Changes Over Time in Dysarthric Patients with Amyotrophic Lateral Sclerosis(ALS). II. A Study of Changes in Speaking Rate and Maximum Repetition Rate(MRR).

Purpose The purpose of this article was to validate a novel acoustic analysis of oral diadochokinesis (DDK) in assessing bulbar motor involvement in amyotrophic lateral sclerosis (ALS). Method An automated acoustic DDK analysis was developed, which filtered out the voice features and extracted the envelope of the acoustic waveform reflecting the temporal pattern of syllable repetitions during an oral DDK task (i.e., repetitions of /tɑ/ at the maximum rate on 1 breath). Cycle-to-cycle temporal variability (cTV) of envelope fluctuations and syllable repetition rate (sylRate) were derived from the envelope and validated against 2 kinematic measures, which are tongue movement jitter (movJitter) and alternating tongue movement rate (AMR) during the DDK task, in 16 individuals with bulbar ALS and 18 healthy controls. After the validation, cTV, sylRate, movJitter, and AMR, along with an established clinical speech measure, that is, speaking rate (SR), were compared in their ability to (a) differentiate individuals with ALS from healthy controls and (b) detect early-stage bulbar declines in ALS. Results cTV and sylRate were significantly correlated with movJitter and AMR, respectively, across individuals with ALS and healthy controls, confirming the validity of the acoustic DDK analysis in extracting the temporal DDK pattern. Among all the acoustic and kinematic DDK measures, cTV showed the highest diagnostic accuracy (i.e., 0.87) with 80% sensitivity and 94% specificity in differentiating individuals with ALS from healthy controls, which outperformed the SR measure. Moreover, cTV showed a large increase during the early disease stage, which preceded the decline of SR. Conclusions This study provided preliminary validation of a novel automated acoustic DDK analysis in extracting a useful measure, namely, cTV, for early detection of bulbar ALS. This analysis overcame a major barrier in the existing acoustic DDK analysis, which is continuous voicing between syllables that interferes with syllable structures. This approach has potential clinical applications as a novel bulbar assessment.

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Frontal Anatomical Correlates of Cognitive and Speech Motor Deficits in Amyotrophic Lateral Sclerosis

Behavioural Neurology ◽

10.1155/2019/9518309 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Yana Yunusova ◽

Jamal Ansari ◽

Joel Ramirez ◽

Sanjana Shellikeri ◽

Greg J. Stanisz ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Frontal Lobe ◽

Speech Rate ◽

Neuropsychological Testing ◽

Partial Least Square ◽

Least Square ◽

Speaking Rate ◽

Motor Deficits ◽

Brain Changes ◽

Lateral Sclerosis

The goal of this study was to identify neurostructural frontal lobe correlates of cognitive and speaking rate changes in amyotrophic lateral sclerosis (ALS). 17 patients diagnosed with ALS and 12 matched controls underwent clinical, bulbar, and neuropsychological assessment and structural neuroimaging. Neuropsychological testing was performed via a novel computerized frontal battery (ALS-CFB), based on a validated theoretical model of frontal lobe functions, and focused on testing energization, executive function, emotion processing, theory of mind, and behavioral inhibition via antisaccades. The measure of speaking rate represented bulbar motor changes. Neuroanatomical assessment was performed using volumetric analyses focused on frontal lobe regions, postcentral gyrus, and occipital lobes as controls. Partial least square regressions (PLS) were used to predict behavioral (cognitive and speech rate) outcomes using volumetric measures. The data supported the overall hypothesis that distinct behavioral changes in cognition and speaking rate in ALS were related to specific regional neurostructural brain changes. These changes did not support a notion of a general dysexecutive syndrome in ALS. The observed specificity of behavior-brain changes can begin to provide a framework for subtyping of ALS. The data also support a more integrative framework for clinical assessment of frontal lobe functioning in ALS, which requires both behavioral testing and neuroimaging.

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Patterns of Non-Invasive Ventilation in Amyotrophic Lateral Sclerosis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.25 ◽

2018 ◽

Vol 45 (4) ◽

pp. 445-450

Author(s):

Nevena Markovic ◽

Marcus Povitz ◽

Joanne Smith ◽

David Leasa ◽

Christen Shoesmith ◽

...

Keyword(s):

Decision Making ◽

Amyotrophic Lateral Sclerosis ◽

End Of Life ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

End Of Life Decision ◽

Life Decision ◽

Lateral Sclerosis ◽

Over Time

AbstractBackground: Non-invasive ventilation (NIV) improves quality of life and survival in patients with amyotrophic lateral sclerosis (ALS) and respiratory symptoms. Little is known about the patterns of NIV use over time and the impact of NIV on end-of-life decision-making in ALS. Objective: This study assessed the pattern of NIV use over the course of the disease and the timing of end-of-life discussions in people living with ALS. Method: A retrospective single-center cohort study was performed at London Health Sciences Centre. Daily NIV duration of use was evaluated at 3-month intervals. The timing of diagnosis, NIV initiation, discussions relating to do-not-attempt-resuscitation (DNAR) and death were examined. Results: In total, 48 patients were included in the analysis. Duration of NIV use increased over time, and tolerance to NIV was observed to be better than expected in patients with bulbar-onset ALS. There was a high degree of variability in the timing of end-of-life discussions in patients with ALS (356±451 days from diagnosis). In this cohort, there was a strong association between the timing of discussions regarding code status and establishment of a DNAR order (r2=0.93). Conclusion: This retrospective cohort study suggests that the use of NIV in ALS increases over time and that there remains a great deal of variability in the timing of end-of-life discussions in people living with ALS. Future prospective studies exploring the use NIV over the disease trajectory and how NIV affects end-of-life decision-making in people with ALS are needed.

