On the notion of a "subtle phonetic deficit" in fluent/posterior aphasia

Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia

Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and-to a limited extent-syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric-the narrative syllable duration-yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.

Lexical stress contrast marking in fluent and non-fluent aphasia in Spanish: The relationship between acoustic cues and compensatory strategies

This study sought to investigate stress production in Spanish by patients with Broca's (BA) and conduction aphasia (CA) as compared to controls. Our objectives were to assess whether: a) there were many abnormal acoustic correlates of stress as produced by patients, b) these abnormalities had a phonetic component and c) ability for articulatory compensation for stress marking was preserved. The results showed abnormal acoustic values in both BA and CA's productions, affecting not only duration but also F0 and intensity cues, and an interaction effect of stress pattern and duration on intensity cubes in BA, but not in CA or controls. The results are interpreted as deriving from two different underlying phenomena: in BA, a compensatory use of intensity as a stress cue in order to avoid 'equal stress'; in CA, related to either a 'subtle phonetic deficit' involving abnormal stress acoustic cue-processing or to 'clear-speech' effects.

Phonetic basis of phonemic paraphasias in aphasia: Evidence for cascading activation

Phonemic paraphasias are a common presenting symptom in aphasia and are thought to reflect a deficit in which selecting an incorrect phonemic segment results in the clear-cut substitution of one phonemic segment for another. The current study re-examines the basis of these paraphasias. Seven left hemisphere-damaged aphasics with a range of left hemisphere lesions and clinical diagnoses including Broca's, Conduction, and Wernicke's aphasia, were asked to produce syllable-initial voiced and voiceless fricative consonants, [z] and [s], in CV syllables followed by one of five vowels [i e a o u] in isolation and in a carrier phrase. Acoustic analyses were conducted focusing on two acoustic parameters signaling voicing in fricative consonants: duration and amplitude properties of the fricative noise. Results show that for all participants, regardless of clinical diagnosis or lesion site, phonemic paraphasias leave an acoustic trace of the original target in the error production. These findings challenge the view that phonemic paraphasias arise from a mis-selection of phonemic units followed by its correct implementation, as traditionally proposed. Rather, they appear to derive from a common mechanism with speech errors reflecting the co-activation of a target and competitor resulting in speech output that has some phonetic properties of both segments.

Speech-like and non-speech lip kinematics and coordination in aphasia

BACKGROUND

In addition to the well-known linguistic processing impairments in aphasia, oro-motor skills and articulatory implementation of speech segments are reported to be compromised to some degree in most types of aphasia.

AIMS

This study aimed to identify differences in the characteristics and coordination of lip movements in the production of a bilabial closure gesture between speech-like and non-speech tasks in individuals with aphasia and healthy control subjects.

METHODS & PROCEDURES

Upper and lower lip movement data were collected for a speech-like and a non-speech task using an AG 100 EMMA system from five individuals with aphasia and five age- and gender-matched control subjects. Each task was produced at two rate conditions (normal and fast), and in a familiar and a less familiar manner. Single articulator kinematic parameters (peak velocity, amplitude, duration and cyclic spatio-temporal index) and multi-articulator coordination indices (average relative phase and variability of relative phase) were measured to characterize lip movements.

OUTCOMES & RESULTS

The results showed that when the two lips had similar task goals (bilabial closure) in speech-like and non-speech task, kinematic and coordination characteristics were not found to be different. However, when changes in rate were imposed on the bilabial gesture, only speech-like task showed functional adaptations, indicated by a greater decrease in amplitude and duration at fast rates. In terms of group differences, individuals with aphasia showed smaller amplitudes and longer movement durations for upper lip, higher spatio-temporal variability for both lips, and higher variability in lip coordination than the control speakers. Rate was an important factor in distinguishing the two groups, and individuals with aphasia were limited in implementing the rate changes.

CONCLUSIONS & IMPLICATIONS

The findings support the notion of subtle but robust differences in motor control characteristics between individuals with aphasia and the control participants, even in the context of producing bilabial closing gestures for a relatively simple speech-like task. The findings also highlight the functional differences between speech-like and non-speech tasks, despite a common movement coordination goal for bilabial closure.

