Speech Deficits Research Articles

Vowel and tone recognition in quiet and in noise among Mandarin-speaking amusics

Music and language are two intricately linked communication modalities in humans. A deficit in music pitch processing as manifested in the condition of congenital amusia has been related to difficulties in lexical tone processing for both tone and non-tonal languages. However, it is still unclear whether amusia also affects the perception of vowel phonemes in quiet and in noise. In this study, we examined vowel-plus-tone identification in quiet and noise conditions among Mandarin-speaking amusics with and without speech tone difficulties (tone agnosics and pure amusics, respectively), and IQ- and age-matched controls. Overall, pure amusics showed vowel and tone identification comparable to the controls in both quiet and noise conditions. Compared to pure amusics and controls, tone agnosics showed deficits in tone perception in both quiet and noise conditions. More importantly, their vowel perception was lower than pure amusics and controls in noise conditions, e.g., at a signal-to-noise ratio of −4 dB, although they showed normal-like performance in quiet and at a signal-to-noise ratio of −8 dB. These results suggest that when amusia affected speech tone processing (e.g., tone agnosics), it could also compromise vowel processing in noise. However, amusia alone does not affect tone or vowel perception in Mandarin Chinese either in quiet or in noise. Overall, the current study highlights the necessity of taking heterogeneity within the amusic group into account when considering the related speech deficits in this group.

Paraneoplastic Encephalopathy in a Patient With Metastatic Lung Cancer: A Case Study

Paraneoplastic Encephalopathy in a Patient With Metastatic Lung Cancer: A Case Study

Deep phenotyping of speech and language skills in individuals with 16p11.2 deletion.

Recurrent deletions of a ~600-kb region of 16p11.2 have been associated with a highly penetrant form of childhood apraxia of speech (CAS). Yet prior findings have been based on a small, potentially biased sample using retrospectively collected data. We examine the prevalence of CAS in a larger cohort of individuals with 16p11.2 deletion using a prospectively designed assessment battery. The broader speech and language phenotype associated with carrying this deletion was also examined. 55 participants with 16p11.2 deletion (47 children, 8 adults) underwent deep phenotyping to test for the presence of CAS and other speech and language diagnoses. Standardized tests of oral motor functioning, speech production, language, and non-verbal IQ were conducted. The majority of children (77%) and half of adults (50%) met criteria for CAS. Other speech outcomes were observed including articulation or phonological errors (i.e., phonetic and cognitive-linguistic errors, respectively), dysarthria (i.e., neuromuscular speech disorder), minimal verbal output, and even typical speech in some. Receptive and expressive language impairment was present in 73% and 70% of children, respectively. Co-occurring neurodevelopmental conditions (e.g., autism) and non-verbal IQ did not correlate with the presence of CAS. Findings indicate that CAS is highly prevalent in children with 16p11.2 deletion with symptoms persisting into adulthood for many. Yet CAS occurs in the context of a broader speech and language profile and other neurobehavioral deficits. Further research will elucidate specific genetic and neural pathways leading to speech and language deficits in individuals with 16p11.2 deletions, resulting in more targeted speech therapies addressing etiological pathways.

Hypoxia-Induced Signaling Activation in Neurodegenerative Diseases: Targets for New Therapeutic Strategies.