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Vocal Fold Diadochokinetic Function of Individuals With Amyotrophic Lateral Sclerosis

American Journal of Speech-Language Pathology ◽

10.1044/1058-0360.0401.73 ◽

1995 ◽

Vol 4 (1) ◽

pp. 73-80 ◽

Cited By ~ 5

Author(s):

Karen A. Renout ◽

Herbert A. Leeper ◽

Donna L. Bandur ◽

Arthur J. Hudson

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Vocal Fold ◽

Group Discussion ◽

Vocal Folds ◽

Laryngeal Function ◽

Analysis System ◽

Reduced Rate ◽

Opening And Closing ◽

Lateral Sclerosis ◽

Over Time

This study relates over time the changes in voluntary opening and closing of the vocal folds (vocal fold diadochokinesis, or VFDDK) of patients with amyotrophic lateral sclerosis (ALS). The rate, pattern, and periodicity of VFDDK were examined for 12 ALS subjects with bulbar and 14 subjects with nonbulbar signs of the disease. The acoustical data were analyzed with a commercially available computer-based speech analysis system. ALS patients with bulbar and nonbulbar symptoms demonstrate reduced rate and aperiodic VFDDK as the symptomatology of the neuromotor system progresses. Individuals with bulbar signs show a greater change in vocal fold activity than do the nonbulbar group. Discussion of the clinical implications for initial diagnosis and monitoring of changes over time in motor control of laryngeal function is presented.

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Correlations in health status between estimates of families of people with amyotrophic lateral sclerosis and estimates of staff

Palliative & Supportive Care ◽

10.1017/s1478951512000089 ◽

2012 ◽

Vol 11 (3) ◽

pp. 183-189 ◽

Cited By ~ 1

Author(s):

Anneli G. Ozanne ◽

Lennart I. Persson

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Analogue Scale ◽

Rating Scale ◽

Well Being ◽

Life Situation ◽

Next Of Kin ◽

Holistic View ◽

The Family ◽

Lateral Sclerosis ◽

Over Time

AbstractObjective:The aim of this study was to compare self-estimates of the physical, psychological, and general well-being of patients with amyotrophic lateral sclerosis (ALS) and their next of kin with the assessment of the nurses and physician of these participants.Method:The well-being of 35 pairs of patients and their next of kin was rated by themselves, and by a physician and nurses. The well-being was examined over time, using a visual analogue scale (VAS). Patients' physical function was estimated at the same time with the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised and the Norris scale.Results:The correlations between the staff's estimates of the well-being of patients and next of kin were similar to their own estimates, even though staff to a higher degree estimated a decrease in well-being over time among the patients. The estimates by the nurses correlated better to that of the patients and next of kin in psychological and general well-being than the physicians' estimates did.Significance of results:Even though the staff's estimates of participants were roughly equivalent to their self-estimates, there were some differences. This result calls attention to the importance of working in teams in which different professional roles are combined and integrated, making it possible to form a holistic view of the situation of each family. A concern overlooked by one member of staff might be covered by another, and different focuses on the family may give a better composite picture of their life situation, which could lead to better support to the family.

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Articulatory-to-Acoustic Relations in Talkers With Dysarthria: A First Analysis

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-s-14-0188 ◽

2015 ◽

Vol 58 (3) ◽

pp. 576-589 ◽

Cited By ~ 20

Author(s):

Antje Mefferd

Keyword(s):

Parkinson’S Disease ◽

Amyotrophic Lateral Sclerosis ◽

Correlation Coefficients ◽

Speaking Rate ◽

Differential Effects ◽

Vowel Contrast ◽

Induced Changes ◽

Tongue Displacement ◽

Lateral Sclerosis ◽

Fast Rates

Purpose The primary purpose of this study was to determine the strength of interspeaker and intraspeaker articulatory-to-acoustic relations of vowel contrast produced by talkers with dysarthria and controls. Methods Six talkers with amyotrophic lateral sclerosis (ALS), six talkers with Parkinson's disease (PD), and 12 controls repeated a sentence at typical, slow, and fast rates. Tongue displacements and acoustic vowel distances were measured to determine articulatory and acoustic vowel contrasts. Results Interspeaker articulatory-to-acoustic relations were strong for talkers with PD and controls but weak for talkers with ALS and controls. Further, predominantly moderate and strong intraspeaker articulatory-to-acoustic relations were found in response to rate modulations; however, correlation coefficients were significantly lower in talkers with ALS than in controls. Conclusions The findings on interspeaker articulatory-to-acoustic relations suggested that the degree of tongue displacement can be accurately inferred from the degree of acoustic vowel contrast in talkers with PD but not in talkers with ALS. Findings on intraspeaker articulatory-to-acoustic relations generally supported the longstanding notion that speaking rate–induced changes in tongue displacement evoke similar changes in acoustic vowel contrast. Differential effects of the pathophysiology on inter- and intraspeaker articulatory-to-acoustic relations are discussed.

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

American Journal of Speech-Language Pathology ◽

10.1044/2018_ajslp-17-0064 ◽

2018 ◽

Vol 27 (3) ◽

pp. 996-1009 ◽

Cited By ~ 8

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.

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