Speech Deterioration in Amyotrophic Lateral Sclerosis

Few detailed reports have been published on the nature of speech and voice changes during the course of amyotrophic lateral sclerosis (ALS). The subject of this case study is a woman who was diagnosed as having ALS with bulbar signs at the age of 53. Speech intelligibility, pulmonary function, and selected speech and voice functions were tested during an approximately 2-year course of her disease. Over this period, her speech intelligibility, as measured by a multiplechoice word identification test, declined from 98% to 48%. Phonetic features that were most affected during the intelligibility decline included voicing contrast for syllable-initial and syllablefinal consonants, place of articulation contrasts for lingual consonants, manner of articulation for lingual consonants, stop versus nasal manner of production, features related to the liquid consonants, and various features related to syllable shape. An acoustic measure, average slope of the second-formant frequency, declined in association with the intelligibility reduction and is thought to reflect the loss of lingual motoneurons. Her pulmonary function also declined over the observation interval, with particularly severe reduction in measures of air flow. Oral diadochokinesis and measures of vocal function (including jitter, shimmer, and signal-to-noise ratio) were highly variable across test sessions. These results are discussed in terms of the challenges they present to sensitive assessment of change and to management of the communication disability in ALS.

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Quantitative Description of the Dysarthria in Women With Amyotrophic Lateral Sclerosis

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3504.723 ◽

1992 ◽

Vol 35 (4) ◽

pp. 723-733 ◽

Cited By ~ 60

Author(s):

Jane Finley Kent ◽

Raymond D. Kent ◽

John C. Rosenbek ◽

Gary Weismer ◽

Ruth Martin ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Speech Intelligibility ◽

Word Identification ◽

Signal To Noise Ratio ◽

Quantitative Description ◽

Initial Position ◽

Control Group ◽

Acoustic Measures ◽

Phonetic Features ◽

Lateral Sclerosis

Speech intelligibility and its phonetic and acoustic correlates were studied in a group of 10 women with amyotrophic lateral sclerosis (ALS). Intelligibility assessment with a word-identification test indicated that the most disrupted phonetic features pertained to velopharyngeal valving, lingual function for consonant contrasts of place and manner, and syllable shape. An acoustic signature analysis based on trajectories of the first and second formants in selected monosyllabic test words revealed that the mean slope of the second formant (F 2 ) was reduced compared with that of a normal geriatric control group. This F 2 slope reduction is interpreted to reflect loss of lingual motoneurons. Acoustic measures of phonatory function for sustained vowel prolongation demonstrated abnormalities in fundamental frequency, perturbations of frequency (jitter) and amplitude (shimmer), and signal-to-noise ratio. The data for women with ALS are compared with data for a normal geriatric control group of women and with data for a group of 25 men with ALS (Kent et al., 1990). Although the overall ranking of errors was similar for males and females with ALS, men were more likely to have impairments of voicing in syllable-initial position.

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Impairment of Speech Intelligibility in Men with Amyotrophic Lateral Sclerosis

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.5504.721 ◽

1990 ◽

Vol 55 (4) ◽

pp. 721-728 ◽

Cited By ~ 54

Author(s):

Raymond D. Kent ◽

Jane F. Kent ◽

Gary Weismer ◽

Robert L. Sufit ◽

John C. Rosenbek ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Speech Intelligibility ◽

Percent Correct ◽

Error Proportion ◽

Male Patients ◽

Phonetic Features ◽

Muscle Impairment ◽

Intelligibility Score ◽

Manner Of Articulation ◽

Lateral Sclerosis

Speech intelligibility was studied in a group of 25 male patients with amyotrophic lateral sclerosis (ALS). The object of the study was to determine the phonetic impairments underlying the speech intelligibility deficits that frequently accompany ALS. Analyses with a word intelligibility test indicated that the most disrupted phonetic features involved phonatory (voicing contrast) function, velopharyngeal valving, place and manner of articulation for lingual consonants, and regulation of tongue height for vowels. The mean error proportion for the five most severely affected features correlated highly (0.97) with the intelligibility score (percent correct). The phonetic feature analyses are one index of bulbar muscle impairment in amyotrophic lateral sclerosis and also may help to direct the speech management in these individuals.

