Speech Motor Research Articles

Clinical and psychological features of the brain organization of mental activity in children with autistic disorders

IntroductionAutism spectrum disorders (ASD) – nosological continuum of genetically and clinically heterogeneous mental disorders united by complex violation of mental development, social interaction and behavior.ObjectivesIdentify the features of brain functioning in children with ASD.Methods Neuropsychological diagnostics (Zh. Glozman), results acoustic brainstem evoked potentials (ABEP), mathematical methods. The study involved 48 children with diagnoses (ICD-10): F84. 0, F84. 1, F84.5, aged 3 to 8 years (average age 4.18 years).ResultsNeuropsychological examination revealed the main Indices of the functioning of brain blocks: the Index of activation and energy components of activity (I Index), the Index of the right-hemisphere holistic strategy of information processing (Index II-rights), the Index of the left-hemisphere analytical strategy of information processing (Index II-left), the Index of programming, regulation and control of activity (III Index). Then the children were divided into groups (p<0.001): 1 group – 10 children with high I Index (W = -6.03); 2 – 20 children with high Index II-rights (W = -5.74); 3 – 18 children with high III Index (W = -2.32). Correlation analysis showed: for group 1 difficulties in the perception of auditory information are characteristic; for group 2 – reduced level of control over the course of mental activity, difficulties in automating thinking and speech, coordination of movements; for group 3 – relationship is not manifested.ConclusionsPhonemic perception causes the greatest difficulties in children of group 1. Children of group 2 are characterized by difficulties in the formation of motor speech skills, a decrease in voluntary activity and control over it.DisclosureNo significant relationships.

Unique treatment principles in the service of speech treatment – The VML method

IntroductionChildhood Apraxia of Speech (CAS) was declared as a motor speech disorder by ASHA (2007). The prevalence of CAS is yet to determined due to difficulties in reliable diagnosis, however 63.6% of children with ASD were found to Apraxic (Tierney et al, 2015), hence prevalence would be at least 1/100 (ASD prevalence is 1/54).ObjectivesThe consequences of inability to speak in early and advanced developmental age are many and might include frustration, anger, depression, communication deficit, language delay, poor social skills and behavioural problems. Not only treating motor speech disorder is challenging enough, the external consequences make it far more difficult.MethodsThe VML method (Verbal Motor Learning) was designed to treat the motor aspect of speech. It uses manual techniques and motor learning principles in order to directly teach the basic milestones of speech for children with CAS. In addition, the importance of the manner of the practice was established over the years, extracting 16 unique treatment principles. These principles guide the therapist regarding HOW to perform the practice, while giving an answer to the external CAS consequences.ResultsThe principles are the platform, managing energy levels, relationship, attention, goal-oriented thinking, emotional safety, treatment structure, rhythm, timing, threshold point, support, dynamic thinking, ecological treatment, proactivity, clarity and commitment.ConclusionsThe lecture will introduce the 16 principles briefly, and demonstrate the use of them via treatment videos.DisclosureI am the founder of the VML method and I teach it in various countries.

Automated Detection of Speech Timing Alterations in Autopsy-Confirmed Nonfluent/Agrammatic Variant Primary Progressive Aphasia.

