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BackgroundBrain-computer interfaces can enable communication for people with paralysis by transforming cortical activity associated with attempted speech into text on a computer screen. Communication with brain-computer interfaces has been restricted by extensive training requirements and limited accuracy.MethodsA 45-year-old man with amyotrophic lateral sclerosis (ALS) with tetraparesis and severe dysarthria underwent surgical implantation of four microelectrode arrays into his left ventral precentral gyrus 5 years after the onset of the illness; these arrays recorded neural activity from 256 intracortical electrodes. We report the results of decoding his cortical neural activity as he attempted to speak in both prompted and unstructured conversational contexts. Decoded words were displayed on a screen and then vocalized with the use of text-to-speech software designed to sound like his pre-ALS voice.ResultsOn the first day of use (25 days after surgery), the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. Calibration of the neuroprosthesis required 30 minutes of cortical recordings while the participant attempted to speak, followed by subsequent processing. On the second day, after 1.4 additional hours of system training, the neuroprosthesis achieved 90.2% accuracy using a 125,000-word vocabulary. With further training data, the neuroprosthesis sustained 97.5% accuracy over a period of 8.4 months after surgical implantation, and the participant used it to communicate in self-paced conversations at a rate of approximately 32 words per minute for more than 248 cumulative hours.ConclusionsIn a person with ALS and severe dysarthria, an intracortical speech neuroprosthesis reached a level of performance suitable to restore conversational communication after brief training. (Funded by the Office of the Assistant Secretary of Defense for Health Affairs and others; BrainGate2 ClinicalTrials.gov number, NCT00912041.).

It is debated whether primary progressive apraxia of speech (PPAOS) and progressive agrammatic aphasia (PAA) belong to the same clinical spectrum, traditionally termed non-fluent/agrammatic variant primary progressive aphasia (nfvPPA), or exist as two completely distinct syndromic entities with specific pathologic/prognostic correlates. We analysed speech, language and disease severity features in a comprehensive cohort of patients with progressive motor speech impairment and/or agrammatism to ascertain evidence of naturally occurring, clinically meaningful non-overlapping syndromic entities (e.g. PPAOS and PAA) in our data. We also assessed if data-driven latent clinical dimensions with aetiologic/prognostic value could be identified. We included 98 participants, 43 of whom had an autopsy-confirmed neuropathological diagnosis. Speech pathologists assessed motor speech features indicative of dysarthria and apraxia of speech (AOS). Quantitative expressive/receptive agrammatism measures were obtained and compared with healthy controls. Baseline and longitudinal disease severity was evaluated using the Clinical Dementia Rating Sum of Boxes (CDR-SB). We investigated the data's clustering tendency and cluster stability to form robust symptom clusters and employed principal component analysis to extract data-driven latent clinical dimensions (LCD). The longitudinal CDR-SB change was estimated using linear mixed-effects models. Of the participants included in this study, 93 conformed to previously reported clinical profiles (75 with AOS and agrammatism, 12 PPAOS and six PAA). The remaining five participants were characterized by non-fluent speech, executive dysfunction and dysarthria without apraxia of speech or frank agrammatism. No baseline clinical features differentiated between frontotemporal lobar degeneration neuropathological subgroups. The Hopkins statistic demonstrated a low cluster tendency in the entire sample (0.45 with values near 0.5 indicating random data). Cluster stability analyses showed that only two robust subgroups (differing in agrammatism, executive dysfunction and overall disease severity) could be identified. Three data-driven components accounted for 71% of the variance [(i) severity-agrammatism; (ii) prominent AOS; and (iii) prominent dysarthria]. None of these data-driven LCDs allowed an accurate prediction of neuropathology. The severity-agrammatism component was an independent predictor of a faster CDR-SB increase in all the participants. Higher dysarthria severity, reduced words per minute and expressive and receptive agrammatism severity at baseline independently predicted accelerated disease progression. Our findings indicate that PPAOS and PAA, rather than exist as completely distinct syndromic entities, constitute a clinical continuum. In our cohort, splitting the nfvPPA spectrum into separate clinical phenotypes did not improve clinical-pathological correlations, stressing the need for new biological markers and consensus regarding updated terminology and clinical classification.

The current study explored the intelligibility and acceptability ratings of dysarthric speakers with African American English (AAE) and General American English (GAE) dialects by listeners who identify as GAE or AAE speakers, as well as listener ability to identify dialect in dysarthric speech. Eighty-six listeners rated the intelligibility and acceptability of sentences extracted from a passage read by speakers with dysarthria. Samples were used from the Atlanta Motor Speech Disorders Corpus and ratings were collected via self-report. The listeners identified speaker dialect in a forced-choice format. Listeners self-reported their dialect and exposure to AAE. AAE dialect was accurately identified in 63.43% of the the opportunities; GAE dialect was accurately identified in 70.35% of the opportunities. Listeners identifying as AAE speakers rated GAE speech as more acceptable, whereas, listeners identifying as GAE speakers rated AAE speech as more acceptable. Neither group of listeners demonstrated a difference in intelligibility ratings. Exposure to AAE had no effect on intelligibility or acceptability ratings. Listeners can identify dialect (AAE and GAE) with a better than chance degree of accuracy. One's dialect may have an effect on intelligibility and acceptability ratings. Exposure to a dialect did not affect listener ratings of intelligibility or acceptability. [ABSTRACT FROM AUTHOR]

