finally, disease severity showed a significant moderate relation with the severity of dysarthria and a significant weak relation with the severity of dysphagia. ConclusionDysarthria and dysphagia occur in about one-third of patients with MD. It is important for treating physicians to pay attention to this subject because of the influence of both disorders on social participation and wellbeing. Referral to a speech and language therapist should therefore be considered, especially in patients with a more severe clinical phenotype. The swallowing speed, TOMASS and 6MMT are the most clinically relevant tests to administer.

The Role of Verbal Fluency in the Cerebellar Cognitive Affective Syndrome Scale in Friedreich Ataxia

Cerebellar pathology engenders the disturbance of movement that characterizes Friedreich ataxia (FRDA), yet the impact of cerebellar pathology on cognition in FRDA remains unclear. Numerous studies have unequivocally demonstrated the role of the cerebellar pathology in disturbed cognitive, language and affective regulation, referred to as Cerebellar Cognitive Affective Syndrome (CCAS), and quantified by the CCAS-Scale (CCAS-S). The presence of dysarthria in many individuals with ataxia, particularly FRDA, may confound results on some items of the CCAS-S resulting in false-positive scores. This study explored the relationship between performance on the CCAS-S and clinical metrics of disease severity in 57 adults with FRDA. In addition, this study explored the relationship between measures of intelligibility and naturalness of speech and scores on the CCAS-S in a subgroup of 39 individuals with FRDA. We demonstrated a significant relationship between clinical metrics and performance on the CCAS-S. In addition, we confirmed the items that returned the greatest rate of failure were based on Verbal Fluency Tasks, revealing a significant relationship between these items and measures of speech. Measures of speech explained over half of the variance in the CCAS-S score suggesting the role of dysarthria in the performance on the CCAS-S is not clear. Further work is required prior to adopting the CCAS-S as a cognitive screening tool for individuals with FRDA.

Precision medicine in ALS: Identification of new acoustic markers for dysarthria severity assessment

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease affecting motorneurons of the bulbar, cervical, thoracic, or lumbar segments. Bulbar presentation is a devastating characteristic that impairs patients’ ability to communicate and is linked to shorter survival. Early acoustic manifestation of voice symptoms, such as dysarthria, is very variable, making its detection and classification challenging, both by human specialists and automatic systems. In this context, precision medicine, defined as “prevention and treatment strategies that take individual variability into account”, has gained a great interest in the ALS community. Specifically, the use of innovative Artificial Intelligence techniques, such as Machine Learning, plays a pivotal role in finding specific patterns in the data set to help neurologists in clinical decision-making. Therefore, the main objective of this study was to find new markers, and new patterns, to promptly detect the possible presence of dysarthria and to correctly classify its severity. We have performed an acoustic analysis on different voice signals of various degrees of impairment acquired during outpatient visits at the ALS center of the “Federico II” University Hospital. From the collected signals, a new database containing different acoustic parameters was realized, on which several experiments were performed. The study led us to the discovery of markers that helped to develop a decision tree that separated healthy subjects from patients and, among patients, those with different severity of dysarthria. This model achieved good results in terms of dysarthria classification accuracy, 86.6%, which is excellent considering the small number of subjects in the data set.

Subclinical articulatory changes of vowel parameters in Korean amyotrophic lateral sclerosis patients with perceptually normal voices.

The available quantitative methods for evaluating bulbar dysfunction in patients with amyotrophic lateral sclerosis (ALS) are limited. We aimed to characterize vowel properties in Korean ALS patients, investigate associations between vowel parameters and clinical features of ALS, and analyze subclinical articulatory changes of vowel parameters in those with perceptually normal voices. Forty-three patients with ALS (27 with dysarthria and 16 without dysarthria) and 20 healthy controls were prospectively collected in the study. Dysarthria was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R) speech subscores, with any loss of 4 points indicating the presence of dysarthria. The structured speech samples were recorded and analyzed using Praat software. For three corner vowels (/a/, /i/, and /u/), data on the vowel duration, fundamental frequency, frequencies of the first two formants (F1 and F2), harmonics-to-noise ratio, vowel space area (VSA), and vowel articulation index (VAI) were extracted from the speech samples. Corner vowel durations were significantly longer in ALS patients with dysarthria than in healthy controls. The F1 frequency of /a/, F2 frequencies of /i/ and /u/, the VSA, and the VAI showed significant differences between ALS patients with dysarthria and healthy controls. The area under the curve (AUC) was 0.912. The F1 frequency of /a/ and the VSA were the major determinants for differentiating ALS patients who had not yet developed apparent dysarthria from healthy controls (AUC 0.887). In linear regression analyses, as the ALSFRS-R speech subscore decreased, both the VSA and VAI were reduced. In contrast, vowel durations were found to be rather prolonged. The analyses of vowel parameters provided a useful metric correlated with disease severity for detecting subclinical bulbar dysfunction in ALS patients.