For the maintenance of cellular homeostasis and energy metabolism, an uninterrupted supply of oxygen (O2) is routinely required in the brain. However, under the impaired level of O2 (hypoxia) or reduced blood flow (ischemia), the tissues are not sufficiently oxygenated, which triggers disruption of cellular homeostasis in the brain. Hypoxia is known to have a notable effect on controlling the expression of proteins involved in a broad range of biological processes varying from energy metabolism, erythropoiesis, angiogenesis, neurogenesis to mitochondrial trafficking and autophagy, thus facilitating neuronal cells to endure in deprived O2. On the contrary, hypoxia to the brain is a major source of morbidity and mortality in humans culminating in cognitive impairment, gradual muscle weakness, loss of motor activity, speech deficit, and paralysis as well as other pathological consequences. Further, hypoxia resulting in reduced O2 deliveries to brain tissues is supposed to cause neurodegeneration in both in vivo and in vitro models. Similarly, chronic exposure to hypoxia has also been reportedly involved in defective vessel formation. Such vascular abnormalities lead to altered blood flow, reduced nutrient delivery, and entry of otherwise restricted infiltrates, thereby limiting O2 availability to the brain and causing neurological disabilities. Moreover, the precise mechanistic role played by hypoxia in mediating key processes of the brain and alternatively, in triggering pathological signals associated with neurodegeneration remains mysterious. Therefore, this review elucidates the intricate role played by hypoxia in modulating crucial processes of the brain and their severity in neuronal damage. Additionally, the involvement of numerous pharmacological approaches to compensate hypoxia-induced neuronal damage has also been addressed, which may be considered as a potential therapeutic approach in hypoxia-mediated neurodegeneration.

Abstract 42: Validation of an Ordinal, 6-Item Functional Outcome Scale for Speech and Language Disability in Stroke: The Austin Speech Labs Communication Disability Scale

Introduction: Assessment of stroke outcomes specific to speech and language typically depends on lengthy batteries yielding a derived score that has little functional meaning to patients. Our aim was to develop a simple, highly reliable, ordinal outcome scale specific to language and communication disability. Methods: Modeled after the Rankin Scale, the Communication Disability Scale is a 6-item ordinal scale to assess degree of disability specifically related to communication deficits. Inter-rater reliability and criterion validity were tested on a cohort of 79 stroke patients with communication /speech deficits in an outpatient intensive speech therapy setting. Speech therapists independently assessed the patients. 0 - No speech or language deficits. 1 - Minor language deficits, without communication limitations. 2 - Language deficits causing limitations on communication, but not on ADLs. 3 - Limitations in ADLs caused or exacerbated by communication deficits*. 4 - Requires listener assistance and inference for most communications of basic needs*. 5 - No effective communication*. *Needs caregiver assistance Results: Inter-rater reliability of the Communication Disability Scale scores (CDS) for all subjects (n=79) yielded an intra-class correlation of 0.823. The kappa statistic for agreement was 0.792. Comparison to a standardized language assessment, the Western Aphasia Battery Aphasia Quotient (WAB-AQ) (n=71) showed a strong correlation on Spearman rank rho = -0.815. When CDS and WAB-AQ were dichotomized as good (0-2, does not require caregiver assistance for communication needs) v bad, kappa was 0.6223 (p < 0.001). Conclusion: The Austin Speech Labs Communication Disability Scale has high inter-rater reliability and is highly correlated with a standard Aphasia Battery. The items link language deficits to limitations in activities of daily living (ADLs) attributable to communication deficits. This new scale may be valuable in assessing the effects of speech therapies in clinical trials and the need for caregiver assistance in practice.

Abstract TMP104: Stroke in Paediatric Bacterial Meningitis

Introduction: Bacterial meningitis is a severe intracranial infection with a high complication rate. Neurological morbidity relates to parenchymal involvement where vascular mechanisms and stroke may predominate. Here, we systematically identified all neonates and children with bacterial meningitis and compared those with and without MRI-confirmed stroke. We hypothesized that patterns of stroke would correlate with causative organism and neurological outcome. Methods: Population-based (2.2 million), ten-year retrospective (2002-2012) cross-sectional study in Southern Alberta, Canada. Inclusion criteria were: (1) age from newborn (including prematurity) to 18 years, (2) brain MRI including DWI during admission, and (3) laboratory confirmed acute bacterial meningitis. Demographics, clinical presentations, risk factors, and laboratory findings were extracted. Original imaging was blindly reviewed and classified for stroke and injury pattern. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure (PSOM). Results: Twenty-four patients had confirmed bacterial meningitis and acute MRI (6 neonates, 83% male, and 18 children, mean age 3.14+/-3.9 years, 67% male). Arterial ischemic stroke was confirmed in 9/24 (38%). Strokes were often multifocal (89%), particularly in neonates (100%). Subjects with stroke were more likely to have longer duration of illness prior to presentation, meningismus, prolonged fever, seizures, and new focal neurological signs. The most common organisms were S. pneumonia in older children (44%) and group B streptococcus in neonates (33%). Three patients received steroids, 3 ASA and 1 heparin and ASA. Mortality was 22% in children with stroke and zero in those without (p=0.16). Survivors with stroke were more likely to have motor deficit (71% vs. 25%, p = 0.07), cognitive deficit (75% vs. 38%, p = 0.5), and speech deficit (60% vs. 10%, p = 0.08). Conclusions: More than a third of children with bacterial meningitis warranting MRI have stroke. Associations include longer duration of illness, meningismus, focal neurological signs and common causative organisms. Stroke was associated with higher mortality and morbidity, warranting consideration of increased MRI screening and new approaches to treatment.