The intelligibility of speech is a primary component to assess the severity level of Dysarthria, a speech disorder, which is caused not only due to weakness in vocal motor muscles but also difficulty in controlling its movements. Prior information about the severity of Dysarthria, aids the therapist during the rehabilitation process. This paper introduces a novel hybrid architecture comprising Gaussian Mixture Model and Neural Network (GMM-NN) for categorizing Dysarthric severity into four classes based on speech intelligibility. Mel Frequency Cepstral Coefficients (MFCC) extracted from the segmented speech signals are used to train the classifier. The proposed model produced a 1.9% improvement in accuracy when compared to the baseline Gaussian Mixture Model (GMM). The Gaussian Mixture Model Deep Neural Network (GMM-DNN) and Gaussian Mixture Model Feed Forward Neural Network (GMM-FFNN) architectures showed an accuracy of 96.7% and 96.42% with F1 scores of 0.9649, 0.9604 respectively. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 72-year-old woman who was evaluated for dysarthria and respiratory failure, following a history of exertional dyspnea, edema, and neurological symptoms such as slurred speech and facial asymmetry. Topics include respiratory failure, neurological symptoms, and differential diagnosis.

Purpose: To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria. Materials and methods: This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index–10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated. Results: Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and −0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001). Conclusion: The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects. IMPLICATIONS FOR REHABILITATION: The present study cross-culturally adapts and validates a dysarthria assessment tool in the Arab culture. The Arabic Radboud Dysarthria Assessment (A-RDA) and the speech component of the Arabic Radboud Oral Motor inventory for Parkinson's disease-speech component (A-ROMP-speech) are valid and reliable measures to be used among Lebanese individuals with dysarthria. The use of the A-RDA and the A-ROMP-speech will contribute to better therapeutic outcomes and will lead to a common language among speech and language therapists. [ABSTRACT FROM AUTHOR]

Introduction: Cortical thinning is well-documented in individuals with amyotrophic lateral sclerosis (ALS), yet its association with speech deterioration remains understudied. This study characterizes anatomical changes in the brain within the context of speech impairment patterns in individuals with ALS, providing insight into the disease's multiregional spread and biology. Methods: To evaluate patterns of cortical thickness in speakers with ALS with and without functional speech changes compared to healthy controls (HCs) using whole-brain and region of interest (ROI) analyses. Forty individuals with ALS and 22 HCs underwent a T1-weighted 3-Tesla magnetic resonance imaging (MRI). Individuals with ALS were divided into two groups based on the preserved speech [ps-ALS] (n = 18) or deteriorated speech [ds-ALS] (n = 22) as measured by the ALSFRSF-R speech subscore (=4 or <4 points, respectively). Sixteen a priori-defined and automatically segmented cortical and subcortical brain ROIs were selected based on their previously documented roles in speech production. Two cortical thickness analyses were performed: (1) group-level whole-brain surface-based analyses and (2) group-level ROI analyses. A case study of 6 ALS individuals examined the cortical thickness, and their speech was characterized using quantitative and qualitative measures. Results: Based on the group-level whole-brain surface-based analyses, the ds-ALS group demonstrated significant cortical thinning compared to HCs in the left primary motor and somatosensory cortices and the right inferior parietal lobe with its adjacent lateral occipital cortical regions. The ps-ALS group demonstrated no significant cortical thinning compared to HCs. Based on the group-level ROI analyses, the ds-ALS group demonstrated significant cortical thinning compared to HCs in bilateral middle motor cortices, right posterior dorsal premotor cortex, and left anterior cingulate cortex. The case study analysis revealed that ALS speakers with speech features characteristic of spastic dysarthria exhibited cortical thinning, while those with speech features characteristic of flaccid dysarthria did not. Discussion: Individuals with ALS have anatomical changes involving multiregional neocortical areas beyond the primary motor cortex that may manifest as subjective (i.e., clinical judgment) and objective (i.e., speaking rate) changes in speech production. Further longitudinal work in ALS is needed to better understand the link between MRI cortical thickness changes and bulbar dysfunction. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The progression of multisystem neurodegenerative diseases such as ataxia significantly impacts speech and communication, necessitating adaptive clinical care strategies. With the deterioration of speech, Alternative and Augmentative Communication (AAC) can play an ever increasing role in daily life for individuals with ataxia. This review describes the spectrum of AAC resources available, ranging from unaided gestures and sign language to high-tech solutions like speech-generating devices (SGDs) and eye-tracking technology. Despite the availability of various AAC tools, their efficacy is often compromised by the physical limitations inherent in ataxia, including upper limb ataxia and visual disturbances. Traditional speech-to-text algorithms and eye gaze technology face challenges in accuracy and efficiency due to the atypical speech and movement patterns associated with the disease. In addressing these challenges, maintaining existing speech abilities through rehabilitation is prioritized, complemented by advances in digital therapeutics to provide home-based treatments. Simultaneously, projects incorporating AI driven solutions aim to enhance the intelligibility of dysarthric speech through improved speech-to-text accuracy. This review discusses the complex needs assessment for AAC in ataxia, emphasizing the dynamic nature of the disease and the importance of regular reassessment to tailor communication strategies to the changing abilities of the individual. It also highlights the necessity of multidisciplinary involvement for effective AAC assessment and intervention. The future of AAC looks promising with developments in brain-computer interfaces and the potential of voice banking, although their application in ataxia requires further exploration. [ABSTRACT FROM AUTHOR]