Motor speech function, including speech timing, is a key domain for diagnosing nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard assessments use subjective, specialist-dependent evaluations, undermining reliability and scalability. Moreover, few studies have examined relevant anatomo-clinical alterations in patients with pathologically confirmed diagnoses. This study overcomes such caveats using automated speech timing analyses in a unique cohort of autopsy-proven cases. In a cross-sectional study, we administered an overt reading task and quantified articulation rate, mean syllable and pause duration, and syllable and pause duration variability. Neuroanatomical disruptions were assessed using cortical thickness and white matter (WM) atrophy analysis. We evaluated 22 persons with nfvPPA (mean age: 67.3 years; 13 female patients) and confirmed underlying 4-repeat tauopathy, 15 persons with semantic variant primary progressive aphasia (svPPA; mean age: 66.5 years; 8 female patients), and 10 healthy controls (HCs; 70 years; 5 female patients). All 5 speech timing measures revealed alterations in persons with nfvPPA relative to both the HC and svPPA groups, controlling for dementia severity. The articulation rate robustly discriminated individuals with nfvPPA from HCs (area under the ROC curve [AUC] = 0.95), outperforming specialist-dependent perceptual measures of dysarthria and apraxia of speech severity. Patients with nfvPPA exhibited structural abnormalities in left precentral and middle frontal as well as bilateral superior frontal regions, including their underlying WM. The articulation rate correlated with atrophy of the left pars opercularis and supplementary/presupplementary motor areas. Secondary analyses showed that, controlling for dementia severity, all measures yielded greater deficits in patients with nfvPPA and corticobasal degeneration (nfvPPA-CBD, n = 12) than in those with progressive supranuclear palsy pathology (nfvPPA-PSP, n = 10). The articulation rate robustly discriminated between individuals in each subgroup (AUC = 0.82). More widespread cortical thinning was observed for the nfvPPA-CBD than the nfvPPA-PSP group across frontal regions. Automated speech timing analyses can capture specific markers of nfvPPA while potentially discriminating between patients with different tauopathies. Thanks to its objectivity and scalability; this approach could support standard speech assessments. This study provides Class III evidence that automated speech analysis can accurately differentiate patients with nonfluent PPA from normal controls and patients with semantic variant PPA.

Deep Clinical Phenotyping of Parkinson's Disease: Towards a New Era of Research and Clinical Care.

Despite recent advances in technology, clinical phenotyping of Parkinson's disease (PD) has remained relatively limited as current assessments are mainly based on empirical observation and subjective categorical judgment at the clinic. A lack of comprehensive, objective, and quantifiable clinical phenotyping data has hindered our capacity to diagnose, assess patients' conditions, discover pathogenesis, identify preclinical stages and clinical subtypes, and evaluate new therapies. Therefore, deep clinical phenotyping of PD patients is a necessary step towards understanding PD pathology and improving clinical care. In this review, we present a growing community consensus and perspective on how to clinically phenotype this disease, that is, to phenotype the entire course of disease progression by integrating capacity, performance, and perception approaches with state-of-the-art technology. We also explore the most studied aspects of PD deep clinical phenotypes, namely, bradykinesia, tremor, dyskinesia and motor fluctuation, gait impairment, speech impairment, and non-motor phenotypes.

Accurate Preoperative Identification of Motor Speech Area as Termination of Arcuate Fasciculus Depicted by Q-Ball Imaging Tractography

Tractography is one way to predict the distribution of cortical functional domains preoperatively. Diffusion tensor tractography (DTT) is commonly used in clinical practice, but is known to have limitations in delineating crossed fibers, which can be overcome by Q-ball imaging tractography (QBT). We aimed to compare the reliability of these 2 methods based on the spatial correlation between the arcuate fasciculus depicted by tractography and direct cortical stimulation during awake surgery. In this study, 15 patients with glioma underwent awake surgery with direct cortical stimulation. Tractography was depicted in a three-dimensional computer graphic model preoperatively, which was integrated with a photograph of the actual brain cortex using our novel mixed-reality technology. The termination of the arcuate fasciculus depicted by either DTT or QBT and the results of direct cortical stimulation were compared, and sensitivity and specificity were calculated in speech-associated brain gyri: pars triangularis, pars opercularis, ventral precentral gyrus, and middle frontal gyrus. QBT had significantly better sensitivity and lower false-positive rate than DTT in the pars opercularis. The same trend was noted for the other gyri. QBT is more reliable than DTT in identification of the motor speech area and may be clinically useful in brain tumor surgery.

Characterization of Mild and Moderate Dysarthria in Parkinson's Disease: Behavioral Measures and Neural Correlates.

