Audiology and Speech Pathology - Research Publications
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ItemNo Preview AvailableDifferentiating profiles of speech impairments in Friedreich's ataxia: a perceptual and instrumental approach(WILEY, 2012)BACKGROUND: The speech disorder associated with Friedreich's ataxia (FRDA) is classically described as ataxic dysarthria. However, variable neuropathology beyond the cerebellum, which may include the corticospinal and corticobulbar tracts, means that the dysarthria can be mixed rather than a pure ataxic dysarthria. AIMS: To characterize physiological features of the dysarthria associated with FRDA and identify differential patterns of deviation that may occur across the subsystems of the speech-production mechanism in a series of seven case studies. METHODS & PROCEDURES: The assessment battery included a perceptual analysis of a speech sample using an interval rating scale, and a range of instrumental measures to investigate the respiratory, laryngeal, velopharyngeal and articulatory systems. OUTCOMES & RESULTS: The results demonstrated the variability that exists in the dysarthria associated with FRDA, highlighting the existence of differential profiles of speech impairment. A particular distinction was observed between the presence of hypernasality and phonatory dysfunction, as evidenced by the instrumental results. CONCLUSIONS & IMPLICATIONS: The distinct profiles of dysarthria associated with FRDA indicate that approaches that address multiple subsystems are necessary for the accurate characterization and quantification of the motor speech disorder. Further research is required to investigate the decline in speech function as the disease progresses, as changes in speech function over time may be a good indicator of neurological decline in FRDA.
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ItemNo Preview AvailableIs age or culture important for the use of speech as a marker of depression?(Frontiers Research Foundation, 2012)Speech is a marker of depression severity and treatment response. Following on from a multisite randomised control trial which demonstrated the feasibility and validity of obtaining neurophysiologically based acoustic measures of depression in 25-65 year old English speakers, we sought to determine the efficacy of the methods in related clinically important cohorts: defined by age and language. 125 adults with major depression were recruited into an 8-week, open label observational study. Four cohorts were included: two English speaking groups (‘younger’ (n= 38) (18-25 years) and ‘older’ (n=27) (60-78 years)) and two Chinese speaking groups (Mandarin (n=29) and Cantonese speakers (n=31)). Participants beginning new treatments for depression were clinically evaluated at baseline, study midpoint (4 weeks), and end-point (8 weeks). After face to face assessment, participants completed the Quick Inventory of Depressive Symptomatology - Interactive Voice Response (QIDS-IVR) version using touch-tone telephones. Speech samples were also recorded for analysis of acoustic characteristics as clinical markers of depression severity and response to treatment. Timing-based measures of speech production, particularly during the performance of automatic speech tasks, showed the most significant correlations with overall depression severity. Specifically, associations between depression severity and total recording durations, pause times, pause variability, and speaking rates were consistent with previous studies. Few acoustic markers of speech, however, were significantly correlated with treatment response. Speech was significantly correlated with depression severity in all groups. Altered speech production and its relationship with clinician defined clinician treatment response was not clearly demonstrated, possibility due to low treatment response rates.
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ItemNo Preview AvailableHealth care utilisation following hospitalisation for transport-related injury(ELSEVIER SCI LTD, 2012-09)BACKGROUND: Transport injuries are a substantial cause of disability and death internationally. There is little published information regarding patterns of healthcare utilisation following transport injury. AIMS: To investigate patterns of in-hospital and post-discharge healthcare use following transport injury. METHODS: Analysis of all accepted adult claims from the database of the transport accident compensation regulator in Victoria, Australia between 1995 and 2008. The analyses focused on injuries resulting in hospitalisation. Indicators of in-hospital and post-discharge healthcare utilisation (e.g. number of services per practitioner group) within the first 12-months were summarised. RESULTS: More than a third (33.6%, n = 68,639) of all accepted compensable transport injuries resulted in admission to an acute care facility within 28 days of injury. In this group, the compensation authority paid for a total of 4.5 million healthcare services in the 12 months post-discharge (median of 19 services per claim). Services provided by medical practitioners were accessed by nearly all claimants (95.7%) at a median of 11 (5-26) per claimant. Less than half of claimants (46.7%) accessed paramedical or allied health services but the median number of services accessed was higher at 29 (9-82) per claimant. CONCLUSION: Transport-related injury cases require a substantial interaction with multiple components of the healthcare system in the year following hospital discharge. Compensation system data may provide a detailed understanding of healthcare utilisation, a key element of injury burden.
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ItemCan we detect altered disease state in early stage Huntington’s Disease using acoustic markers of speech?(Australasian Speech Science and Technology Association (ASSTA), 2012)Altered prosody has been described in symptomatic Huntington’s Disease (HD) individuals, however, the extent to which acoustic analysis of speech is sensitive to gene positive pre-manifest (PreHD) individuals is unknown. Speech samples were acquired from 30 individuals carrying the mutant HTT gene (13 PreHD, 17 early stage HD) and 15 matched controls. Participants read a passage, produced a monologue, counted from 1-20 and said the days of the week. Data were analysed acoustically for measures of timing, frequency and intensity. Tasks were compared to determine their relative sensitivity to disease state. Tasks with greater cognitive demand appeared more suitable for detecting Huntington’s disease compared to tasks with high levels of automaticity.