The majority of patients with Parkinson's disease (PD) develop hypokinetic dysarthria with a disturbance of prosody. The most important acoustic characteristic of prosodic impairment in PD is a lack of fundamental frequency (F0)-variability. It is well established that a lack of F0-variability can negatively influence the speech intelligibility of neurotypical speakers in background noise. The purpose of this study was to investigate which aspect of processing speech realised by speakers with PD is affected by lack of intonation: intelligibility as measured by a transcription task, scaled intelligibility and/or perceived listening effort when there is no background noise. F0-flattening of Semantically Unpredictable Sentences (SUS) was achieved, while the natural F0-declination was preserved. This kind of F0-flattening affected scaled intelligibility and perceived listening effort, while transcription performance remained unchanged. [ABSTRACT FROM AUTHOR]

Purpose: Error related to incorrect use of rating scales is problematic in the assessment and treatment of dysarthria. The main purpose of this project was to determine scale fit for cardinal speech features of hypokinetic dysarthria. A secondary aim was to determine rater reliability for the two different scales explored. Method: Forty-three speakers with Parkinson's disease (PD) and 25 neurologically healthy control talkers were recorded reading sentences from the Speech Intelligibility Test. Twenty-two healthy female listeners used both an equal appearing interval (EAI) scale and a direct magnitude estimation (DME) scale to rate five perceptual speech features (i.e., overall speech severity, articulatory imprecision, reduced loudness, short rushes of speech, and monotony) from these recordings. Regression analyses were used to determine the linearity of the relationship between the means of the EAI and DME ratings. Inter- and intrarater reliability was calculated using intraclass correlation coefficients and Spearman's correlation coefficients, respectively, for both EAI and DME ratings. Results: There was a linear relationship between EAI and DME means for monotony, indicating it is a metathetic dimension. Curvilinear relationships were observed between the EAI and DME means for the other four features, indicating prothetic dimensions. Intra- and interrater reliability values were similar for EAI and DME ratings. Discussion: Overall, results of this work suggest that DME is the best fit for scaling several hypokinetic dysarthria features, and not the conventionally used EAI scale. Prothetic dimensions best scaled by DME include overall speech severity, articulatory imprecision, reduced loudness, and short rushes of speech. Monotony was the only feature found to be a metathetic dimension and would be best scaled using EAI or DME. Findings call for rethinking the widespread use of EAI scales for rating perceptual features as part of the assessment and treatment of motor speech disorders. [ABSTRACT FROM AUTHOR]

Purpose: Up to 90% of people with Parkinson's disease (PD) develop communication difficulties over the course of the disease. While the negative effect of dysarthria on communicative participation has been well-documented, the impact of the occurrence of acquired stuttered disfluencies on communication in different speech situations is unknown. This study aimed to determine if the frequency of occurrence of stuttered disfluencies affects communicative participation in individuals with PD, and whether such a relationship is mediated by examiner- and self-rated measures of disease severity. Method: Conversational speech samples were collected from 100 people with PD aged 53-91 years to calculate the frequency of occurrence of stuttered disfluencies. Participants completed the Communicative Participation Item Bank to assess participation in communicative situations. Information on overall speech, cognitive, and motor performance was collected using both self-rated and examiner-rated methods. Results: Participants with PD presented with 0.2%-9.9% stuttered disfluencies during conversation. Overall, participants with PD reported their communicative participation to be impacted "a little" (19.5 ± 7.0), but there was considerable interindividual variation. A higher frequency of stuttered disfluencies was associated with significantly lower communicative participation (1 = -0.32, p < .01). In addition, examiner-rated frequency of stuttered disfluencies (p < .01), speech (p < .01), and motor severity (p = .04) were all significant predictors of communicative participation. Using self-ratings, speech (p < .01) and cognitive (p < .01) measures significantly predicted communicative participation. Conclusions: In people with PD, communicative participation was significantly worse for those with a higher frequency of stuttered disfluencies. Examiner- and self-rated measures of disease severity contributed different information related to communicative constraints. Together, these results highlight the importance of individualized and holistic speech therapy that considers a wide variety of symptoms, including stuttered disfluencies, to ensure positive functional outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated relationships within and between perceptual, acoustic, and kinematic measures in speakers with and without dysarthria due to Parkinson's disease (PD) across different clarity conditions. Additionally, the study assessed the predictive capabilities of selected acoustic and kinematic measures for intelligibility and articulatory precision ratings. Method: Forty participants, comprising 22 with PD and 18 controls, read three phrases aloud using conversational, less clear, and more clear speaking conditions. Acoustic measures and their theoretical kinematic parallel measures (i.e., acoustic and kinematic distance and vowel space area [VSA]; second formant frequency [F2] slope and kinematic speed) were obtained from the diphthong /a/ and selected vowels in the sentences. A total of 368 listeners from crowdsourcing provided ratings for intelligibility and articulatory precision. The research questions were examined using correlations and linear mixed-effects models. Results: Intelligibility and articulatory precision ratings were highly correlated across all speakers. Acoustic and kinematic distance, as well as F2 slope and kinematic speed, showed moderately positive correlations. In contrast, acoustic and kinematic VSA exhibited no correlation. Among all measures, acoustic VSA and kinematic distance were robust predictors of both intelligibility and articulatory precision ratings, but they were stronger predictors of articulatory precision. Conclusions: The findings highlight the importance of measurement selection when examining cross-domain relationships. Additionally, they support the use of behavioral modifications aimed at eliciting larger articulatory gestures to improve intelligibility in individuals with dysarthria due to PD. [ABSTRACT FROM AUTHOR]

