Audiology and Speech Pathology - Research Publications
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ItemSpeech biometrics can predict cerebellar dysfunction in multiple sclerosis(International Parkinson and Movement Disorder Society, 2020-09-01)Objective: To objectively describe cerebellar mediated speech function using a multiparameter index that reflects pathology and quality of life in MS. Background: Cerebellar function plays a role in cognitive processing and motor control and is important for speech production. Multiple sclerosis (MS) can result in impaired cerebellar function, leading to speech deficits. These deficits can be detected by instrumental measurement. Speech as a marker of cerebellar impairment but is not well described. Method: The speech and clinical features of 85 people with MS (plus 21 matched controls) were assessed using objective acoustic analysis, validated questionnaires of quality of life and disease severity using the Scale for the Assessment and rating of Ataxia. Magnetic resonance imaging was used to measure cerebellar pathology. A regression model with eight speech variables were used to predict cerebellar function. A composite speech score was developed from the model and tested for prediction of fine motor function using the 9-hole peg test (9HPT), for correlations with imaging outcomes and self-assessed quality of life. Results: Speech timing metrics (eg. slow rate of syllable repetition, increased proportion of silence) were the strongest predictors of cerebellar impairment, alongside phonatory instability. The acoustic composite score accounted for 54% of variation in cerebellar dysfunction, was associated with cerebellar white matter volume (r=0.3, p=0.017), quality of life (r=0.5, p<0.001) and predicted an abnormal 9HPT with 85% accuracy. Conclusion: Motor cerebellar impairment in MS was reflected in an objective multi-feature speech metric.
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ItemNo Preview AvailableSwallowing function in people with Friedreich's ataxia(WILEY-BLACKWELL, 2013-06)
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ItemNo Preview AvailableSystematic review of treatment options for dysarthria in hereditary ataxia syndromes(John Wiley & Sons, 2014)Objective: To evaluate the effectiveness of therapies for dysarthria in adults and children with Friedreich ataxia and other hereditary ataxias. Background: Hereditary ataxia syndromes may result in significant communication impairment. The speech disorder most commonly reported in these disorders is dysarthria, which can limit an individual’s ability to communicate and participate in society. Recently developed clinical guidelines for Friedreich ataxia reported limited and low quality evidence for the treatment of dysarthria. Methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Education Resources Information Center (ERIC). We also searched Linguistics and Language Behavior Abstracts (LLBA), Dissertation Abstracts and Trials Registries. Included studies were randomised, controlled clinical trials (RCTs)or quasi-RCTs that compared treatments for hereditary ataxias with no treatment, placebo or another treatment and which measured speech as an outcome. Results: Of the 346 abstracts reviewed, 13 studies met inclusion criteria. Twelve studies compared pharmaceutical treatments with placebo in heterogeneous groups of cerebellar ataxias, while the thirteenth study compared physiotherapy and occupational therapy with no treatment. No study demonstrated an effect of treatment which was both statistically and clinically significant. Three studies identified slight improvements to speech following treatment with betame-thasone, idebenone or TRH tartrate, however results may have been confounded by the use of subjective measures of speech which lack adequate levels of intra- and inter-rater reliability. Conclusions: There is a critical lack of high quality evidence for the treatment of dysarthria in ataxia. The current level of evidence is not sufficient to guide clinical practice and intervention studies are needed.
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ItemNo Preview AvailableAcoustic monitoring of speech impairment in motor neuron disease associated with frontotemporal dementia: a case series(European Journal of Neurology, 2016)Frontotemporal dementia is the second most common form of younger onset dementia. A subset of people with this disorder develop motor neuron disease (MND) with associated speech impairment (dysarthria). Here, we aim to measure the progression of dysarthria in a case of FTD-MND with acoustic analysis. Four individuals with FTD (one developing concomitant MND) were longitudinally assessed over two years. Two acoustic measures demonstrated capacity to objectively monitor dysarthria in FTD-MND. These preliminary data highlight potential for the clinical use of these methods to identify the initial signs of bulbar onset motor neuron disease. Index terms: acoustics, disease monitoring, dysarthria, frontotemporal dementia, motor neuron disease.
