scholarly journals Neuromotor Speech Recovery Across Different Behavioral Speech Modifications in Individuals Following Facial Transplantation

2021 ◽  
Vol 11 ◽  
Author(s):  
Marziye Eshghi ◽  
Bridget J. Perry ◽  
Brian Richburg ◽  
Hayden M. Ventresca ◽  
Bohdan Pomahac ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Motor System ◽  
Normal Range ◽  
Range Of Movement ◽  
Lower Lip ◽  
Face Transplantation ◽  
Facial Transplantation ◽  
Slow Speech ◽  
Speech Clarity ◽  
Late Stages

Despite signs of facial nerve recovery within a few months following face transplantation, speech deficits persist for years. Behavioral speech modifications (e.g., slower-than-normal speaking rate and increased loudness) have shown promising potential to enhance speech intelligibility in populations with dysarthric speech. However, such evidence-based practice approach is lacking in clinical management of speech in individuals with facial transplantation. Because facial transplantation involves complex craniofacial reconstruction and facial nerve coaptation, it is unknown to what extent individuals with face transplant are capable of adapting their motor system to task-specific articulatory demands. The purpose of this study was to identify the underlying articulatory mechanisms employed by individuals with face transplantation in response to speech modification cues at early and late stages of neuromotor recovery. In addition, we aimed to identify speech modifications that conferred improved speech clarity. Participants were seven individuals who underwent full or partial facial vascularized composite allografts that included lips and muscles of facial animation and were in early (~2 months) or late (~42 months) stages of recovery. Participants produced repetitions of the sentence “Buy Bobby a puppy” in normal, fast, loud, and slow speech modifications. Articulatory movement traces were recorded using a 3D optical motion capture system. Kinematic measures of average speed (mm/s) and range of movement (mm3) were extracted from the lower lip (± jaw) marker. Two speech language pathologists rated speech clarity for each speaker using a visual analog scale (VAS) approach. Results demonstrated that facial motor capacity increased from early to late stages of recovery. While individuals in the early group exhibited restricted capabilities to adjust their motor system based on the articulatory demands of each speech modification, individuals in the late group demonstrated faster speed and larger-than-normal range of movement for loud speech, and slower speed and larger-than-normal range of movement for slow speech. In addition, subjects in both groups showed overreliance on jaw rather than lip articulatory function across all speech modifications, perhaps as a compensatory strategy to optimize articulatory stability and maximize speech function. Finally, improved speech clarity was associated with loud speech in both stages of recovery.

Articulatory Range of Movement in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis

2018 ◽  
Vol 27 (3) ◽  
pp. 996-1009 ◽  
Author(s):  
Jimin Lee ◽  
Michael Bell
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Convex Hull ◽  
Speaking Rate ◽  
Range Of Movement ◽  
Lower Lip ◽  
Working Space ◽  
Electromagnetic Articulography ◽  
Differential Involvement ◽  
Lateral Sclerosis ◽  
Anterior Posterior

Purpose The current study examined overall articulatory range of movement (ROM) in individuals with amyotrophic lateral sclerosis (ALS). Differential involvement of articulators was also tested using articulatory working space in individuals with varying degrees of dysarthria severity and in typically aging individuals. A strong association between overall articulatory ROM and severity measures among individuals with ALS was hypothesized. In addition, it was hypothesized that differential involvement of articulators would be detected using overall articulatory ROM measures. Method Twenty-two speakers with dysarthria secondary to ALS and 22 typically aging speakers participated. Speech intelligibility and speaking rate were used as indices of severity. Movement range and overall articulatory working space area (convex hull) of the tongue, lower lip, and jaw were each measured by electromagnetic articulography while the speakers produced the Rainbow Passage. Results Tongue convex hull size was significantly correlated with both indices of severity. A significant interaction between articulators and groups was observed. Individuals with severe dysarthria had reduced tongue convex hull size and exaggerated lower lip convex hull size. ROM in the anterior–posterior dimension showed a more notable differential involvement pattern than ROM in the superior–inferior dimension. Results in the area under a receiver operating characteristic curve analysis revealed group-specific ROM sensitivity. Conclusions The findings indicate that tongue ROM is reduced in individuals with more severe dysarthria when estimated using a standardized paragraph containing all American English phonemes. The articulatory working space measure could be useful for estimating speech dysfunction in ALS. ROM of the tongue decreases, but ROM of the lower lip and jaw each increase in individuals with severe dysarthria. Differential involvement of the articulators in the anterior–posterior dimension needs to be further investigated.