Quantitative vs qualitative muscle MRI: Imaging biomarker in patients with Oculopharyngeal Muscular Dystrophy (OPMD)

Oculopharyngeal muscular dystrophy (OPMD) is a genetic muscle disease causing ptosis, severe swallowing difficulties and progressive limb weakness, although atypical presentations may be difficult to diagnose. Sensitive biomarkers of disease progression in OPMD are needed to enable more effective clinical trials. This study was designed to test the feasibility of using MRI to aid OPMD diagnosis and monitor OPMD progression. Twenty-five subjects with Dixon whole-body muscle MRI were enrolled: 10 patients with genetically confirmed OPMD, 10 patients with non-OPMD muscular dystrophies, and 5 controls. Using the MRI Dixon technique, muscle fat replacement was evaluated in the tongue, serratus anterior, lumbar paraspinal, adductor magnus, and soleus muscles using quantitative and semi-quantitative rating methods. Changes were compared with muscle strength testing, dysphagia severity, use of gait aids, and presence of dysarthria. Quantitative MRI scores of muscle fat replacement in the tongue could differentiate OPMD from other muscular dystrophies and from controls. Moreover, fat fraction in the tongue correlated with clinical severity of dysphagia. This study provides preliminary support for the use of Dixon-based quantitative MRI images as outcome measures for monitoring disease progression in clinical trials and provides rationale for future prospective studies aimed at methodological refinement and covariate identification.

Survival in Korean Patients with Frontotemporal Dementia Syndrome: Association with Behavioral Features and Parkinsonism

We investigated the survival time of each clinical syndrome of frontotemporal dementia (FTD) and the impacts of behavioral and motor features on survival of FTD. A total of 216 patients with FTD [82 behavioral variant FTD (bvFTD), 78 semantic variant primary progressive aphasia (svPPA), 43 non-fluent/agrammatic variant PPA (nfvPPA), 13 FTD-motor neuron disease (MND)] were enrolled from 16 centers across Korea. Behaviors and parkinsonism were assessed using the Frontal Behavioral Inventory and Unified Parkinson’s Disease Rating Scale Part III, respectively. The Kaplan–Meier method was used for the survival analysis and the Cox proportional hazards model was applied for analysis of the effect of behavioral and motor symptoms on survival, after controlling vascular risk factors and cancer. An overall median survival of FTD was 12.1 years. The survival time from onset was shortest for FTD-MND and longest for svPPA. The median survival time of patients with bvFTD was unavailable but likely comparable to that of patients with nfvPPA. In the bvFTD group, negative behavioral symptoms and akinetic rigidity were significantly associated with survival. In the nfvPPA group, the presence of dysarthria had a negative impact on survival. These findings provide useful information to clinicians planning for care.

Optimising Speaker-Dependent Feature Extraction Parameters to Improve Automatic Speech Recognition Performance for People with Dysarthria.

Within the field of Automatic Speech Recognition (ASR) systems, facing impaired speech is a big challenge because standard approaches are ineffective in the presence of dysarthria. The first aim of our work is to confirm the effectiveness of a new speech analysis technique for speakers with dysarthria. This new approach exploits the fine-tuning of the size and shift parameters of the spectral analysis window used to compute the initial short-time Fourier transform, to improve the performance of a speaker-dependent ASR system. The second aim is to define if there exists a correlation among the speaker’s voice features and the optimal window and shift parameters that minimises the error of an ASR system, for that specific speaker. For our experiments, we used both impaired and unimpaired Italian speech. Specifically, we used 30 speakers with dysarthria from the IDEA database and 10 professional speakers from the CLIPS database. Both databases are freely available. The results confirm that, if a standard ASR system performs poorly with a speaker with dysarthria, it can be improved by using the new speech analysis. Otherwise, the new approach is ineffective in cases of unimpaired and low impaired speech. Furthermore, there exists a correlation between some speaker’s voice features and their optimal parameters.