Organophosphorus and carbamate Insectiside is common in Asia–Pacific region consisting of 63% of the Global death. Organophosphorus and Carbamate poisoning can lead into different complications in the respiratory,digestive,neurological aspects and maybe fatal in certain cases.Besides medical management of the same,early rehabilitation is also required to manage different kinds of neurological aspects caused due to Organophosphorus and carbamate poisoning. The study was done to introspect the early intervention in swallowing and speech therapy in organophosphorus and carbamate poisoning individual,as a part of management besides medical intervention. A 19 years old female reported to the hospital with history of consuming organophos and carbamate insecticide with the intention of self harming causing cardiac arrest and as diagnosed as Flaccid Dysarthria with Oro-Pharyngeal Dysphagia when assessed with diagnostic tools respectively. Early speech and swallowing intervention was provided and introspected using MASA which showed improvement in scores during the therapeutic intervention and was statistically analysed using linear regression analysis. The result showed the improvement in MASA scores (the slope of the best fit) and proved that MASA scores improved significantly (slope = 14.3, p < 0.05) over time as the therapy sessions proceeded. The regression model was also significant (p < 0.05). The motor-speech therapeutic intervention provided improvement in the kinematics of oro-motor skills along with improvement in intelligibility of speech. This study concludes that early intervention in managing speech and swallowing abilities in Dysarthria and Dysphagia is helpful besides medical intervention in such cases. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a patient with cirrhosis who presented with weakness, dysarthria, insomnia, and depression. Initially, his cirrhosis was attributed to alcohol use, but further investigation led to the diagnosis of Wilson's disease, a rare genetic disorder that affects copper metabolism. The article highlights the challenges of diagnosing Wilson's disease, which can mimic other diseases, and emphasizes the importance of obtaining a detailed family history. It also discusses the barriers to diagnosis and care that can occur in underserved populations, such as language barriers and low health literacy. Early identification and treatment of Wilson's disease can reverse symptoms and improve outcomes. [Extracted from the article]

The article focuses on an 11-year-old boy presenting with slurred speech and involuntary movements, later diagnosed with a neurological disorder. Topics include his clinical symptoms such as dysarthria and abnormal involuntary movements, his physical exam findings including hyperreflexia and abnormal gait, and the absence of significant prior medical or family history.

This paper investigates the nuanced characteristics of the spectral envelope attributes due to vocal-tract resonance structure and fine-level excitation source features within short-term Fourier transform (STFT) magnitude spectra for the assessment of dysarthria. The single-channel convolutional neural network (CNN) employing time-frequency representations such as STFT spectrogram (STFT-SPEC) and Mel-spectrogram (MEL-SPEC) does not ensure capture of the source and system information simultaneously due to the filtering operation using a fixed-size filter. Building upon this observation, this study first explores the significance of convolution filter size in the context of the CNN-based automated dysarthric assessment system. An approach is then introduced to effectively capture resonance structure and fine-level features through a multi-channel CNN. In the proposed approach, the STFT-SPEC is decomposed using a one-level discrete wavelet transform (DWT) to separate the slow-varying spectral structure and fine-level features. The resulting decomposed coefficients in four directions are taken as the inputs to multi-channel CNN to capture the source and system features by employing different sizes of convolution filters. The experimental results conducted on the UA-speech corpus validate the efficacy of the proposed approach utilizing multi-channel CNN. The proposed approach demonstrates the notable enhancement in accuracy and F1 score (60.86% and 48.52%) compared to a single-channel CNN using STFT-SPEC (46.45% and 40.97%), MEL-SPEC (48.86% and 38.20%), and MEL-SPEC appended with delta and delta-delta coefficients (52.40% and 42.84%) for assessment of dysarthria in a speaker-independent and text-independent mode. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse the relationship between automatic vowel articulation index (aVAI) and direct magnitude estimation (DME) among speakers with Parkinson's disease (PD) and healthy controls. We further analysed the potential of aVAI to serve as an objective measure of speech impairment in the clinical setting. Method: Speech samples from native Finnish speakers were utilised. Expert raters utilised DME to scale the intelligibility of speech samples. aVAI scores for PD speakers and healthy control speakers were analysed in relationship to DME speech intelligibility ratings and, among PD speakers, disease stage utilising nonparametric statistical analysis. Result: Mean DME intelligibility ratings were lower among PD speakers compared to healthy controls. Mean aVAI scores were nearly the same between speaker groups. DME intelligibility ratings and aVAI were strongly correlated within the PD speaker group. aVAI and DME intelligibility ratings were moderately correlated with disease stage as measured by the Hoehn and Yahr scale. Conclusion: aVAI was observed to be a promising tool for analysing vowel articulation in PD speakers. Further research is warranted on the application of aVAI as an objective measure of severity of speech impairment in the clinical setting, with varying patient populations and speech samples. [ABSTRACT FROM AUTHOR]