PurposeAlterations in speech and voice are among the most common symptoms in Parkinson’s disease (PD), often resulting in motor speech disorders such as hypokinetic dysarthria. We investigated dysarthria, verbal fluency, executive functions, and global cognitive function in relation to structural and resting-state brain changes in people with PD.MethodsParticipants with mild-moderate PD (n = 83) were recruited within a randomized controlled trial and divided into groups with varying degrees of dysarthria: no dysarthria (noDPD), mild dysarthria (mildDPD), moderate dysarthria (modDPD), and also combined mildDPD and modDPD into one group (totDPD). Voice sound level and dysphonia, verbal fluency, motor symptoms, executive functions, disease severity, global cognition, and neuroimaging were compared between groups. Gray matter volume and intensity of spontaneous brain activity were analyzed. Additionally, regressions between behavioral and neuroimaging data were performed.ResultsThe groups differed significantly in mean voice sound level, dysphonia, and motor symptom severity. Comparing different severity levels of dysarthria to noDPD, groups differed focally in resting-state activity, but not in brain structure. In totDPD, lower scores on semantic verbal fluency, a composite score of executive functions, and global cognition correlated with lower superior temporal gyrus volume.ConclusionThis study shows that severity of dysarthria may be related to underlying structural and resting-state brain alterations in PD as well as behavioral changes. Further, the superior temporal gyrus may play an important role in executive functions, language, and global cognition in people with PD and dysarthria.

Outcomes of a novel single case study incorporating Rapid Syllable Transition treatment, AAC and blended intervention in children with cerebral palsy: a pilot study

Purpose Motor speech and augmentative and alternative communication (AAC) interventions are commonly used with children with cerebral palsy (CP) but there is limited literature comparing the effectiveness of these interventions. The purpose of this study was to investigate the effectiveness of intensive AAC, Rapid Syllable Transition Treatment (ReST), and blended intervention, a combination of motor-speech and AAC, on speech accuracy and sentence length and complexity. Methods A single case experimental design across participants with repeated measurements across phases (ABACADA design) was used. Four participants aged 8–14 years with CP who used a speech-generating device (SGD) received three 6-week intervention blocks that included ReST, AAC, and blended intervention. Measures were taken during intervention and baseline phases and at maintenance two and four weeks after the last intervention phase. Participants were randomized to starting with either ReST or AAC with the blended intervention delivered last. Results All participants improved their speech accuracy and sentence length and complexity in speech and with their SGD in all three interventions. The data demonstrated overall immediacy of the effect with all interventions and retention of gains across the whole sequence of phases. The order of AAC or ReST interventions or the severity of CP did not impact the intervention gains. Conclusion This study suggests that intensive AAC, a multi-modal approach, and ReST improve speech accuracy and sentence length and complexity in children with moderate CP, but all require further investigation. Implications for rehabilitation In this paper intensive AAC intervention with a speech generating device (SGD), ReST treatment and multimodal blended intervention were effective in improving speech accuracy and sentence length and complexity in both verbal speech and on communication with the SGD. ReST treatment has not been used with children with CP before. This study established a proof of concept for its effectiveness in children with CP. Further research is warranted.

A Tool for Differential Diagnosis of Childhood Apraxia of Speech and Dysarthria in Children: A Tutorial.

While there has been mounting research centered on the diagnosis of childhood apraxia of speech (CAS), little has focused on differentiating CAS from pediatric dysarthria. Because CAS and dysarthria share overlapping speech symptoms and some children have both motor speech disorders, differential diagnosis can be challenging. There is a need for clinical tools that facilitate assessment of both CAS and dysarthria symptoms in children. The goals of this tutorial are to (a) determine confidence levels of clinicians in differentially diagnosing dysarthria and CAS and (b) provide a systematic procedure for differentiating CAS and pediatric dysarthria in children. Evidence related to differential diagnosis of CAS and dysarthria is reviewed. Next, a web-based survey of 359 pediatric speech-language pathologists is used to determine clinical confidence levels in diagnosing CAS and dysarthria. Finally, a checklist of pediatric auditory-perceptual motor speech features is presented along with a procedure to identify CAS and dysarthria in children with suspected motor speech impairments. Case studies illustrate application of this protocol, and treatment implications for complex cases are discussed. The majority (60%) of clinician respondents reported low or no confidence in diagnosing dysarthria in children, and 40% reported they tend not to make this diagnosis as a result. Going forward, clinicians can use the feature checklist and protocol in this tutorial to support the differential diagnosis of CAS and dysarthria in clinical practice. Incorporating this diagnostic protocol into clinical practice should help increase confidence and accuracy in diagnosing motor speech disorders in children. Future research should test the sensitivity and specificity of this protocol in a large sample of children with varying speech sound disorders. Graduate programs and continuing education trainings should provide opportunities to practice rating speech features for children with dysarthria and CAS. https://doi.org/10.23641/asha.19709146.