Machine learning assistive application for users with speech disorders

This paper investigates machine learning approaches toward the development of a speaker dependent keywords spotting system intended for users with speech disorders, in particular for those with dysarthria, i.e., a neuromotor speech impairment associated with severe physical disabilities. In the field of assistive technologies, nowadays automatic speech recognition (ASR) is an open challenge since standard voice recognition approaches and voice driven services are ineffective to recognize atypical speech. To address these issues, we focus our attention on keywords spotting task in presence of dysarthria and we exploit deep learning technology in conjunction with an existing convolutional neural network model to build a tailored ASR system for users with such speech disabilities. However, the usage of a machine learning approach requires enough data availability for the training of the model; to this aim, we introduce a mobile software (app) allowing those with speech disorders to collect their audio contribution in order to enrich the speech model. Considering Italian as main language, this approach allows us to build the first database containing speech samples from Italian native users with dysarthria. As discussed in the end of the article, early experiments show promising results and give us interesting perspectives for future research directions.

A Prospective Evaluation of Swallowing and Speech in Patients with Neurofibromatosis Type 2.

Objective Neurofibromatosis type 2 (NF2) patients report that swallowing and speech problems significantly affect their quality of life, but the etiology of these phenomena is poorly understood. Swallowing and speech deficits may arise due to the neuropathy of involved nerves, due to posterior fossa tumor growth, or as iatrogenic effects from neurosurgical procedures to remove these tumors. This study aims to identify the natural history of swallowing and speech deficits in an NF2 cohort and to characterize the factors that may lead to those deficits. Methods Subjects ( n = 168) were enrolled in a prospective, longitudinal study of NF2 with yearly imaging and clinical exams. The patients completed a self-reported questionnaire that included responses regarding subjective swallowing and speech dysfunction. A formal speech-language pathology evaluation and modified barium swallow (MBS) study (reported as American Speech-Language Hearing Association [ASHA] swallowing independency score from 1 through 7) was obtained when a speech/swallowing deficit was reported on the questionnaire. Results Of the 168 enrolled subjects, 55 (33%, median age = 31 years) reported subjective speech and/or swallowing deficits. These patients underwent one ( n = 37) or multiple ( n = 18) MBS studies during 44.8 ± 10.4 months follow-up. During MBS, a majority demonstrated near-normal swallowing (ASHA score >6, 82%), and no evidence of aspiration (aspiration/laryngeal penetration score = 1, 96%). Prior to initial MBS consultation, 38 (69%) patients had undergone relevant neurosurgical procedures. In those with recent (<1 week) posterior fossa surgery ( n = 12), 2 (17%) patients had severe dysphagia and high aspiration risk on postoperative MBS. Both of these patients recovered to functionally independent swallowing status. Unilateral ( n = 10) or bilateral ( n = 6) tongue deficits unrelated to previous history suggestive of hypoglossal nerve injury were detected on clinical examination. There was a correlation between the presence of dysarthria and tongue deficits and tumors associated with the hypoglossal canal noted on imaging. Conclusion A large proportion of patients with NF2 report speech and swallow deficits that are not evident on objective measurements. We also found hypoglossal neuropathy unrelated to prior surgical interventions. Our findings suggest that swallowing and speech problems in NF2 are associated with lower cranial nerve neuropathy, some due to compressive effects of posterior fossa tumors. Adaptation over the course of the disease allows for the compensation of these deficits and subsequent normal findings on objective testing.