scholarly journals Dual mobility THR: Resolving instability and providing near normal range of movement

2020 ◽  
Author(s):  
Sanjay Agarwala ◽  
Vivek Shetty ◽  
Shounak Taywade ◽  
Mayank Vijayvargiya ◽  
Mahmoud Bhingraj
Keyword(s):  
Normal Range ◽  
Range Of Movement ◽  
Dual Mobility

Lower lip-lifting brace for bilateral facial nerve palsy: A case report

2001 ◽  
Vol 82 (12) ◽  
pp. 1737-1739 ◽  
Author(s):  
Suguru Ohsawa ◽  
Sakae Yamamoto ◽  
Akimitsu Kanda
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Lower Lip

Surgical Treatment of the “Marginal Mandibular Lip” Deformity

1987 ◽  
Vol 97 (5) ◽  
pp. 462-468 ◽  
Author(s):  
Michael G. Glenn ◽  
Richard L. Goode
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Neck Surgery ◽  
Partial Resection ◽  
Surgical Correction ◽  
Simple Method ◽  
Lower Lip ◽  
Marginal Mandibular Branch ◽  
Methods Of Treatment ◽  
Mandibular Branch

Unilateral permanent paralysis of the lower lip after section or compression of the marginal mandibular branch of the facial nerve is not rare. It may occur after trauma or as a result of parotid, ear, or upper neck surgery. Surgical treatment of the deformity—which we term the marginal mandibular lip—is indicated to improve cosmesis and restore oral competence during eating and speech. We describe our experience with partial resection of the paralyzed lower lip as an effective yet simple method of surgical correction. We also review the alternate methods of treatment for comparison.

scholarly journals 3122 Longitudinal Recovery of Speech Motor Function Following Facial Transplantation

2019 ◽  
Vol 3 (s1) ◽  
pp. 108-109
Author(s):  
Bridget Jane Perry ◽  
Kaila Stipancic ◽  
Brian Richburg ◽  
Jordan Green
Keyword(s):  
Range Of Motion ◽  
Recovery Period ◽  
Speaking Rate ◽  
Effect Sizes ◽  
Post Transplantation ◽  
Motor Speech ◽  
Lower Lip ◽  
Facial Transplantation ◽  
Post Surgery ◽  
Intelligibility Test

OBJECTIVES/SPECIFIC AIMS: Using a novel biomechanical-based motor speech assessment alongside commonly used clinically-based motor speech assessments, the goal of this study was to describe longitudinal recovery in speech movements and functional speech in a cohort of 5 patients following facial transplantation. METHODS/STUDY POPULATION: Five participants who had received either full or partial face transplantation were included in this study. Each participant received a unique facial graft from their donor, which included varied amounts of soft tissue, facial musculature, nerve, and bone. Two participants were early in the recovery period and were assessed from zero to 24 months post-transplantation. Three participants were late in the recovery period and were assessed from 36 to 60 months post-transplantation. Each participant completed two data collection sessions and the average time between sessions was 20.4 months. At each session, orofacial movements were recorded using a 3D motion capture system. A 4-sensor head marker was used to subtract head movement (translation and rotation) from the facial markers. The analyses in this study were restricted to two markers: midline lower lip and a virtually calculated midline jaw marker. A marker at the top of the nose bridge was used as the origin point. The following kinematic variables were obtained from each lip-jaw movement time-series: peak movement speed (mm/s), and displacement (mm). Each patient was instructed to perform 10 repetitions of the phrase “buy bobby a puppy” at his or her typical speaking rate and volume. Sentence-level intelligibility was obtained using the Sentence Intelligibility Test (SIT) and word-level intelligibility was obtained using the Word Intelligibility Test, using standard procedures. Intelligibility, measured in percentage of words correctly transcribed, and speaking rate, measured in words per minute (wpm), was derived from the SIT sentences for each patient. Intelligibility, measured in percentage of words correctly chosen via multiple choice was derived from the Word Intelligibility Test. RESULTS/ANTICIPATED RESULTS: Effect sizes (Cohen’s d) across the 10 trials of “buy bobby a puppy” were computed to assess the effects of recovery time on range of motion and speed of the lower lip alone, the jaw alone, and the lower lip and jaw together for both range of motion and for speed. The largest effect sizes were observed for increased range of motion and increased speed of the articulators for participants within 24 months of surgery. Smaller effect sizes were observed for these parameters for the participants in the later stages of recovery, with some participants showing declines in range of motion and speed of some but not all articulators. Descriptive statistics indicate that both speech and word intelligibility improvements are most notable in the first two years following transplantation and appear to plateau during the later stages of recovery. Only two out of five of our participants achieved “normal” speech intelligibility (i.e., >97%) at five years post-transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: Biomechanical assessment revealed that kinematic recovery of articulator range of motion and speed appears most significant in the first two years following surgery, but that improvement continues to some degree as far as five-years post-transplant. Clinically-based assessments suggest that gains in intelligibility appear to plateau by 3-years post-surgery.