Dysarthria and Apraxia of Speech (AoS) are motor speech disorders in which neurological lesions differentially affect motor control, possibly leading to noticeable differences in articulation and consequently sound production. Among the sounds requiring greater motor capacity because of its articulatory complexity is the voiceless alveolar sibilant fricative /s/. The aim of this study was to identify acoustic variables able to distinguish between dysarthria and AoS, and between these disorders and normal speech in Spanish speakers. The production of this fricative was acoustically examined in 28 individuals with motor neurological disorders (20 with dysarthria, 8 with AoS) and in 28 neurologically healthy persons. Participants repeated 12 monosyllabic words containing the fricative plus one of the five Spanish vowels. The variables measured were absolute durations of the fricative, vowel, and fricative+vowel sequence, along with the vowel-to-fricative duration ratio. Findings indicate that duration of the fricative can distinguish between controls and speakers with dysarthria, but not between controls and speakers with AoS. Measures related to vowel duration served to distinguish between speakers with dysarthria and speakers with AoS and between each of them and controls. Further, speakers with dysarthria and those with AoS differed from each other and from controls in terms of articulatory variability; speakers with dysarthria showing most variability. In the latter participants, articulatory variability was higher for unrounded segments, vowels and fricatives, while in speakers with AoS this variability was higher for rounded segments. These observations are discussed within a framework of motor control models. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to determine the relationship between the perceptual measure of speech naturalness and objective measures of pitch, loudness, and rate control as a potential tool for assessment of ataxic dysarthria. Method: Twenty-seven participants with ataxia and 29 age- and sex-matched control participants completed the pitch glide and loudness step tasks drawn from the Frenchay Dysarthria Assessment-Second Edition (FDA-2) in addition to speech diadochokinetic (DDK) tasks. First, group differences were compared for pitch variability in the pitch glide task, loudness variability in the loudness step task, and syllable duration and speech rate in the DDK task. Then, these acoustic measures were compared with previously collected ratings of speech naturalness by speech-language pathology graduate students. Results: Robust group differences were measured for pitch variability and both DDK syllable duration and speech rate, indicating that the ataxia group had greater pitch variability, longer DDK syllable duration, and slower DDK speech rate than the control group. No group differences were measured for loudness variability. There were robust relationships between speech naturalness and pitch variability, DDK syllable duration, and DDK speech rate, but not for loudness variability. Conclusions: Objective acoustic measures of pitch variability in the FDA-2 pitch glide task and syllable duration and speech rate in the DDK task can be used to validate perceptual measures of speech naturalness. Overall, speechlanguage pathologists can incorporate both perceptual measures of speech naturalness and acoustic measures of pitch variability and DDK performance for a comprehensive evaluation of ataxic dysarthria. [ABSTRACT FROM AUTHOR]

Purpose: Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). Method: In this commentary, we consider preliminary evidence for both languageindependent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. Conclusions: Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this study was to explore the effects of intensive voice-focused treatment on speech parameters in Spanish speakers with dysarthria associated with Parkinson's disease (PD) as perceived by naïve listeners. Method: Fifteen Spanish speakers with dysarthria associated with PD received the Lee Silverman Voice Treatment (LSVT LOUD) for a month. Voice and speech recordings were conducted pretreatment, posttreatment, and at a 1-month follow-up. Thirty naïve adult listeners rated the perceptual dimensions of ease of understanding (EoU), resonance, articulatory precision, prosody, and voice quality from sentences extracted from an emotional monologue on a visual analogue scale. Results: EoU, resonance, articulatory precision, and voice quality significantly improved pre- to posttreatment, but gains were not maintained at follow-up. Speech severity was a significant source of variance in mean listener response for all perceptual dimensions, although the interaction between speech severity and time was only significant for resonance and voice quality. Conclusions: LSVT LOUD may be beneficial to improve perceptual speech domains affected by PD in Spanish speakers with dysarthria. Its impact on the different speech subsystems may reflect a universal distribution of effects when directly targeting the glottal source. Language-specific contributions of each perceptual domain to speech intelligibility should be explored in further research to determine linguistically sensitive treatment targets. [ABSTRACT FROM AUTHOR]