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ItemNo Preview AvailableObjective measures of efficacy of Deep Brain Stimulation for treatment of tremor(Frontiers, 2012)Patients with intractable tremor not alleviated by pharmaceutical therapies can be successfully treated using Deep Brain Stimulation of subcortical areas such as the Subthalamic Nucleus (STN). Current DBS devices produce constant-current or constant-voltage biphasic pulse trains and offer a range of pulse rate and pulse duration options as well as different current or voltage levels. The clinical method of setting the parameters by observation is non-ideal, firstly because of the number of possible parameter combinations, and a current lack of knowledge of how the parameters interact with each other, and secondly because subjective clinical observation is prone to observer error and bias. In this study, we aimed to develop an objective method of recording the severity of tremor and to use it to explore the effect on tremor of stimulus parameters. Six patients with Essential Tremor who had been fitted with a DBS device in the Posterior Subthalamic Area (PSA) participated in the study. Tremor was measured by position sensors attached to the arms and wrists while the patient was holding both arms stretched out in front of them and when performing a finger-nose pointing task. Clinical rating of tremor was also performed. Results of the experiments showed that the optimal stimulus parameters were subject specific and the effects of each parameter were non-monotonic, often with a very specific range providing therapeutic benefit (for example, Fig. 1). The objective measures were more sensitive than clinical judgement and show that an objective fitting method could improve benefits in individual patients.
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ItemNo Preview AvailableTreatment for dysphagia (swallowing difficulties) in hereditary ataxia syndromes (Protocol)(John Wiley & Sons, Ltd, 2012-10-17)This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy of interventions for swallowing impairment (dysphagia) in people with hereditary ataxia syndromes.
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ItemVocal Acoustic Biomarkers of Depression Severity and Treatment Response(ELSEVIER SCIENCE INC, 2012-10-01)BACKGROUND: Valid, reliable biomarkers of depression severity and treatment response would provide new targets for clinical research. Noticeable differences in speech production between depressed and nondepressed patients have been suggested as a potential biomarker. METHODS: One hundred five adults with major depression were recruited into a 4-week, randomized, double-blind, placebo-controlled research methodology study. An exploratory objective of the study was to evaluate the generalizability and repeatability of prior study results indicating vocal acoustic properties in speech may serve as biomarkers for depression severity and response to treatment. Speech samples, collected at baseline and study end point using an automated telephone system, were analyzed as a function of clinician-rated and patient-reported measures of depression severity and treatment response. RESULTS: Regression models of speech pattern changes associated with clinical outcomes in a prior study were found to be reliable and significant predictors of outcome in the current study, despite differences in the methodological design and implementation of the two studies. Results of the current study replicate and support findings from the prior study. Clinical changes in depressive symptoms among patients responding to the treatments provided also reflected significant differences in speech production patterns. Depressed patients who did not improve clinically showed smaller vocal acoustic changes and/or changes that were directionally opposite to treatment responders. CONCLUSIONS: This study supports the feasibility and validity of obtaining clinically important, biologically based vocal acoustic measures of depression severity and treatment response using an automated telephone system.
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ItemSpeech acoustic markers of early stage and prodromal Huntington's disease: A marker of disease onset?(PERGAMON-ELSEVIER SCIENCE LTD, 2012-12)Speech disturbances (e.g., altered prosody) have been described in symptomatic Huntington's Disease (HD) individuals, however, the extent to which speech changes in gene positive pre-manifest (PreHD) individuals is largely unknown. The speech of individuals carrying the mutant HTT gene is a behavioural/motor/cognitive marker demonstrating some potential as an objective indicator of early HD onset and disease progression. Speech samples were acquired from 30 individuals carrying the mutant HTT gene (13 PreHD, 17 early stage HD) and 15 matched controls. Participants read a passage, produced a monologue and said the days of the week. Data were analysed acoustically for measures of timing, frequency and intensity. There was a clear effect of group across most acoustic measures, so that speech performance differed in-line with disease progression. Comparisons across groups revealed significant differences between the control and the early stage HD group on measures of timing (e.g., speech rate). Participants carrying the mutant HTT gene presented with slower rates of speech, took longer to say words and produced greater silences between and within words compared to healthy controls. Importantly, speech rate showed a significant correlation to burden of disease scores. The speech of early stage HD differed significantly from controls. The speech of PreHD, although not reaching significance, tended to lie between the performance of controls and early stage HD. This suggests that changes in speech production appear to be developing prior to diagnosis.
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ItemLongitudinal change in dysarthria associated with Friedreich ataxia: a potential clinical endpoint(SPRINGER HEIDELBERG, 2012-11)CNS functions that show change across short periods of time are particularly useful clinical endpoints for Friedreich ataxia. This study determined whether there is measurable acoustical change in the dysarthria associated with Friedreich ataxia across yearly intervals. A total of 29 participants diagnosed with Friedreich ataxia were recorded across 4 years at yearly intervals. A repeated measures ANOVA was used to determine which acoustic measures differed across time, and pairwise t tests were used to assess the consistency of the change across the time intervals. The relationship between the identified measures with perceptual severity was assessed with stepwise regression. Significant longitudinal change was observed with four measures that relate to the utterance duration and spectral changes in utterances. The spectral measures consistently detected change across time intervals of two or more years. The four measures combined moderately predicted perceptual severity. Together, the results implicate longitudinal change in speaking rate and utterance duration. Changes in speech associated with Friedreich ataxia can be measured across intervals of 2 years and therefore show rich potential for monitoring disease progression and therapy outcomes.