Apraxia of speech and phonological errors in the diagnosis of nonfluent/agrammatic and logopenic variants of primary progressive aphasia

PURPOSE

The International Consensus Criteria for the diagnosis of primary progressive aphasia (PPA; Gorno-Tempini et al., 2011) propose apraxia of speech (AOS) as 1 of 2 core features of nonfluent/agrammatic PPA and propose phonological errors or absence of motor speech disorder as features of logopenic PPA. We investigated the sensitivity and specificity of AOS and phonological errors as markers for these variants and also investigated the relationship between AOS, phonological errors, and findings on C-labeled Pittsburgh Compound B (PiB)-positron emission tomography (PET) imaging associated with putative Alzheimer-type pathology.

METHOD

Connected speech and word repetition in 23 people with PPA who underwent PiB-PET imaging were rated for apraxic versus phonological disruption by 1 rater who was blind to diagnosis and by 2 raters who were blind to PiB-PET results.

RESULTS

Apraxic characteristics had high sensitivity for nonfluent/agrammatic PPA, and phonological errors had high sensitivity for logopenic PPA; however, phonological errors showed lower specificity for logopenic PPA. On PiB imaging, 8 of 9 people with predominant AOS returned negative results, whereas participants with no or questionable AOS with and without phonological errors returned positive results.

CONCLUSIONS

Attention to AOS and phonological errors may help counter some of the inherent limitations of diagnosis-by-exclusion in the current International Consensus Criteria for diagnosing PPA.

Effects of utterance length on lip kinematics in aphasia

Most existing models of language production and speech motor control do not explicitly address how language requirements affect speech motor functions, as these domains are usually treated as separate and independent from one another. This investigation compared lip movements during bilabial closure between five individuals with mild aphasia and five age and gender-matched control speakers when the linguistic characteristics of the stimuli were varied by increasing the number of syllables. Upper and lower lip movement data were collected for mono-, bi- and tri-syllabic nonword sequences using an AG 100 EMMA system. Each task was performed under both normal and fast rate conditions. Single articulator kinematic parameters (peak velocity, amplitude, duration, and cyclic spatio-temporal index) were measured to characterize lip movements. Results revealed that compared to control speakers, individuals with aphasia showed significantly longer movement duration and lower movement stability for longer items (bi- and tri-syllables). Moreover, utterance length affected the lip kinematics, in that the monosyllables had smaller peak velocities, smaller amplitudes and shorter durations compared to bi- and trisyllables, and movement stability was lowest for the trisyllables. In addition, the rate-induced changes (smaller amplitude and shorter duration with increased rate) were most prominent for the short items (i.e., monosyllables). These findings provide further support for the notion that linguistic changes have an impact on the characteristics of speech movements, and that individuals with aphasia are more affected by such changes than control speakers.

Nasal consonant production in Broca's and Wernicke's aphasics: speech deficits and neuroanatomical correlates

The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three acoustic measures were analyzed corresponding to different properties of articulatory implementation: murmur duration (a measure of timing), amplitude of the first harmonic at consonantal release (a measure of articulatory coordination), and murmur amplitude over time (a measure of laryngeal control). Results showed that Broca's aphasics displayed impairments in all of these parameters, whereas Wernicke's aphasics only exhibited greater variability in the production of two of the parameters. The lesion extent data showed that damage in either Broca's area or the insula cortex was not predictive of the severity of the speech output impairment. Instead, lesions in the upper and lower motor face areas and the supplementary motor area resulted in the most severe implementation impairments. For the Wernicke's aphasics, the posterior areas (superior marginal gyrus, parietal, and sensory) appear to be involved in the retrieval and encoding of lexical forms for speech production, resulting in increased variability in speech production.

A re-evaluation of the nature of speech errors in normal and disordered speakers

It is well known that speech errors in normal and aphasic speakers share certain key characteristics. Traditionally, many of these errors are regarded as serial misorderings of abstract phonological segments, which maintain the phonetic well-formedness of the utterance. The current paper brings together the results of several articulatory studies undertaken independently for both subject populations. These show that, in an error, instead of one segment substituting for another, two segments are often produced simultaneously even though only one segment may be heard. Such data pose problems for current models of speech production by suggesting that the commonly assumed dichotomous distinction between phonological and phonetic errors may not be tenable in the current form or may even be altogether redundant.