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ItemVideo game-based speech rehabilitation for reducing dysarthria severity in adults with degenerative ataxia(Wiley, 2016)Background and aims: Dysarthria affects all individuals with degenerative ataxia. No treatments halt or reverse the effects of disease progression. There is no evidence supporting the use of speech therapy to reduce dysarthria severity. We aimed to evaluate the utility and efficacy of intensive, home-based exergame rehabilitation for improving speech intelligibility in adults with Friedreich ataxia. Methods: A single blinded delayed entry cross-over trial control design was used. 6 individuals with FRDA were recruited. Participants were provided with a Sony PlayStation 4, and a karaoke based game, ’Singstar’. The video game based interface required participants to sing 30 minutes per day, 5 days a week for 4 weeks. The treatment employed principles of motor learning and biofeedback. Participants were also coached on maximising articulatory precision during activities. Assessments included SARA, acoustic and perceptual speech assessments, dysarthria impact profile and a patient experience survey. Results: One participant withdrew from the study because they did not enjoy the singing game format. Several subsections of the standardised oral motor examination ’Frenchay Dysarthria Assessment – 2’ showed improvements, including respiration and breath support for speech, palate and intelligibility (as measured on a 9-point scale). The participants who completed the study found the process enjoyable and a better experience than traditional speech therapies. Conclusion: The primary goal of improving intelligibility was partially supported in this study. However, the effect size for this outcome measure was modest. This is the first study to use commercially available exergame technology to deliver therapy for dysarthria. Data show promise and warrant further investigation.
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ItemNo Preview AvailableQuantification of motor speech in primary progressive aphasia and frontotemporal dementia(WILEY-BLACKWELL, 2016-08-01)Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) are two groups of related disorders which are classified into the behavioural (bvFTD), semantic (svPPA), nonfluent/agrammatic (nfvPPA) and logopaenic (lvPPA) variants. Each variant presents with characteristic impairments of communication or behaviour, and the defining features of the syndromes are under ongoing debate in the literature. Researchers and clinicians usually assess speech with listener-based rating scales, which pose a challenge for identifying subtle changes to speech. Objective measures of speech may therefore improve characterisation of speech impairments in the literature and assist in clinical diagnosis and management. In this study, speech samples were taken from 43 people with PPA or FTD (8 svPPA, 4 nfvPPA, 9 lvPPA, 22 bvFTD) and 24 healthy controls. Speech was analysed perceptually using a 5-point rating scale across all speech subsystems. Speech was objectively quantified with measures of lexical stress (the pairwise variability index, PVI), vowel production, timing, voice quality and diadochokinetic (DDK) speech rate. The ability of speech measures to predict regions of neurodegeneration was assessed by comparison of speech to calculations of cortical thickness and subcortical volume derived from participants’ clinical magnetic resonance imaging (MRI) scans. Longitudinal speech investigations were conducted for a subgroup of participants to investigate the capacity of the measures to track disease progression. Group comparisons indicated that several speech measures differentiate pathological groups from controls, including measures of speech timing, DDK rate, and PVI. PVI and DDK also differentiated the nfvPPA group from other subtypes. Case studies of longitudinal data highlight measures which reflect motor speech changes in a case of bvFTD progressing to motor neurone disease (MND), and in two cases of nfvPPA. Findings add to the documentation of speech production in PPA and FTD by establishing acoustic correlates which differ from the healthy population. Longitudinal case studies demonstrate the potential for these measures to be used clinically to improve monitoring of disease progression.