The cognitive and neural underpinnings of discourse coherence in post-stroke aphasia.

Although impaired discourse production is one of the prominent features of aphasia, only a handful of investigations have addressed the cognitive, linguistic and neural processes that support the production of coherent discourse. In this study, we investigated the cognitive and neural correlates of discourse coherence in a large mixed cohort of patients with post-stroke aphasia, including the first voxel-based lesion-symptom mapping of coherence deficits. Discourse responses using different tasks were collected from 46 patients with post-stroke aphasia, including a wide range of classifications and severity levels, and 20 matched neuro-typical controls. Global coherence, defined as the degree to which utterances related to the expected topic of discourse, was estimated using a previously validated computational linguistic approach. Coherence was then related to fundamental language and cognitive components in aphasia identified using an extensive neuropsychological battery. Relative to neuro-typical controls, patients with aphasia exhibited impaired coherence, and their ability to maintain coherent discourse was related to their performance on other language components: phonological production, fluency and semantic processing, rather than executive functions or motor speech. These results suggest that impairments in core language components play a role in reducing discourse coherence in post-stroke aphasia. Whole-brain voxel-wise lesion-symptom mapping using univariate and multivariate approaches identified the contribution of the left prefrontal cortex, and particularly the inferior frontal gyrus (pars triangularis), to discourse coherence. These findings provide convergent evidence for the role of the inferior frontal gyrus in maintaining discourse coherence, which is consistent with the established role of this region in producing connected speech and semantic control (organizing and selecting appropriate context-relevant concepts). These results make an important contribution to understanding the root causes of disrupted discourse production in post-stroke aphasia.

Sex differences in the symptom presentation of stroke: A systematic review and meta-analysis.

Early diagnosis through symptom recognition is vital in the management of acute stroke. However, women who experience stroke are more likely than men to be initially given a nonstroke diagnosis and it is unclear if potential sex differences in presenting symptoms increase the risk of delayed or missed stroke diagnosis. To quantify sex differences in the symptom presentation of stroke and assess whether these differences are associated with a delayed or missed diagnosis. PubMed, EMBASE, and the Cochrane Library were systematically searched up to January 2021. Studies were included if they reported presenting symptoms of adult women and men with diagnosed stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) and were published in English. Mean percentages with 95% confidence intervals (CIs) of each symptom were calculated for women and men. The crude relative risks (RRs) with 95% CI of symptoms being present in women, relative to men, were also calculated and pooled. Any data on the delayed or missed diagnosis of stroke for women compared to men based on symptom presentation were also extracted. Pooled results from 21 eligible articles showed that women and men presented with a similar mean percentage of motor deficit (56% in women vs 56% in men) and speech deficit (41% in women vs 40% in men). Despite this, women more commonly presented with nonfocal symptoms than men: generalized nonspecific weakness (49% vs 36%), mental status change (31% vs 21%), and confusion (37% vs 28%), whereas men more commonly presented with ataxia (44% vs 30%) and dysarthria (32% vs 27%). Women also had a higher risk of presenting with some nonfocal symptoms: generalized weakness (RR 1.49, 95% CI 1.09-2.03), mental status change (RR 1.44, 95% CI 1.22-1.71), fatigue (RR 1.42, 95% CI 1.05-1.92), and loss of consciousness (RR 1.30, 95% CI 1.12-1.51). In contrast, women had a lower risk of presenting with dysarthria (RR 0.89, 95% CI 0.82-0.95), dizziness (RR 0.87, 95% CI 0.80-0.95), gait disturbance (RR 0.79, 95% CI 0.65-0.97), and imbalance (RR 0.68, 95% CI 0.57-0.81). Only one study linking symptoms to definite stroke/TIA diagnosis found that pain and unilateral sensory loss are associated with lower odds of a definite diagnosis in women compared to men. Although women showed a higher prevalence of some nonfocal symptoms, the prevalence of focal neurological symptoms, such as motor weakness and speech deficit, was similar for both sexes. Awareness of sex differences in symptoms in acute stroke evaluation, careful consideration of the full constellation of presenting symptoms, and further studies linking symptoms to diagnostic outcomes can be helpful in improving early diagnosis and management in both sexes.

Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk.

Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

Decoding grasp and speech signals from the cortical grasp circuit in a tetraplegic human

The cortical grasp network encodes planning and execution of grasps and processes spoken and written aspects of language. High-level cortical areas within this network are attractive implant sites for brain-machine interfaces (BMIs). While a tetraplegic patient performed grasp motor imagery and vocalized speech, neural activity was recorded from the supramarginal gyrus (SMG), ventral premotor cortex (PMv), and somatosensory cortex (S1). In SMG and PMv, five imagined grasps were well represented by firing rates of neuronal populations during visual cue presentation. During motor imagery, these grasps were significantly decodable from all brain areas. During speech production, SMG encoded both spoken grasp types and the names of five colors. Whereas PMv neurons significantly modulated their activity during grasping, SMG's neural population broadly encoded features of both motor imagery and speech. Together, these results indicate that brain signals from high-level areas of the human cortex could be used for grasping and speech BMI applications.

The prevalence of apraxia of speech in chronic aphasia after stroke: A bayesian hierarchical analysis

Apraxia of speech is a motor speech disorder that occurs after lesions to the left cerebral hemisphere, most often concomitant with aphasia. It requires specific approaches in the study of its physiological and neuroanatomical basis and special expertise in clinical care. Knowing its prevalence in patients with aphasia after stroke is therefore relevant for planning specific resources in clinical research and in health care provision. Systematic studies of the frequency of this condition are lacking.We examined the frequency of apraxia of speech in a representative sample of 156 patients with chronic post-stroke aphasia. Three experts classified the patients’ speech by best-practice auditory-perceptual methods. Bayesian hierarchical models were fitted to obtain probability distributions for prevalence estimates. A prior distribution was calculated in two steps, including Bayesian models for published frequency data (step 1) and prevalence estimates from experienced clinicians (step 2). Separate models were fitted for different severity ranges.Overall, a prevalence rate of .44 [.30, .58] was obtained. When only moderate and severe cases were taken into account, the rate was .35 [.23, .49]. After a further restriction to only severe impairment, prevalence dropped to .22 [.12, .34]. Patients identified with apraxia of speech had suffered more severe strokes according to clinical criteria and had more severe aphasias. The presence of apraxia of speech was predicted by the articulation/prosody and syntax rating scales of the Aachen Aphasia Test.Lower prevalence estimates published earlier are probably biased by low sensitivity of assessment instruments for mild speech impairment.

Understanding, Recognizing, and Managing Functional Speech Disorders: Current Thinking Illustrated With a Case Series.

Functional speech disorders (FSDs), a subtype of functional neurological disorders, are distinguishable from neurogenic motor speech disorders based on their clinical features, clinical course, and response to treatment. However, their differential diagnosis and management can be challenging. FSDs are not well understood, but growing evidence suggests a biopsychosocial basis distinct from structural lesions that cause neurogenic motor speech disorders. Following an overview of FSDs, four patients are described to illustrate the range of clinical manifestations, biopsychosocial contexts, and responses to treatment of FSDs. The path to differential diagnosis is discussed, with particular attention to positive features that led to the FSD diagnosis. Approaches to education, counseling, and management are discussed. This case series demonstrates that FSDs can present with a variety of manifestations including dysfluencies, articulation errors, dysphonia, rate and prosodic abnormalities, and combinations of disruptions in speech subsystems. FSDs may present in the context of known recent or remote physical or psychosocial trauma or, as in many cases, in the absence of an identifiable triggering event. FSDs are recognizable by positive clinical features and should not be considered a diagnosis of exclusion. With appropriate identification, counseling, and treatment, FSDs may resolve, sometimes rapidly; in some cases, treatment may be prolonged or ineffective.