Abstract WP386: Swallowing Assessment of Nurses and Speech-Therapists

Background: A relevant number of stroke patients have swallowing disabilities; assessment of swallowing ability is an important procedure on a stroke unit to reduce complications. There is still doubt whether or not a trained nurse has a similar efficacy in the assessment of swallowing difficulties as does a specialized speech therapist (ST). Methods: Our ST has trained any stroke unit nurse (SN) in assessment of swallowing function. A test using first thickened flavored water (custard consistency) and 5 ml water is done. For a pilot study, during 6 weeks all stroke unit patients with cerebral ischemia were included. Patients with TIA, non-stroke diagnoses or altered consciousness (score 2-3 for item 1a of the NIHSS) were excluded. Swallowing function was evaluated independently by the patient’s SN and latest on the next working day by the ST. A 5 step scale was used, measuring from no food, to 2 different texture-modified diets, to normal food. Cohen’s kappa statistic was calculated to evaluate congruence of the assessments. Univariate statistics were done to analyze difference between cohorts with equivalent and different grading. Results: Overall 90 patients were included (53% male, 93% ischemic stroke, mean age 71 years). In 72 (80%) of the SN and ST scored identical (10% no food allowed, 11% special food preparation, 79% no problem). In 11 (12%) SN were more careful than the ST, and in 7 (8%) the SN assessed less swallowing-problems than the ST. Cohens’s kappa was 0.6067. In four of those patients the ST found relevant swallowing problems, which could have led to feeding abstention (2 patients) or special food preparation (2 patients). Comparing those 18 patients with differences in the assessments and those 72 without, presence of dysarthria was the only different parameter and was more present in the patients with varying rating (Mann Whitney U, p=0.0019) Conclusion: In this unselected cohort of ischemic stroke patients, swallowing problems were detected in 32%, when using the ST’s assessment as gold standard. Inter-rater agreement with a trained SN was good. In a small percentage (8%) nurses had overseen swallowing problems and in 4% this was relevant. Presence of dysarthria was the only factor, which was different between equal and unequal graded patients.

Vowel formant dispersion reflects severity of Apraxia of Speech

Vowel formant dispersion reflects severity of Apraxia of Speech

Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

Purpose: Patients with a neuromuscular disease (NMD) can present with dysarthria and/or dysphagia. Literature regarding prevalence rates of dysarthria and dysphagia is scarce. The purpose of this study was to determine prevalence rates, severity and co-presence of dysarthria and dysphagia in adult patients with NMD. Method: Two groups of adult patients with NMD were included: 102 consecutive outpatients (the “unselected cohort”) and 118 consecutive patients who were referred for multidisciplinary assessment (the “selected cohort”). An experienced speech-language pathologist examined each patient in detail. Results: The pooled prevalence of dysarthria was 46% (95% CI: 36.5–55.9) and 62% (95% CI: 53.3–70.8) in the unselected and selected cohorts, respectively. The pooled prevalence of dysphagia was 36% (95% CI: 27.1–45.7) and 58% (95% CI: 49.4–67.2) in the unselected and selected cohorts, respectively. There was a modest but significant association between the presence of dysarthria and dysphagia (rs = 0.40; p < 0.01). Although the dysphagia was generally mild, dysarthria was moderate to severe in 15% of the dysarthric patients. Conclusion: The prevalence rates of dysarthria and dysphagia among patients with various types of NMD are high. Physicians should therefore be aware of this prevalence and consider referring NMD patients to a speech-language pathologist.Implicatons of RehabilitationBoth dysarthria and dysphagia are highly prevalent among patients with neuromuscular diseases; moreover, although often mild, these disorders can occur relatively early in the course of the disease.Clinicians should routinely check for signs and symptoms related to dysarthria and/or dysphagia in patients who present with a neuromuscular disease, preferably using standardised instruments.

Dysarthria in stroke: A narrative review of its description and the outcome of intervention

Dysarthria is a frequent and persisting sequel to stroke and arises from varied lesion locations. Although the presence of dysarthria is well documented, for stroke there are scant data on presentation and intervention outcome. A literature search was undertaken to evaluate (a) the features of dysarthria in adult stroke populations relative to the conventional Mayo system for classification, which was developed from diverse pathological groups, and (b) the current status of evidence for the effectiveness of intervention in dysarthria caused by stroke. A narrative review of results is presented. The limited data available indicate that, regardless of stroke location, imprecise articulation and slow speaking rate are consistent features, and voice disturbances, especially harshness, and reduced prosodic variation are also common. Dysarthria is more prevalent in left than in right hemisphere lesions. There is a need for comprehensive, thorough analysis of dysarthria features, involving larger populations, with stroke and other variables controlled and with appropriate age-referenced control data. There is low level evidence for benefits arising from intervention in stroke-related dysarthria. Because studies involve few participants, without external control, and sometimes include stroke with other aetiologies, their results lack the required weight for confident evidence-based practice.