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ItemNo Preview AvailableObjective speech marker correlates with clinical scores in non-dysarthric MS(SAGE PUBLICATIONS LTD, 2017-10-01)Background: Reduction of brain volume occurs in clinically active disease and correlates with progressive disability in multiple Sclerosis (MS). Although dysarthria is highly prevalent in MS, it only becomes clinically relevant in advanced stages of the disease. The relationship between early sub-clinical markers of dysarthria and overall disease severity is poorly understood. Aim: To examine the relationship between an objective marker of speech performance and validated clinical scores for disease severity in non-dysarthric subjects with relapsing-remitting and secondary progressive MS. Method: An experienced neurologist scored patients according to the Expanded Disability Status Scale (EDSS) and the Scale for the Assessment and Rating of Ataxia (SARA). Acoustic analysis was used to investigate the diadochokinetic speed in “as fast as possible” repetition of the meaningless word /pa/ta/ka/. Brain images were acquired using 3 Tesla magnetic resonance. Images were automatically segmented using FreeSurfer (5.7) to determine volumes for whole brain (excluding ventricules) and cerebellum. Lesions were automatically segmented by the lesion prediction algorithm as implemented in the Lesion Segmentation Tool version 2.0.15 for SPM (Statistical Parametric Mapping software). Statistical correlations were processed in SPSS (v 23.0) controlling for age. After adjustment for multiple comparisons, a p< 0.01 was considered for statistical significance. Results: We assessed 35 MS patients with normal speech (i.e. SARA speech sub-score 0-1; age=47.7±12years; disease duration=13.2±8.4). Diadochokinetic rate (mean=5.63±0.83 syllables per second) directly correlated with EDSS (Spearman's rho=0.454, 2-tailed p=0.007; median EDSS=3.5, interquartile range=3.5) and SARA (rho=0.515, p=0.002; SARA median=9, interquartile range 11.975), but not with whole brain volume (p=0.022), lesion load (p=0.032) or cerebellar volume (p=0.037). Conclusion: Changes in acoustic markers can be detected before overt dysarthria in MS and reflect overall disease severity. Larger and longitudinal studies are needed to understand if those markers can help monitoring disease progression.
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ItemNo Preview AvailablePathophysiology of MS tremor: an fMRI study(SAGE PUBLICATIONS LTD, 2017-10)
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ItemNo Preview AvailableSubclinical speech signs correlate with MS disease severity and differentiates patients with and without clinical cerebellar dysfunction(SAGE PUBLICATIONS LTD, 2017-10-01)Background: Dysarthria is highly prevalent in Multiple Sclerosis (MS). The relationship between dysarthria, MS disease severity and other cerebellar manifestations (such as tremor) is poorly understood. Aim: To examine the relationship between objective markers of speech, disease severity and upper limb tremor in relapsing-remitting and secondary progressive MS. Method: An experienced neurologist determined A) the presence of upper limb tremor, B) the Expanded Disability Status Scale (EDSS) score and C) the degree of dysarthria (from 0, no disturbance to 4, unintelligible). We used acoustic analysis to investigate 4 speech domains: 1) stability of vocal pitch, in sustained utterance of the vowel /a/; 2) stability of loudness, in the same sustained vowel; 3) diadochokinetic speed, in fast repetition of the meaningless word /pa/ta/ka/ and 4) maximum speed of vocal tract movement (i.e. change in pharynx and mouth cavity shape), measured through change in the second formant frequency in the word “always”, from reading of the “Grandfather Passage”. After adjustment for multiple comparisons, a p< 0.0125 was considered for statistical significance. Results: We assessed 24 MS patients with upper limb tremor (47.2±12.3years, 75% female, EDSS=3.7±1.6) and 24 matched patients without tremor (51.2±10.7years, 75% female, EDSS=3.6±1.7). Clinical dysarthria (median=0, mean=0.375±0.76) moderately correlated with EDSS scores (Spearman's rho =.586, p< .001) and with syllable repetition rates (/pa/ta/ka/ rho=.561, p< .001), marginally correlated with speed of tract movement (rho=.363, p=.012), pitch stability (rho=.37, p=.011), loudness stability (rho=.37, p=.01) but not with upper limb tremor presence (p=.039). Only /pa/ta/ka/ rate correlated with EDSS (rho=.529, p< .001) and speed of tract movement differentiated tremor and non-tremor groups (2-tailed t-test p=0.002, rho=.418). Conclusion: Acoustic speech measurements correlate with MS disease severity and can differentiate overt cerebellar dysfunction. Further study is needed to understand the significance of this relationship longitudinally.