Orofacial Muscle Strength across the Dysarthrias.

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

Intensive Voice Treatment (Lee Silverman Voice Treatment [LSVT LOUD]) for Children With Down Syndrome: Phase I Outcomes.

This study examined the effects of an intensive voice treatment Lee Silverman Voice Treatment (LSVT LOUD) on children with Down syndrome (DS) and motor speech disorders. A Phase I, multiple baseline, single-subject design with replication across nine participants with DS was used. Single-word intelligibility, acoustic measures of vocal functioning, and parent perceptions of pre- and posttreatment communication function were used as treatment outcome measures. All participants completed the full dose of LSVT LOUD and showed gains on one or more of the outcome measures. Patterns of posttreatment improvements were not consistent across participants but were more frequently observed on trained maximum performance tasks compared to tasks reflecting generalization of the treatment skillset. Some participants exhibited a stronger response to treatment, whereas others showed a mixed or weaker response. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS and motor speech disorders. These preliminary results show that children with DS tolerated intensive voice treatment without adverse effects and made select meaningful therapeutic gains. The treatment evidence from this study warrants Phase II treatment studies using LSVT LOUD with a larger group of children with DS.

Is there a continuum between speech and other oromotor tasks? evidence from motor speech disorders

ABSTRACT Background Oral diadochokinetic (DDK) tasks are widely used in the assessment of patients with motor speech disorders (MSD). They require the repetition of homogeneous and of heterogeneous syllables at a maximum rate. The nature of DDK tasks is a matter of debate: although they are usually considered as “non-speech”, given the involvement of real speech syllables, they have also been recognized to share more properties and requirements with speech as compared to other oromotor behaviours (i.e., non-speech gestures). Additionally, the production of heterogeneous syllables has been suggested to exhibit closer correspondence with speech given the production of a cluster of different syllables, as compared to the repetition of a monosyllable. Each DDK task being differently related to speech supports the assumption of a continuum between speech and other oromotor processes, in which tasks with increasingly speech-like properties may overlap to a larger extent with speech. Aim To test the potentially differential relationship between speech and DDK tasks in patients with MSD. Traditional views of MSD claim that speech and other oromotor behaviours are impaired in patients with dysarthria, while patients with AoS present with speech being exclusively compromised. This suggests that DDK tasks should be differently affected in these two MSD populations. Moreover, in the framework of a continuum, oromotor tasks sharing some characteristics with speech (i.e., heterogeneous DDK task) should also be impaired in patients with AoS. Method Syllabic rates of a sentence production (SP) task are contrasted with those of homogeneous and heterogeneous DDK tasks in three pathological populations: patients with dysarthria due to Parkinson’s Disease (PD, n = 10) or due to amyotrophic lateral sclerosis (ALS, n = 10) and patients with apraxia of speech (AoS, n = 10); and 30 matched neurotypical controls. Results While patients with PD show similar rates across the SP and the DDK tasks relative to control speakers, patients with ALS display significantly slower rates across all tasks as compared to matched controls. Patients with AoS show reduced performances in the SP and in the heterogeneous DDK task, but not on the repetition of homogeneous syllables. Conclusions The findings of this study confirm that the repetition of heterogeneous syllables shares more principles and properties with speech than the homogeneous DDK task. This dissimilar relationship between speech and the two types of DDK tasks points to the existence of a continuum among oromotor tasks.

Differences and Commonalities in Children with Childhood Apraxia of Speech and Comorbid Neurodevelopmental Disorders: A Multidimensional Perspective.

Childhood apraxia of speech (CAS) is a motor speech disorder often co-occurring with language impairment and complex neurodevelopmental disorders. A cohort of 106 children with CAS associated to other neurodevelopmental disorders underwent a multidimensional investigation of speech and language profiles, chromosome microarray analysis and structural brain magnetic resonance (MR). Our aim was to compare the clinical profiles of children with CAS co-occurring with only language impairment with those who, in addition to language impairment, had other neurodevelopmental disorders. Expressive grammar was impaired in the majority of the sample in the context of similar alterations of speech, typical of the core symptoms of CAS. Moreover, children with complex comorbidities also showed more severe and persistent receptive language deficits. About 25% of the participants harbored copy number variations (CNVs) already described in association to neurodevelopmental disorders. CNVs occurred more frequently in children with complex comorbidities. MR structural/signal alterations were found in a small number of children and were of uncertain pathogenic significance. These results confirm that CAS needs multidimensional diagnostic and clinical management. The high frequency of language impairment has important implications for early care and demands a personalized treatment approach in which speech and language goals are consistently integrated.