Purpose: Reduced speech intelligibility is often a hallmark of children with dysarthria secondary to cerebral palsy (CP), but effects of speech strategies for increasing intelligibility are understudied, especially in children who speak languages other than English. This study examined the effects of (the Korean translation of) two cues, "speak with your big mouth" and "speak with your strong voice," on speech acoustics and intelligibility of Korean-speaking children with CP. Method: Fifteen Korean-speaking children with CP repeated words and sentences in habitual, big mouth, and strong voice conditions. Acoustic analyses were performed and intelligibility was assessed by means of 90 blinded listeners' ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC). Results: In response to both cues, children's vocal intensity and utterance duration increased significantly and differentially, whereas their vowel space area gains did not reach statistical significance. EoU increased significantly in the big mouth condition at word, but not sentence, level, whereas in the strong voice condition, EoU increased significantly at both levels. PWC increases were not statistically significant. Considerable variability in children's responses to cues was noted overall. Conclusions: Korean-speaking children with CP modify their speech styles differentially when provided with cues aimed to increase their articulatory working space and vocal intensity. The results provide preliminary support for the use of the strong voice cue, in particular, to increase EoU. While the findings do not offer conclusive evidence of the intelligibility benefits of these cues, investigation with a larger sample size should provide further insight into optimal cueing strategies for increasing intelligibility in this population. Implications for language-specific versus language-independent treatment approaches are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Despite the general agreement that dysarthria characteristics are largely language-independent, few efforts have attempted a systematic comparison across languages. To examine the role of native languages in the perception of speech characteristics of dysarthria secondary to Parkinson's disease (PD), auditory-perceptual ratings of dysarthria, and confidence level of the judgments were compared between two listener groups: language-matched and language-crossed. Method: A total of 60 listeners (35 native speakers of Korean and 25 native speakers of American English) estimated speech abnormality for 20 speech dimensions using a visual analog scale method for both language-matched and language-crossed speech stimuli. Speech stimuli were passage readings of the respective languages obtained from individuals with and without PD. Results: For speech dimension ratings, eight of 20 speech dimensions revealed significant differences in response to PD speech between the two listener groups, for most of which, language-crossed listeners' estimation was lower (i.e., more impaired) than language-matched listeners. For confidence-level ratings, language-matched listeners were less confident in the ratings of speakers with PD compared to the language-crossed listeners. Conclusions: The data support both language-universal and language-specific aspects in perceiving dysarthria characteristics, such that native language plays a role, especially when rating articulatory- and rhythmic-related characteristics. The findings are discussed with respect to the role of linguistic information, such as phonetic inventories and prosodic structures, in perceiving dysarthria characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Cross-language studies suggest more similarities than differences in how dysarthria affects the speech of people with Parkinson's disease (PwPD) who speak different languages. In this study, we aimed to identify the relative contribution of acoustic variables to distinguish PwPD from controls who spoke varieties of two Romance languages, French and Portuguese. Method: This bi-national, cross-sectional, and case-controlled study included 129 PwPD and 124 healthy controls who spoke French or Portuguese. All participants underwent the same clinical examinations, voice/speech recordings, and self-assessment questionnaires. PwPD were evaluated off and on optimal medication. Inferential analyses included Disease (controls vs. PwPD) and Language (French vs. Portuguese) as factors, and random decision forest algorithms identified relevant acoustic variables able to distinguish participants: (a) by language (French vs. Portuguese) and (b) by clinical status (PwPD on and off medication vs. controls). Results: French-speaking and Portuguese-speaking individuals were distinguished from each other with over 90% accuracy by five acoustic variables (the mean fundamental frequency and the shimmer of the sustained vowel /a/ production, the oral diadochokinesis performance index, the relative sound level pressure and the relative sound pressure level standard deviation of the text reading). A distinct set of parameters discriminated between controls and PwPD: for men, maximum phonation time and the oral diadochokinesis speech proportion were the most significant variables; for women, variables calculated from the oral diadochokinesis were the most discriminative. Conclusions: Acoustic variables related to phonation and voice quality distinguished between speakers of the two languages. Variables related to pneumophonic coordination and articulation rate were the more effective in distinguishing PwPD from controls. Thus, our research findings support that respiration and diadochokinesis tasks appear to be the most appropriate to pinpoint signs of dysarthria, which are largely homogeneous and language-universal. In contrast, identifying language-specific variables with the speech tasks and acoustic variables studied was less conclusive. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to raise awareness about the importance of diverting from English-centric approaches in the management of dysarthria associated with Parkinson's disease (PD) in the United States, and embracing a language- and culture-specific perspective when working with linguistically and culturally diverse populations within the context of culturally responsive, precision medicine. Method: This tutorial is divided into two primary components: a critical review of language universal and language-specific characteristics of dysarthria associated with PD and their relationship with speech intelligibility, and a practical guide to culturally responsive evidence-based practice for speech-language pathologists. Conclusions: We offer a framework for linguistically and culturally appropriate considerations when working with clients with dysarthria associated with PD. While "universal" representations of dysarthria may be part of the big picture, language-specific contributions to speakers' intelligibility should be carefully examined to maximize treatment outcomes. Additionally, an evidence-based model that fully embraces clients' wishes and values within the context of culturally responsive, precision medicine should be prioritized, a practice that may include the use of interpreters. [ABSTRACT FROM AUTHOR]

The etiology of neurodevelopmental disorders and epilepsy is very heterogeneous and partly still unknown, and the research of causative genes related to these diseases is still in progress. In 2020, pathogenic variants of the TET3 gene were associated with Beck–Fahrner syndrome, which is characterized by neurodevelopmental delay, intellectual and learning disabilities of variable degree, growth abnormalities, hypotonia and seizures. Variants of TET3 have been described having both an autosomal dominant with a milder phenotype and an autosomal recessive pattern. To date, in the literature, only 28 patients are reported with pathogenic variants of the TET3 gene, and only 9 of them have epilepsy. We describe a 31-year-old woman with macrocephaly, mild neurodevelopmental delay and a long history of epilepsy. Trio-based exome sequencing identified a de novo heterozygous TET3 variant, c.2867G>A p.(Arg956Gln), never described before, absent in the general population and predicted to be potentially pathogenetic by bioinformatics tools. This report aims to describe the clinical history of our patient, the pharmacological treatment and clinical response, as well as the biological characteristics of this new variant. [ABSTRACT FROM AUTHOR]