Impaired corticolingual pathways in patients with or without dysarthria after acute monohemispheric stroke

The occurrence of dysarthria is not infrequent in stroke but little is known about its pathophysiology. The aims of the present study were to assess the central motor innervation of the tongue in normal adults using transcranial magnetic stimulation (TMS) and to compare this with that seen in stroke patients with or without dysarthria. The study included 46 patients with acute monohemispheric stroke due to occlusion of the territory of the middle cerebral artery as documented by CT brain scan (26 patients with dysarthria and 20 patients without dysarthria). Forty-five (age and sex matched) normal volunteers served as controls. Corticolingual pathways were assessed for each subject after TMS of each hemisphere. TMS over the motor cortex of healthy subjects elicited consistent ipsilateral and contralateral lingual responses. The ipsilateral response was usually smaller and approximately 73% of the amplitude of the contralateral response. The cross talk between the two halves of the tongue as estimated after unilateral electrical stimulation of hypoglossal nerve gave a contra/ipsi ratio of 36%, which was significantly smaller than the ratio seen after cortical stimulation (CL). For the patients, with or without dysarthria, motor evoked potential (MEP) latencies (ipsilateral and contralateral) were significantly prolonged after stimulation of affected hemisphere compared with the non-affected hemisphere or the control group ( P < 0.001). MEP amplitudes were significantly smaller in hemiplegic patients with dysarthria compared to patients without dysarthria. In patients without dysarthria stimulation of the unaffected hemisphere tended to evoke responses that were of similar size on both sides. There were no significant associations between neurophysiological parameters and side of infarction. We conclude that interruption of the corticolingual pathways is frequent in stroke patients with or without dysarthria. The ability of unaffected hemisphere to evoke responses in the side contralateral to the lesion may relate to the absence or presence of dysarthria.

Poststroke Fatigue: Characteristics and Related Factors

Background and Purpose: Poststroke fatigue (PoSF) is a common, but poorly studied problem. The purpose of the present study was to elucidate the characteristics of and the factors associated with PoSF. Methods: We studied 220 consecutive outpatients at an average of 15 months after the onset of stroke. The presence of poststroke depression (PSD) and poststroke emotional incontinence were identified with the use of a standardized questionnaire. The presence of PoSF was assessed using the visual analogue scale and Fatigue Severity Scale. The presence of prestroke fatigue (PrSF) was also assessed. The impact of PoSF on patients’ daily activities was also assessed using the Fatigue Impact Scale. Results: One hundred and twenty-five patients (57%) had PoSF, 83 (38%) had PrSF and 53 (24%) had PSD. Thirty-six percent of the patients without PrSF and 50% of the patients without PSD had PoSF. The impact of PoSF on patients’ daily activities was more severe in the physical domain as compared with the psychological or cognitive domains (p < 0.01). Multivariate analyses showed that the presence of PrSF (p < 0.01, OR 33.5), high modified Rankin scale (MRS; p < 0.05, OR 3.3), PSD (p < 0.05, OR 2.7) were independently associated with PoSF. Cessation of cigarette smoking (p < 0.05) and the presence of PrSF (p < 0.01) were independently related to PoSF in patients without PSD while decrease in sexual activities (p < 0.05) and the presence of dysarthria (p < 0.05) were related to PoSF in patients without PrSF. Conclusions: Fatigue is a fairly common sequela of stroke patients, exerting an impact on their daily activities, especially physical ones. PrSF is the most important factor related to PoSF, followed by high MRS and PSD. Nevertheless, the causes of PoSF appear multifactorial. Strategies to improve the PoSF should be individualized according to the causative factors.

Association of lacunar infarcts with small artery and large artery disease: a comparative study