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Speech Deterioration of Amyotrophic Lateral Sclerosis Before and After Diagnosis: A Case Study of a Newscaster

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig19-2019-0005 ◽

2019 ◽

Vol 4 (5) ◽

pp. 1189-1198

Author(s):

Emily Watkins ◽

Austin Thompson ◽

Yunjung Kim

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Speech Disorders ◽

Formant Frequency ◽

Motor Speech ◽

Motor Speech Disorders ◽

Vowel Space ◽

Before And After ◽

Second Formant ◽

Lateral Sclerosis

Purpose This case study traced speech deterioration in an individual before and after the time of diagnosis of amyotrophic lateral sclerosis (ALS). Our participant was diagnosed with spinal-onset, familial ALS in 2017. The speaker's occupation, a professional newscaster for 37 years, allowed a retrospective examination of her speech during news segments over 37 months around the diagnosis, including prediagnosis. Method A total of 6 time points were selected to track auditory-perceptual and acoustic speech deterioration (2 years, 14 months, and 7 months prior to diagnosis; the month of diagnosis; and 7 months and 12 months after diagnosis). For perceptual ratings, 2 experts in motor speech disorders rated 17 speech dimensions on a 7-point scale. Four acoustic parameters were chosen for measurement: articulation rate, utterance duration, second formant frequency slope, and acoustic vowel space. Additionally, kinematic data were obtained from 1 time-point (8 months postdiagnosis) and descriptively compared to the movement of other individuals with ALS and to healthy speakers. Results As expected, both perceptual and acoustic results indicated a decline in the selected speech measures as the disease progressed. More interestingly, the measures showed a consistent curvilinear appearance in which the speech parameters exhibit an improvement until immediately before and around the diagnosis, followed by sudden, drastic deterioration. Kinematic results indicated a greater degree of movement and speed compared to healthy speakers, probably due to the speaker's occupation. Conclusions Based on the findings, the time around diagnosis is considered a critical period with respect to speech deterioration in ALS wherein a dynamic, increasing–decreasing pattern of changes occur. This finding appears to reflect the patient's compensatory strategies and the speech deficits associated with bulbar involvement.

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Speech intelligibility loss due to amyotrophic lateral sclerosis: the effect of tongue movement reduction on vowel and consonant acoustic features

Clinical Linguistics & Phonetics ◽

10.1080/02699206.2020.1868021 ◽

2021 ◽

pp. 1-22

Author(s):

Panying Rong ◽

Evan Usler ◽

Linda M. Rowe ◽

Kristen Allison ◽

Jonghye Woo ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Speech Intelligibility ◽

Acoustic Features ◽

Tongue Movement ◽

Lateral Sclerosis

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A Phonetic Complexity-Based Approach for Intelligibility and Articulatory Precision Testing: A Preliminary Study on Talkers With Amyotrophic Lateral Sclerosis

Journal of Speech Language and Hearing Research ◽

10.1044/2018_jslhr-s-17-0462 ◽

2018 ◽

Vol 61 (9) ◽

pp. 2205-2214 ◽

Cited By ~ 2

Author(s):

Mili Kuruvilla-Dugdale ◽

Claire Custer ◽

Lindsey Heidrick ◽

Richard Barohn ◽

Raghav Govindarajan

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Speech Intelligibility ◽

Speech Impairments ◽

Word Level ◽

Preliminary Study ◽

Perceived Impact ◽

Complex Words ◽

Level Analysis ◽

Precision Testing ◽

Lateral Sclerosis

Purpose This study describes a phonetic complexity-based approach for speech intelligibility and articulatory precision testing using preliminary data from talkers with amyotrophic lateral sclerosis. Method Eight talkers with amyotrophic lateral sclerosis and 8 healthy controls produced a list of 16 low and high complexity words. Sixty-four listeners judged the samples for intelligibility, and 2 trained listeners completed phoneme-level analysis to determine articulatory precision. To estimate percent intelligibility, listeners orthographically transcribed each word, and the transcriptions were scored as being either accurate or inaccurate. Percent articulatory precision was calculated based on the experienced listeners' judgments of phoneme distortions, deletions, additions, and/or substitutions for each word. Articulation errors were weighted based on the perceived impact on intelligibility to determine word-level precision. Results Between-groups differences in word intelligibility and articulatory precision were significant at lower levels of phonetic complexity as dysarthria severity increased. Specifically, more severely impaired talkers showed significant reductions in word intelligibility and precision at both complexity levels, whereas those with milder speech impairments displayed intelligibility reductions only for more complex words. Articulatory precision was less sensitive to mild dysarthria compared to speech intelligibility for the proposed complexity-based approach. Conclusions Considering phonetic complexity for dysarthria tests could result in more sensitive assessments for detecting and monitoring dysarthria progression.