Abnormal Speech Motor Control in Individuals with 16p11.2 Deletions

Speech and motor deficits are highly prevalent (>70%) in individuals with the 600 kb BP4-BP5 16p11.2 deletion; however, the mechanisms that drive these deficits are unclear, limiting our ability to target interventions and advance treatment. This study examined fundamental aspects of speech motor control in participants with the 16p11.2 deletion. To assess capacity for control of voice, we examined how accurately and quickly subjects changed the pitch of their voice within a trial to correct for a transient perturbation of the pitch of their auditory feedback. When compared to controls, 16p11.2 deletion carriers show an over-exaggerated pitch compensation response to unpredictable mid-vocalization pitch perturbations. We also examined sensorimotor adaptation of speech by assessing how subjects learned to adapt their sustained productions of formants (speech spectral peak frequencies important for vowel identity), in response to consistent changes in their auditory feedback during vowel production. Deletion carriers show reduced sensorimotor adaptation to sustained vowel identity changes in auditory feedback. These results together suggest that 16p11.2 deletion carriers have fundamental impairments in the basic mechanisms of speech motor control and these impairments may partially explain the deficits in speech and language in these individuals.

Relations between Sensorimotor Integration and Speech Disorders in Parkinson's Disease.

Sensorimotor integration mechanisms can be affected by many factors, among which are those involving neuromuscular disorders. Parkinson's disease (PD) is characterized by well-known motor symptoms, among which lately have been included motor speech deficits. Measurement of the acoustic startle reflex (ASR) and its modulations (prepulse inhibition and prepulse facilitation, PPI and PPF respectively) represent a simple and quantifiable tool to assess sensorimotor function. However, it remains unknown whether measures of the PPI and PPF are associated with motor speech deficits in PD. A total of 88 subjects participated in this study, 52 diagnosed with PD and 36 control subjects. After obtaining written informed consent, participants were assessed with PPI at several interstimulus intervals, and PPF at 1000 ms using the SRH-Lab system (San Diego, CA). Percentage of change in the amplitude and latency of the ASR was analyzed between groups. Voice recordings were register of a specific text given to the subjects with a professional recorder and temporal patterns of speech were analyzed. Statistical analysis conducted in this study showed differences in PPI and PPF in subjects with PD compared to controls. In addition, discriminative parameters of voice abnormalities were observed in PD subjects related to control subjects showing a reduction in phonation time, vowel pulses, breaks, breakage and voice speech periods. PD presents a disruption in sensorimotor filter mechanisms and speech disorders, and there is a relationship between these alterations. The correlation between the PPI and PPF with an alteration of the voice in PD subjects contributes toward understanding mechanism underlying the neurophysiological alterations in both processes. Overall, easy and non-invasive tests such as PPI, PPF together with voice analysis may be useful to identify early stages of PD.