Abstract WP92: Healing Strokes: Virtually Improving Stroke Survivors And Caregivers’ Well-being Through Student-run Art Therapy Support Group

Background: Depression and anxiety impact recovery and quality of life in 1 in 3 stroke survivors. Caregivers also experience burnout. Creative art-based therapy boosts feelings of accomplishment, self-esteem, and neuroplasticity by stimulating diverse brain regions. Few outpatient art therapy programs exist for stroke survivors and caregivers, limited further during the COVID-19 pandemic. We aim to implement an outpatient, student-run virtual art therapy curriculum using a patient-carer team approach to foster a supportive peer community, reduce depressive symptoms in survivors, and increase relief for caregivers. Methods: A multidisciplinary team of stroke physician, nurse, occupational therapist, clinic managers, and undergraduate student volunteers created an evidenced-based art therapy curriculum feasible for stroke survivors. An art educator trained volunteers in empathetic communication, teaching techniques, and patient privacy. Participants pre-registered for weekly 1 hour classes held via video conference and received art materials by mail. We administered surveys at initial registration and quarterly. An institutional grant provided funding. Results: From September 2020 - July 2021, Healing Strokes hosted 30 classes using the curriculum (Table 1) for 71 survivors and caregivers from 9 states at a 1:5 volunteer-to-participant ratio. 20 participants (14 survivors, 6 caregivers) self-reported benefits of peer support, creative inspiration, increased sense of accomplishment, and improvement in speech and fine motor skills. Conclusion: Implementation of a virtual outpatient art-based therapy program for stroke survivors and caregivers is feasible with participants self-reporting benefits in functional recovery and mood. Post-stroke supportive care programs can expand to include art therapy during a pandemic. Future studies can validate the impact on peer support, function, and post-stroke depression and anxiety.

Neuro-Oncology Patients as Human Research Subjects: Ethical Considerations for Cognitive and Behavioral Testing for Research Purposes.

Simple SummaryPrevious publications have elaborated on the exposure of ethical issues surrounding the enrollment and neurological testing of brain cancer patients into clinical studies. Existing literature has been tailored to provide insight on how to overcome ethical challenges for clinical team members but not for the research component that runs in parallel. The aim of this paper is to highlight the obstacles that researchers encounter when obtaining informed consent and administering language, cognitive or behavioral tasks for the sole purpose of research. Researchers should be encouraged to practice their best judgment and effectively communicate the purpose of the study while emphasizing the voluntary participation of neurologically impaired cancer patients. The solutions proposed in this paper can serve as future reference and a guide on maintaining a transparent balance between research and clinical testing for both researchers and clinical team members in the neuro-oncology field.Language, cognition, and behavioral testing have become a fundamental component of standard clinical care for brain cancer patients. Many existing publications have identified and addressed potential ethical issues that are present in the biomedical setting mostly centering around the enrollment of vulnerable populations for therapeutic clinical trials. Well-established guides and publications have served as useful tools for clinicians; however, little has been published for researchers who share the same stage but administer tests and collect valuable data solely for non-therapeutic investigational purposes derived from voluntary patient participation. Obtaining informed consent and administering language, cognition, and behavioral tasks for the sole purpose of research involving cancer patients that exhibit motor speech difficulties and cognitive impairments has its own hardships. Researchers may encounter patients who experience emotional responses during tasks that challenge their existing impairments. Patients may have difficulty differentiating between clinical testing and research testing due to similarity of task design and their physician’s dual role as a principal investigator in the study. It is important for researchers to practice the proposed methods emphasized in this article to maintain the overall well-being of patients while simultaneously fulfilling the purpose of the study in a research setting.