Parkinson's disease is related to nervous system disorders in human beings. In this paper, the status of Parkinson's disease has been predicted based on the analysis of features of two Parkinson's disease symptoms: Dysphonia and Dysarthria. The Dysphonia symptom has been measured by analyzing the features extracted from the vocal sounds of a patient. The Dysarthria symptom of Parkinson's disease has been analyzed by the features extracted from the speech signals of a patient. Hence, two different prediction models have been built for deriving the status of Parkinson's disease. The derivation of these prediction systems is based on statistical and discriminant feature analysis. The statistical-based feature analysis is carried out using descriptive and inferential analysis. In contrast, the enteric, deviation, and correlation-based information between the features are utilized for descriptive analysis. The inferential analysis has been performed using hypothetical testing of the distribution of features. The descriptive and inferential feature analyses are used to derive effective features for the Parkinson's disease problem based on the Dysphonia and Dysarthria symptoms. In the discriminant feature analysis, the feature sets undergo deriving discriminant features. The best-selected features are used to build a prediction model for detecting Parkinson's disease problems in a patient. Extensive experimentation has been carried out using a Dysphonia dataset containing 195 samples. Each sample has 23 features. One dataset for Dysarthria symptoms contains 756 observations, with each observation having 754 features. The best prediction models that have been obtained correspond to these datasets, and 93.50% is obtained for Dysphonia and 87.63% for Dysarthria symptoms databases, respectively. The performance of the proposed system has been compared with some existing methods concerning each employed dataset, showing the superiority of the proposed approach. [ABSTRACT FROM AUTHOR]

A 20-year-old man was brought to the emergency room with chief complaints of dysarthria and vomiting after placing several drops of an inhalation liquid containing hexahydrocannabiphorol (HHCP) under his tongue. During ambulance transport, the patient had a post-vomiting convulsion that lasted approximately 1 minute. Upon arrival at the hospital, he was agitated, had dysarthria to the extent that he was in danger of falling from the stretcher, and was having visual hallucinations. Blood tests showed acidosis and a high lactic acid concentration. The patient was urgently admitted to the hospital with a diagnosis of acute poisoning and was started on supplemental intravenous fluids. The patient was able to communicate from the second day, started eating on the third day, finished receiving supplemental fluids on the fourth day, and was discharged from the hospital on the fifth day. HHCP was not illegal in Japan at the time and was distributed mainly through mail order. Clinical information on HHCP is lacking, but this case shows that the drug causes health problems. Although HHCP has been regulated by law in Japan since January 2024, clinicians and the general public should be aware that similar cases may occur in the future. [ABSTRACT FROM AUTHOR]

Importance: Viral encephalitis is one of the main causes of the perisylvian syndrome, which can cause damage to children's language‐speech, feeding, and swallowing functions. Comprehensive assessment of language‐speech and swallowing function and comorbidity research on these children will help children's rehabilitation workers to better understand the disease and strengthen the systematic management of comorbid disorders. Objective: To describe speech and language pathology and the occurrence of comorbid disorders in children with perisylvian syndrome induced by viral encephalitis. Methods: Twenty‐two children with acquired perisylvian syndrome were recruited in this study. Language and speech functions, including oral motor function, swallowing function, language ability, and dysarthria were assessed in these patients. Craniocerebral magnetic resonance imaging (MRI), electroencephalogram examination, and intelligence evaluation were performed to determine brain lesions and comorbid disorders. Results: All children exhibited different degrees of oral movement, dysphagia, and speech and language disorders. There was a significant difference between expressive and receptive language ability (P < 0.05). There were 10, 8, and 12 children who had an intellectual disability, limb disability, and epilepsy, respectively. In addition to the damage of the peri‐tegmental cortex found in MRI, thalamus lesions occurred in 19 cases and white matter involvement in six cases. Interpretation: Children with acquired perisylvian syndrome caused by viral encephalitis are characterized by persistent pseudobulbar dysfunction, speech and language impairment, and orofacial diplegia. They have a high probability of secondary epilepsy and are prone to motor and cognitive impairment, which need systematic management. [ABSTRACT FROM AUTHOR]

Background: Chorea is a neurological disorder characterized by random, fluid movements that may affect the limbs, trunk, neck, or face. In children, Sydenham's chorea (SC) is the most common cause of acute chorea, mainly following group A beta-hemolytic streptococcal (GABHS) infection. Other autoimmune and metabolic disorders may also cause chorea. Case presentation: We report the case of a 6-year-old girl who developed chorea following cardiac surgery for mitral insufficiency. One week after discharge, the patient presented with right-sided hyposthenia, slower speech, mild dysarthria, and sialorrhea. Brain MRI and intracranial MRI angiography revealed a small vascular lesion consistent with a microembolic event. Extensive diagnostic investigations, including serum panels for autoimmune encephalitis, neurotropic viruses, and metabolic disorders, were negative. Conclusions: Considering the patient's history, clinical course, and the exclusion of other potential causes, a diagnosis of post-pump chorea was made. This case underlines the importance of a thorough differential diagnosis in pediatric chorea and highlights post-pump chorea as a significant postoperative complication in pediatric cardiac surgery. The patient's motor symptoms improved with symptomatic treatment, and follow-up showed good recovery without neurological sequelae. [ABSTRACT FROM AUTHOR]