Report Case of Van Der Knaap Syndrome in Two Ecuadorian Siblings

Van Der knaap syndrome is a very uncommon disease seen mainly in the Aggarwal community in northern India. The characteristics of this disease are early onset macrocephaly with mild motor developmental delay, progressive gait alterations, muscular stiffness (spasticity), progressive ataxia, sporadic seizures and usually mild cognitive impairment (MCI) which is of late appearance. Only a few cases of this pathology have been reported in worldwide literature. for the knowledge of all, there are no reports so far of two siblings of parents in which there is apparently no Indian descent or consanguinity. In this case the brothers started with abnormal growth of the cephalic perimeter, difficulty to start the march which progressively got worse, muscular stiffness was developed while intellectual functioning was preserved for several years after onset of the disorder. Was more notorious in one of the two brothers in terms of motor and speech deficit.

Aggressive management of vasospasm with direct intra-arterial nimodipine therapy.

The conventional medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is associated with uncertainty of outcome and complications. To examine the effect of direct intra-arterial nimodipine therapy on outcome in patients with delayed cerebral ischemia (DCI). The retrospective observational study was conducted at a single neurosurgical unit and interventional neuroradiolgy suite of a center managing SAH. Data analysis of SAH managed surgically during the period from January 2014 through October 2015 was performed. Any decline in the neurological status on clinical examination, such as consciousness, motor and speech deficits, without other identifiable causes such as hydrocephalus, hyponatremia, seizure, intracranial hematoma, or infection, was used to define the presence of DCI. Patients with suspected DCI underwent computed tomography (CT) scan of the head followed by angiography. When vasospasm was detected in the absence of any major arterial territory infarct, the patients were managed with intra-arterial nimodipine therapy. The outcome at discharge was assessed. Mid-P exact, two-tailed P value was used for categorical variables. A total of 106 patients underwent surgical clipping of an aneurysm following SAH. DCI was diagnosed in 26 (24.5%) patients. Twenty three (88.5%) patients underwent intra-arterial nimodipine therapy. Angiographic response was seen in 22 (95.7%) patients and clinical response in 20 (87%) patients. At discharge, 19 patients (73.1%) with vasospasm had a favorable outcome. There was no significant difference in the outcome of patients with or without vasospasm. Aggressive management with intra-arterial nimodipine therapy is effective in preventing disability caused by DCI.

The electrophysiological correlates of sublexical speech perception: A combined electrophysiological/cognitive neuropsychology approach

The electrophysiological correlates of sublexical speech perception: A combined electrophysiological/cognitive neuropsychology approach

Preparing Your Pediatric Patients and Their Families for the Operating Room: Reducing Fear of the Unknown.

1. Adam C. Adler, MS, MD*,‡ 2. Stephanie Leung, BS, CCLS† 3. Benjamin H. Lee, MD*,‡ 4. Scott R. Dubow, MD§ 1. *Department of Anesthesiology, Perioperative and Pain Medicine and 2. †Department of Child Life, Texas Children’s Hospital, Houston, TX 3. ‡Baylor College of Medicine, Houston, TX 4. §Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA * Abbreviations: BiPAP: : bilevel positive airway pressure CLS: : child life specialist CPAP: : continuous positive airway pressure DEA: : Drug Enforcement Administration IV: : intravenous MRI: : magnetic resonance imaging OSA: : obstructive sleep apnea Clinicians should: identify the resources available to patients and families to allow for a smooth perioperative experience; understand the long-term effects and potential maladaptive changes associated with an anxiety-provoking perioperative period; understand the most common parental and patient concerns and misconceptions regarding surgery; understand the most common and up-to-date perioperative anesthesia practices; understand the indication for referral to the preoperative anesthesia clinic for patient evaluation to avoid unnecessary cancellation. Pediatricians are often tasked with preparing children and their families for the preoperative period and dealing with questions related to postoperative issues and concerns. Instruction based on current practice and new research and techniques may help patients and families cope with the stressors of surgery. Determining which patients may benefit from a medical or child life preoperative visit is of crucial importance. After completing this article, the reader should be able to: 1. Describe common preoperative anesthesia practice. 2. Recognize the role of a child life specialist in preparing children for surgery. 3. Differentiate children who would benefit from a preoperative anesthesia and/or child life evaluation. 4. Instruct patients and families on issues related to the perioperative period. 5. Address a wide array of parental concerns regarding surgery, anesthesia, and postoperative pain management. The period of time surrounding a planned surgical procedure can be tumultuous and anxiety provoking for both pediatric patients and their parents. The “mysterious place” that is the operating room often remains a mystery to many health care providers, including those tasked with caring for patients both before and after a procedure. As the health care provider most familiar to patients and their families, the pediatrician is in a …