Patients with lacunar infarcts (LI) and ipsilateral large artery disease (LAD) greater than 50% must be classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria as strokes of undetermined etiology. The purpose of this study was to compare the vascular risk factors, clinical symptoms, and outcome characteristics of LI associated with LAD with those patients with LI who fulfilled the TOAST criteria of small artery disease (SAD). Among 1754 consecutive first ever stroke patients admitted to our department, we analyzed age, gender, vascular risk factors (hypertension, diabetes, ischemic heart disease, arterial peripheral disease, hypercholesterolemia, smoking, alcohol, or illicit drug use), clinical data (motor or sensitive deficit and presence of dysarthria), and outcome (hospitalization length, in-hospital medical complications rate, need of rehabilitation, treatment at discharge, in-hospital mortality, and modified Rankin Scale at discharge) of those patients classified as LI associated with LAD as compared with those with SAD. After a strict application of the TOAST criteria, we found 144 patients with LI associated with SAD and 73 patients with LI associated with LAD. Univariate analysis showed statistical differences in gender (OR: 0.46; 95% CI: 0.23-0.89; P = 0.014), past history of ischemic heart disease (OR: 0.32; 95% CI: 0.13-0.78; P = 0.004), and smoking (OR: 0.56; 95% CI: 0.31-1.04; P = 0.048). After logistic regression analysis only ischemic heart disease (OR: 0.31; 95% CI: 0.11-0.78; P = 0.013), and gender (OR: 0.51; 95% CI: 0.28-0.98; P = 0.05) showed statistical differences. During the follow-up, six patients (all with LI associated with LAD) experienced stroke recurrences (OR: 0.32; 95% CI: 0.26-0.39; P < 0.001). 1) There are no differences in clinical presentation and in-hospital outcome between patients with LI associated with SAD and patients with LI associated with LAD. 2) Risk factors are very similar in both groups, and the only differences observed (gender and ischemic heart disease) are related to the atherosclerotic factor. 3) Stroke recurrence seems to be more frequent in LI associated with LAD than in LI associated with SAD, but large follow-up studies are needed to be able to decide whether clinical recurrence of stroke allows to differentiate both clinical entities.

Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients

Background and Purpose: Obstructive sleep apnea (OSA) is suspected to be an independent risk factor for atherosclerotic artery disease. The aim of this hospital-based case-control study was to assess the association between OSA and extracranial artery disease (EAD) as well as peripheral artery disease (PAD) in stroke survivors adjusting for potential confounders. Methods: Out of 395 stroke survivors in reconvalescent phase, 235 (male 165, female 70, mean age 64.3 years, standard deviation 10.8 years) were retrospectively examined for the presence of OSA as well as EAD. Statistical analyses were then performed to detect correlations between the presence of medium to high degree artery disease (extracranial stenosis equal or higher than 50%: n=67) and the presence of severe OSA ( n=58). Adjustments were made for sex, age, Barthel index and concomitant risk factors as well as body mass index and presence of dysarthria or dysphagia. Additionally, the presence of PAD (Fontaine IIa and higher: n=20) was retrospectively examined in 240 out of 395 patients. Results: Severe OSA was associated independently with EAD (OR=2.0, 95%CI 1.0–4.1) and with PAD (OR=6.7, 95%CI 2.1–21.0). EAD additionally showed a stronger association with hypertension and hyperlipidemia. PAD additionally showed a strong association with smoking. Conclusion: Our results support the hypothesis that OSA is associated with atherosclerosis and may contribute to ischemic stroke and PAD.

Motor speech problems associated with stroke: The dysarthrias.

Dysarthria is one of a number of communication problems that may occur following a stroke. The presence of dysarthria can affect both rehabilitation efforts as well as social and vocational adjustment. This article reviews methods of classifying the dysarthrias and presents the types of dysarthria most often encountered poststroke. The characteristics of these dysarthria types are then related to the underlying neuropathology. Finally, a model of intervention that addresses the impairment, disability, and handicap of the dysarthria is presented. Specific examples of the role of the rehabilitation team in the management of dysarthria are provided.

Transient mutism after posterior fossa surgery

An 8-year-old girl developed mutism after removal of a vermian medulloblastoma. The mutism was not accompanied by long tract signs or cranial nerve palsy. The girl started to regain her speech 2 weeks postoperatively, showing marked improvement 2 months after the operation, after passing through a dysarthric phase. Magnetic resonance imaging showed only normal postoperative changes without abnormalities of dentate nuclei or supranuclear region. Nineteen similar cases of transient mutism following cerebellar operations have been reported in the literature, most of them with a delayed postoperative onset. In all patients the recovery of speech started to appear 4 days to 4 months postoperatively, and all patients passed through a monotonous, dysarthric phase. The absence of long tract or other brain stem signs, together with the presence of dysarthria during the recovery of speech, suggested a cerebellar cause of the transient mutism. Various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.