One of the dysarthria features is inaccurate articulation of consonants and vowels, which is the main cause of speech unintelligibility. However, it is not clear what acoustic measures are more related to speech intelligibility in dysarthria. On the other hand, the number of vowels, their articulation and acoustic characteristics are various in different languages. As far as we know, no study investigated vowels articulation in developmental dysarthria in Persian, so there is not enough information about movement details which make their inaccuracies articulation. Hence, the present study aimed to investigate some acoustic measures including vowel formants, vowel space area (VSA), formant centralization ratio (FCR) and vowel articulation index (VAI) and aim to study their correlation with speech intelligibility in Persian speaking children with dysarthria due to spastic cerebral palsy. In this cross ـ sectional study, 11 monolingual children with dysarthria aged 3 ـ 9 years and their typically developing matched peers were selected through convenience sampling. For each of the six Persian vowels, two monosyllable words were acoustically analyzed using PRAAT software. To determine intelligibility of words and vowels, the percentage of correct detected ones was calculated. Results showed a significant difference between the two groups in the third formant of the vowels /a/ and /u/ and the second formant of the vowel /o/. The vowel space area and intelligibility were significantly reduced in dysarthria. VAS was more correlated with intelligibility and is a good acoustic measurement to assess speech intelligibility in dysarthria. However all three studied acoustic indices had moderate significant correlation with intelligibility. [ABSTRACT FROM AUTHOR]

Abstract Dysarthria is a speech disorder that affects the ability to communicate due to articulation difficulties. This research proposes a novel method for automatic dysarthria detection (ADD) and automatic dysarthria severity level assessment (ADSLA) by using a variable continuous wavelet transform (CWT) layered convolutional neural network (CNN) model. To determine their efficiency, the proposed model is assessed using two distinct corpora, TORGO and UA-Speech, comprising both dysarthria patients and healthy subject speech signals. The research study explores the effectiveness of CWT-layered CNN models that employ different wavelets such as Amor, Morse, and Bump. The study aims to analyze the models’ performance without the need for feature extraction, which could provide deeper insights into the effectiveness of the models in processing complex data. Also, raw waveform modeling preserves the original signal’s integrity and nuance, making it ideal for applications like speech recognition, signal processing, and image processing. Extensive analysis and experimentation have revealed that the Amor wavelet surpasses the Morse and Bump wavelets in accurately representing signal characteristics. The Amor wavelet outperforms the others in terms of signal reconstruction fidelity, noise suppression capabilities, and feature extraction accuracy. The proposed CWT-layered CNN model emphasizes the importance of selecting the appropriate wavelet for signal-processing tasks. The Amor wavelet is a reliable and precise choice for applications. The UA-Speech dataset is crucial for more accurate dysarthria classification. Advanced deep learning techniques can simplify early intervention measures and expedite the diagnosis process.

Background: Deep Brain Stimulation (DBS) in the Subthalamic Nucleus (STN) or the Globus Pallidus Interna (GPI) is well-established as a surgical technique for improving global motor function in patients with idiopathic Parkinson’s Disease (PD). Previous research has indicated speech deterioration in more than 30% of patients after STN-DBS implantation, whilst speech outcomes following GPI-DBS have received far less attention. Research comparing speech outcomes for patients with PD receiving STN-DBS and GPI-DBS can inform pre-surgical counseling and assist with clinician and patient decision-making when considering the neural targets selected for DBS-implantation. The aims of this pilot study were (1) to compare perceptual and acoustic speech outcomes for a group of patients with PD receiving bilateral DBS in the STN or the GPI with DBS stimulation both ON and OFF, and (2) examine associations between acoustic and perceptual speech measures and clinical characteristics. Methods: Ten individuals with PD receiving STN-DBS and eight individuals receiving GPI-DBS were audio-recorded reading a passage. Three listeners blinded to neural target and stimulation condition provided perceptual judgments of intelligibility and overall speech severity. Speech acoustic measures were obtained from the recordings. Acoustic and perceptual measures and clinical characteristics were compared for the two neural targets and stimulation conditions. Results: Intelligibility and speech severity were not significantly different across neural target or stimulation conditions. Generally, acoustic measures were also not statistically different for the two neural targets or stimulation conditions. Acoustic measures reflecting more varied speech prosody were associated with improved intelligibility and lessened severity. Convergent correlations were found between UPDRS-III speech scores and perceptual measures of intelligibility and severity. Conclusion: This study reports a systematic comparison of perceptual and acoustic speech outcomes following STN-DBS and GPI-DBS. Statistically significant differences in acoustic measures for the two neural targets were small in magnitude and did not yield group differences in perceptual measures. The absence of robust differences in speech outcomes for the two neural targets has implications for pre-surgical counseling. Results provide preliminary support for reliance on considerations other than speech when selecting the target for DBS in patients with PD.

Myasthenia gravis (MG) is a neuromuscular disease of autoimmune etiology and chronic evolution. In addition to the muscle weakness and fatigue that characterize MG, in some studies patients show an inferior performance in cognitive tasks and difficulties in recognizing basic emotions from facial expressions. However, it remains unclear if these difficulties are due to anxious–depressive symptoms that these patients present or related to cognitive abilities, such as facial recognition. This study had a descriptive cross-sectional design with a sample of 92 participants, 52 patients with MG and 40 healthy controls. The data collection protocol included measures to assess recognition of facial expressions (BRFT), facial emotional expression (FEEL), and levels of anxiety and depression (HADS). The MG group had worse performance than the control group in recognizing "fear" (p = 0.001; r = 0.344), "happiness" (p = 0.000; r = 0.580), "disgust" (p = 0.000; r = 0.399), "surprise" (p = 0.000; r = 0.602), and "anger" (p = 0.007; r = 0.284). Likewise, the MG group also underperformed in facial recognition (p = 0.001; r = 0.338). These difficulties were not related to their levels of anxiety and depression. Alterations were observed both in the recognition of facial emotions and in facial recognition, without being mediated by emotional variables. These difficulties can influence the interpersonal interaction of patients with MG. [ABSTRACT FROM AUTHOR]