A Posterior Circulation Ischemia Risk Score System to Assist the Diagnosis of Dizziness

We aimed to establish a risk score system without radio-image examination, which could help clinicians to differentiate patients with vertigo and posterior circulation ischemia (PCI) rapidly from the other dizzy patients. We analyzed 304 patients with vertigo (50% PCI). The attributes with more significant contributions were selected as the risk factors for the PCI risk score system, and every one of them was assigned a value according to their respective odds ratio values. We also compared the respective receiver operating characteristic curves of the 3 diagnostic methods (PCI score system, ABCD2, and Essen score systems) to evaluate their prediction effectiveness. Nine risk factors were ultimately selected for PCI score system, including high blood pressure (1'), diabetes mellitus (1'), ischemic stroke (1'), rotating and rocking (-1'), difficulty in speech (5'), tinnitus (-5'), limb and sensory deficit (5'), gait ataxia (1'), and limb ataxia (5'). According to their respective PCI risk scores, the patients were divided into 3 subgroups: low risk (≤0', risk <37.4%), medium risk (1'-5'), and high risk (≥6', risk >95.0%). When 0' was selected as a cutoff point for differentiating the patients with PCI from patients without PCI, the sensitivity was 94.1%, with a specificity of 41.4%. The areas under the receiver operator curve value of PCI score system was .82 (P = .000), much higher than the areas under the receiver operator curve value of ABCD2 (.69, P = .000) and that of the Essen system (.67, P = .000) CONCLUSION: The PCI score system could help clinicians to differentiate patients with vertigo and PCI rapidly from the other dizzy patients.

Speech Perception Deficits in Mandarin-Speaking School-Aged Children with Poor Reading Comprehension.

Previous studies have shown that children learning alphabetic writing systems who have language impairment or dyslexia exhibit speech perception deficits. However, whether such deficits exist in children learning logographic writing systems who have poor reading comprehension remains uncertain. To further explore this issue, the present study examined speech perception deficits in Mandarin-speaking children with poor reading comprehension. Two self-designed tasks, consonant categorical perception task and lexical tone discrimination task were used to compare speech perception performance in children (n = 31, age range = 7;4–10;2) with poor reading comprehension and an age-matched typically developing group (n = 31, age range = 7;7–9;10). Results showed that the children with poor reading comprehension were less accurate in consonant and lexical tone discrimination tasks and perceived speech contrasts less categorically than the matched group. The correlations between speech perception skills (i.e., consonant and lexical tone discrimination sensitivities and slope of consonant identification curve) and individuals’ oral language and reading comprehension were stronger than the correlations between speech perception ability and word recognition ability. In conclusion, the results revealed that Mandarin-speaking children with poor reading comprehension exhibit less-categorized speech perception, suggesting that imprecise speech perception, especially lexical tone perception, is essential to account for reading learning difficulties in Mandarin-speaking children.

Predicting Intelligibility Deficit in Dysphonic Speech with Cepstral Peak Prominence.

The aim of this study was to examine the potential of cepstral peak prominence (CPP) for predicting the intelligibility deficit in dysphonic speech. Sentences from Hearing-in-Noise Test were recorded from 18 speakers with dysphonia and 18 speakers with normal voice. These samples were presented to 60 adults with normal hearing in quiet and noise at signal to noise ratio of +0 dB. Intelligibility was measured by orthographic transcription. Cepstral peak prominence was measured for all samples. Correlation between CPP and intelligibility score was examined. Intelligibility was significantly lower in dysphonic speech than normal speech in the presence of background noise. The correlation between CPP and intelligibility score was moderate when the intelligibility scores were averaged per speaker. Cepstral peak prominence only moderately predicts intelligibility deficit in dysphonic speech. Accordingly, CPP alone is not sufficient for describing the deficit.