scholarly journals Soft-tissue Cephalometric Norms of Kashmiri Population with Normal Occlusion and Well-balanced Faces

2020 ◽  
Vol 54 (4) ◽  
pp. 304-310
Author(s):  
Sneh Kalgotra ◽  
Mohammad Mushtaq ◽  
Abhishek Khajuria
Keyword(s):  
Soft Tissue ◽  
European American ◽  
Age Group ◽  
Upper Lip ◽  
Normal Range ◽  
Lateral Cephalogram ◽  
Lower Lip ◽  
Normal Occlusion ◽  
Angular Measurements ◽  
Kashmiri Population

Objective: To establish soft-tissue cephalometric norms of Kashmiri population and to compare them with European-American norms. Material and Methods: A total of 102 subjects falling in the age group of 19 to 25 years were selected from random and representative sample of 5317. Reference lines were traced according to the definitions given by Holdaway, Rickett, Steiners, Merrifield, and nasiolabial angle. Thirteen linear and 4 angular measurements were analyzed on the lateral cephalogram of the sample. Results: Significant differences were found between male and female subjects in measurements of the soft-tissue facial angle, upper lip thickness, upper lip strain, lower sulcus depth and soft-tissue chin thickness, and upper lip to S line and nasiolabial angle. Soft-tissue cephalometric norms of Kashmiri population that were measured in the present study when compared with the norms set by Holdaway’s parameters, Rickett’s E line, Merrifield Z angle, Steiner’s S line, and nasiolabial angle did not fall within the normal range. The facial angle was found to be greater by 1.36°, upper lip sulcus depth was greater by 0.53 mm, convexity at point A was greater by 2.43 mm, the H angle was greater by 5.64°, upper lip thickness and strain were greater by 2.30 and 2.36 mm, respectively, soft-tissue chin thickness was greater by 0.92 mm, upper lip to S line was greater by 0.60 mm, and lower lip was greater by 0.91 mm when compared with the standard European-American norms. Conclusion: According to the present study, the measured soft-tissue cephalometric norms for Kashmiri population differed from the standard norms. When planning orthodontics treatment, it should be kept in mind that the profile may not necessarily be orthognathic.

Patterns of Orofacial Movement Velocity Across Variations in Speech Rate

2000 ◽  
Vol 43 (1) ◽  
pp. 205-216 ◽  
Author(s):  
Michael D. McClean
Keyword(s):  
Motor Coordination ◽  
Speech Rate ◽  
Tangential Velocity ◽  
Clinical Aspects ◽  
Repeated Testing ◽  
Mean Velocity ◽  
Movement Velocity ◽  
Electromagnetic System ◽  
Lower Lip ◽  
Slow Speech

To understand the clinical aspects of speech rate control, a clearer picture is needed of how orofacial structures are coordinated across variations in speech rate. To address this problem, patterns of orofacial tangential velocity or speed were analyzed in a group of 9 normal speakers as they produced the utterance “a bad daba” at fast, normal, and slow speech rates. An electromagnetic system was used to record the movements of the upper lip, lower lip, jaw, and tongue. Measures of the magnitude of peak tangential velocities were obtained across the four structures. Orofacial velocities consistently decreased at slow rates relative to normal rates, whereas at fast rates increased and decreased velocities were observed in an equivalent number of cases. Significant correlations frequently were obtained across speech rate between lip, tongue, and jaw velocities. Upper and lower lip velocities showed consistent positive correlations with one another, whereas marked intersubject differences were observed in the sign of jaw-related correlations. Repeated testing on 3 subjects indicated a high degree of consistency within subjects in the overall patterns of mean velocity for the different structures. Results are discussed in relation to possible motor control differences underlying fast and slow speech, neural coupling of muscle systems, and jaw-related individual differences in speech motor coordination.