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Monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of pulmonary function evaluation in amyotrophic lateral sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2013000300004 ◽

2013 ◽

Vol 71 (3) ◽

pp. 146-152 ◽

Cited By ~ 6

Author(s):

Guilherme Fregonezi ◽

Palomma Russelly Saldanha Araújo ◽

Tathiana Lindemberg Ferreira Macêdo ◽

Mario Emilio Dourado Junior ◽

Vanessa Regiane Resqueti ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Muscle Strength ◽

Early Diagnosis ◽

Pulmonary Function ◽

Healthy Subjects ◽

Respiratory Muscle ◽

Function Evaluation ◽

Respiratory Muscle Strength ◽

Respiratory Dysfunction ◽

Lateral Sclerosis

ObjectiveIt was study the relationship between respiratory muscle strength and forced vital capacity (FVC) in patients with amyotrophic lateral sclerosis (ALS) versus healthy subjects.MethodsPulmonary function and respiratory muscle strength [maximal inspiratory (PImax), maximal expiratory (PEmax) and sniff nasal inspiratory pressure (SNIP)] were assessed in patients with ALS and healthy subjects, matched using cutoffs established in the literature for impaired pulmonary function and respiratory muscle weakness.ResultsTwenty-eight ALS patients and 28 healthy subjects were studied. We found sensitivity and specificity for PImax, PEmax and SNIP of 75/58%, 81/67% and 75/67%. The Receiver Operating Characteristic curve (ROC curve) indicated that the variables PImax, PEmax and SNIP can identify differences in respiratory muscle strength between ALS and healthy individuals at 0.89, 0.9 and 0.82, respectively. A positive correlation was recorded between FVC (%) versus SNIP, PImax and PEmax.ConclusionIn ALS, monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of FVC.

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Pulmonary function in patients with Amyotrophic Lateral Sclerosis at disease onset

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2012.146 ◽

2015 ◽

Vol 77 (3-4) ◽

Author(s):

B. Chandrasoma ◽

D. Balfe ◽

T. Naik ◽

A. Elsayegh ◽

M. Lewis ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Pulmonary Function ◽

Muscle Weakness ◽

Motor Neurons ◽

Neurodegenerative Disorder ◽

Pulmonary Function Tests ◽

Disease Onset ◽

Group Versus ◽

Combination Methods ◽

Lateral Sclerosis

Background. Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Deteriorating pulmonary function as a reflection of progressive respiratory muscle weakness is a common feature, accounting for the majority of deaths. The aim of the study was to describe a trend in initial pulmonary function tests (PFT) of Amyotrophic Lateral Sclerosis (ALS) patients, in addition, differentiating between the types of disease onset, bulbar, limb muscle, and a combination. Methods. Initial PFT were gathered from 32 consecutive patients in our clinic with the diagnosis of ALS, they were categorized by the type of disease onset. Values obtained were referenced to the 95% confidence limits for normality. Results. There was evidence of significant reductions in both the FEV1 (64.7% predicted) and FVC (61.2%), with preservation of the FEV1/FVC (81.7%). The MVV was significantly reduced(43%). Total lung capacity was 93.2%, the residual volumes was increased at 145.7%. Subgroup analysis failed to show significant differences between types of disease onset. In the bulbar onset group (versus the limb group) there was a trend for the MVV to be further reduced (p=0.15) and the RV to be higher (157.4% versus 135.9%, P=0.24). Conclusions. ALS is a devastating disease that invariably leads to respiratory failure. Abnormal spirometric variables such as the FVC and MVV, likely reflect inspiratory muscle weakness and increased RV likely reflect expiratory muscle weakness. The type of disease onset did not result in a different pattern of PFT abnormalities.

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