Structural connectivity of right frontal hyperactive areas scales with stuttering severity.

A neuronal sign of persistent developmental stuttering is the magnified coactivation of right frontal brain regions during speech production. Whether and how stuttering severity relates to the connection strength of these hyperactive right frontal areas to other brain areas is an open question. Scrutinizing such brain-behaviour and structure-function relationships aims at disentangling suspected underlying neuronal mechanisms of stuttering. Here, we acquired diffusion-weighted and functional images from 31 adults who stutter and 34 matched control participants. Using a newly developed structural connectivity measure, we calculated voxel-wise correlations between connection strength and stuttering severity within tract volumes that originated from functionally hyperactive right frontal regions. Correlation analyses revealed that with increasing speech motor deficits the connection strength increased in the right frontal aslant tract, the right anterior thalamic radiation, and in U-shaped projections underneath the right precentral sulcus. In contrast, with decreasing speech motor deficits connection strength increased in the right uncinate fasciculus. Additional group comparisons of whole-brain white matter skeletons replicated the previously reported reduction of fractional anisotropy in the left and right superior longitudinal fasciculus as well as at the junction of right frontal aslant tract and right superior longitudinal fasciculus in adults who stutter compared to control participants. Overall, our investigation suggests that right fronto-temporal networks play a compensatory role as a fluency enhancing mechanism. In contrast, the increased connection strength within subcortical-cortical pathways may be implied in an overly active global response suppression mechanism in stuttering. Altogether, this combined functional MRI-diffusion tensor imaging study disentangles different networks involved in the neuronal underpinnings of the speech motor deficit in persistent developmental stuttering.

Technology-assisted rehabilitation interventions following pediatric brain injury.

Following traumatic brain injury (TBI), children experience a variety of physical, motor, speech, and cognitive deficits that can have a long-term detrimental impact. The emergence and popularity of new technologies has led to research into the development of various apps, gaming systems, websites, and robotics that might be applied to rehabilitation. The objective of this narrative review was to describe the current literature regarding technologically-assisted interventions for the rehabilitation of motor, neurocognitive, behavioral, and family impairments following pediatric TBI. We conducted a series of searches for peer-reviewed manuscripts published between 2000 and 2017 that included a technology-assisted component in the domains of motor, language/communication, cognition, behavior, social competence/functioning, family, and academic/school-based functioning. Findings suggested several benefits of utilizing technology in TBI rehabilitation including facilitating engagement/adherence, increasing access to therapies, and improving generalizability across settings. There is fairly robust evidence regarding the efficacy of online family problem-solving therapy in improving behavior problems, executive functioning, and family functioning. There was less compelling, but still promising, evidence regarding the efficacy other technology for motor deficits, apps for social skills, and computerized programs for cognitive skills. Overall, many studies were limited in the rigor of their methodology due to small heterogeneous samples and lack of control groups. Technology-assisted interventions have the potential to enhance pediatric rehabilitation after TBI. Future research is needed to further support their efficacy with larger controlled trials and to identify characteristics of children who are most likely to benefit.

Clinical observation the effect of Tongue Manipulation of Pulling and massage on stroke in acute stage with allolalia

Objective To analyze the clinical effect of tongue traction massage in the improvement of speech deficit in acute stage of ischemic stroke. Methods A total of 60 cases of acute ischemic stroke aphasia patients from June 2015 to June 2016 were selected and divided into experimental group (30 cases) and control group (30 cases)by random digits table method, the control group was treated with drug therapy, experimental group was treated with drug plus tongue traction massage therapy. The curative effect of tongue body massage and traction safety was compared between two groups. Results After 2 courses of treatment, there was no significant change in vital signs in the experimental group, the total effective rate was 90.00% (27/30), and the total effective rate of the control group was 70.00% (21/30), there was significant difference between two groups (Z=-2.05, P < 0.05). Conclusions In the treatment of acute ischemic stroke aphasia, the tongue traction massage, good clinical effect, can effectively improve the patient′s speech function, simple operation, safety, compliance is good, worthy of promotion. Key words: Tongue Manipulation of Pulling and massage; Acute stage of stroke; Allolalia; Clinical observation

Dysphagia screening after intracerebral hemorrhage.