Relative contributions of eyelid and eye-retraction motor systems to reflex and classically conditioned blink responses in the rabbit

2004 ◽  
Vol 96 (4) ◽  
pp. 1541-1554 ◽  
Author(s):  
Rocío Leal-Campanario ◽  
José Alberto Barradas-Bribiescas ◽  
José M. Delgado-García ◽  
Agnès Gruart
Keyword(s):  
Facial Nerve ◽  
Motor System ◽  
Compensatory Mechanisms ◽  
Motor Systems ◽  
Nerve Section ◽  
Eyelid Closure ◽  
Conditioned Eyelid ◽  
Muscle Lesions ◽  
Central Reorganization ◽  
Classically Conditioned

Early compensatory mechanisms between eyelid and eye-retraction motor systems following selective nerve and/or muscle lesions were studied in behaving rabbits. Reflex and conditioned eyelid responses were recorded in 1) controls and following 2) facial nerve section, 3) retractor bulbi muscle removal, and 4) facial nerve section and retractor bulbi muscle removal. Animals were classically conditioned with a delay paradigm by using a tone (350 ms, 600 Hz, 90 dB) as conditioned stimulus, followed 250 ms later by an air puff (100 ms, 3 kg/cm2) as unconditioned stimulus. Conditioned eyelid responses generated in the absence of the facial motor system (i.e., by the almost sole action of the retractor bulbi motor system) presented a wavy profile, due to the succession of eye-retraction movements. Learned eyelid responses generated in the absence of the eye-retraction motor system (i.e., by the almost exclusive action of the facial motor system) were similar to those of controls, but were reduced in amplitude and peak velocity. Finally, the isolated action of the extraocular recti muscle produced very small eyelid movements during both reflex and learned eyelid responses. Although each of these motor systems could act independently of the others, the motor result of their joint action did not coincide with the simple addition of their separate actions. Both facial and eye-retraction motor systems appear to be necessary for normal eyelid closure during blinking in rabbits. Central reorganization to compensate for loss of either of these systems may explain why the response of each system in isolation cannot be added linearly to obtain normal blink response magnitudes and profiles.

scholarly journals Physiological effects of an 8-week mechanically aided resistance facial exercise program

2002 ◽  
Vol 28 (01) ◽  
pp. 49-73
Author(s):  
Pascal van Lieshout ◽  
◽  
Arpita Bose ◽  
Aravind Namasivayam
Keyword(s):  
Motor System ◽  
Exercise Program ◽  
Speech Disorders ◽  
Training Period ◽  
Emg Activity ◽  
Physiological Effects ◽  
Motor Speech ◽  
Lower Lip ◽  
Systematic Training ◽  
Variable Movement

This paper describes a study that for the first time addresses the physiological effects of an 8-week mechanically aided facial exercise program, using the Facial-Flex device (Facial Concepts, Inc., Blue Bell, PA) with four healthy individuals with no motor, speech, language, or hearing problems. For a variety of non-speech and speech tasks, upper and lower lip muscle activity (EMG) and upper and lower lip movements were recorded at two baseline sessions (separated by 1 week) and immediately after an 8-week training period. The results indicate that after the training period, all four subjects showed an increase in the number of task repetitions and the duration of isometric contraction using the Facial-Flex device with a fixed resistance (Linebaugh tests). However, with respect to physiological changes as related to the exercise program, the results were mixed. Only one subject showed the expected significant increase in normalized EMG activity. This response was mirrored in a significant overall increase in movement range and peak velocity after the 8-week training period. Regarding the other three subjects, one subject showed no systematic training effect at all, whereas the remaining two subjects showed a significant increase in movement duration. Non-speech and speech tasks were found to be clearly different in their overall physiological characteristics; speech related movements were found to be more clearly defined in terms of larger amplitudes, shorter durations, higher peak velocities, and less variable movement cycles. The apparent discrepancy between the results of the Linebaugh tests and the physiological measures on specific oromotor tasks warrants some caution in drawing conclusions on changes in the oro-motor system based on general performance measures. Further studies with well-defined clinical populations are needed to assess the usefulness of this device as an aid in the treatment of speech disorders based on motor system impairments.

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