Background Dysphagia screening is recommended after acute stroke to identify patients at risk of aspiration and implement appropriate care. However, little is known about the frequency and outcomes of patients undergoing dysphagia screening after intracerebral hemorrhage (ICH). Methods We used the Ontario Stroke Registry from 1 April 2010 to 31 March 2013 to identify patients hospitalized with acute stroke and to compare dysphagia screening rates in those with ICH and ischemic stroke. In patients with ICH we assessed predictors of receiving dysphagia screening, predictors of failing screening, and outcomes after failing screening. Results Among 1091 eligible patients with ICH, 354 (32.4%) patients did not have documented dysphagia screening. Patients with mild ICH were less likely to receive screening (40.4% of patients were omitted, adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI) 0.26-0.63). Older age, greater stroke severity, speech deficits, lower initial level of consciousness, and admission to intensive care unit were predictive of failing the screening test. Failing screening was associated with poor outcomes, including pneumonia (aOR 5.3, 95% CI 2.36-11.88), severe disability (aOR 4.78, 95% CI 3.08-7.41), and 1-year mortality (adjusted hazard ratio 2.1, 95% CI 1.38-3.17). When compared to patients with ischemic stroke, patients with ICH were less likely to receive dysphagia screening (aOR 0.64, 95% CI 0.54-0.76) and more likely to fail screening (aOR 1.98, 95% 1.62-2.42). Conclusion One-third of patients with ICH did not have documented dysphagia screening, increasing to 40% in patients with mild clinical severity. Failing screening was associated with poor outcomes. Patients with ICH were less like to receive screening and twice as likely to fail compared to patients with ischemic stroke, and thus efforts should be made to include ICH patients in dysphagia screening protocols whenever possible.

Impaired Feedforward Control and Enhanced Feedback Control of Speech in Patients with Cerebellar Degeneration.

The cerebellum has been hypothesized to form a crucial part of the speech motor control network. Evidence for this comes from patients with cerebellar damage, who exhibit a variety of speech deficits, as well as imaging studies showing cerebellar activation during speech production in healthy individuals. To date, the precise role of the cerebellum in speech motor control remains unclear, as it has been implicated in both anticipatory (feedforward) and reactive (feedback) control. Here, we assess both anticipatory and reactive aspects of speech motor control, comparing the performance of patients with cerebellar degeneration and matched controls. Experiment 1 tested feedforward control by examining speech adaptation across trials in response to a consistent perturbation of auditory feedback. Experiment 2 tested feedback control, examining online corrections in response to inconsistent perturbations of auditory feedback. Both male and female patients and controls were tested. The patients were impaired in adapting their feedforward control system relative to controls, exhibiting an attenuated anticipatory response to the perturbation. In contrast, the patients produced even larger compensatory responses than controls, suggesting an increased reliance on sensory feedback to guide speech articulation in this population. Together, these results suggest that the cerebellum is crucial for maintaining accurate feedforward control of speech, but relatively uninvolved in feedback control.SIGNIFICANCE STATEMENT Speech motor control is a complex activity that is thought to rely on both predictive, feedforward control as well as reactive, feedback control. While the cerebellum has been shown to be part of the speech motor control network, its functional contribution to feedback and feedforward control remains controversial. Here, we use real-time auditory perturbations of speech to show that patients with cerebellar degeneration are impaired in adapting feedforward control of speech but retain the ability to make online feedback corrections; indeed, the patients show an increased sensitivity to feedback. These results indicate that the cerebellum forms a crucial part of the feedforward control system for speech but is not essential for online, feedback control.