Phonology: a review and proposals from a connectionist perspective

A parallel distributed processing (PDP) model of phonological processing is developed, including components to support repetition, auditory processing, comprehension, and language production. From the performance of the PDP reading model of Plaut, McClelland, Seidenberg, and Patterson (1996), it is inferred that the acoustic-articulatory motor pattern associator that supports repetition provides the basis for phonological sequence knowledge. From the observation that many patients make phonemic paraphasic errors in language production, as in repetition, it is argued that there must be a direct link between distributed concept representations (lexical semantic knowledge) and this network representation of sequence knowledge. In this way, both lexical semantic and phonotactic constraints are brought to bear on language production. The literature on phonological function in normal subjects (slip-of-the-tongue corpora) and in patients with aphasia is critically reviewed from this perspective. The relationship between acoustic and articulatory motor representations in the process of phonetic perception is considered. Repetition and reproduction conduction aphasia are reviewed in detail and extended consideration is given to the representation of auditory verbal short-term memory in the model. Finally, the PDP model is reconciled with information processing models of phonological processing, including that of Lichtheim, and with current knowledge of the anatomic localization of phonological processing. Although no simulations of the model were run, a number of simulation studies are proposed.

Functional heterogeneity of inferior frontal gyrus is shaped by linguistic experience

A crosslinguistic, positron emission tomography (PET) study was conducted to determine the influence of linguistic experience on the perception of segmental (consonants and vowels) and suprasegmental (tones) information. Chinese and English subjects (10 per group) were presented binaurally with lists consisting of five Chinese monosyllabic morphemes (speech) or low-pass-filtered versions of the same stimuli (nonspeech). The first and last items were targeted for comparison; the time interval between target tones was filled with irrelevant distractor tones. A speeded-response, selective attention paradigm required subjects to make discrimination judgments of the target items while ignoring intervening distractor tones. PET scans were acquired for five tasks presented twice: one passive listening to pitch (nonspeech) and four active (speech = consonant, vowel, and tone; nonspeech = pitch). Significant regional changes in blood flow were identified from comparisons of group-averaged images of active tasks relative to passive listening. Chinese subjects show increased activity in left premotor cortex, pars opercularis, and pars triangularis across the four tasks. English subjects, on the other hand, show increased activity in left inferior frontal gyrus regions only in the vowel task and in right inferior frontal gyrus regions in the pitch task. Findings suggest that functional circuits engaged in speech perception depend on linguistic experience. All linguistic information signaled by prosodic cues engages left-hemisphere mechanisms. Storage and executive processes of working memory that are implicated in phonological processing are mediated in discrete regions of the left frontal lobe.

Effect of sentence length on the production of linguistic stress by left- and right-hemisphere-damaged patients

An acoustical/perceptual study of phonemic stress (e.g., HOTdog vs. hot DOG) was conducted to evaluate the effect of sentence length on stress production after brain damage. Productions of phonemic stress pairs were elicited in sentence contexts of increasing length from eight left-hemisphere-damaged nonfluent (LHD-NFL), fluent LHD-FL), right-hemisphere-damaged (RHD), and normal speakers (n = 32). Tape recordings of subjects' productions were presented to naïve listeners for perceptual identification of stress placement. Acoustic analysis focused on fundamental frequency, duration, and intensity of the initial and final syllables as well as pause duration between syllables. Perceptual tests indicated that regardless of sentence length, all brain-damaged groups exhibited an impairment in the production of linguistic stress when compared to normals. The LHD-NFL group experienced the greatest difficulty in signaling stress contrasts, followed in order by the LHD-FL and RHD groups. In medium-length sentences, the LHD-FL group's performance was degraded by comparison to short-length sentences. Acoustic analysis showed that pause duration was the strongest predictor of phonemic stress for all groups. Acoustic profiles of the RHD group were similar qualitatively to those of normals, but differed quantitatively in terms of magnitude of effect associated with shifts in stress patterns. Findings are brought to bear on the nature of the stress production deficit after unilateral brain damage, the role of the right hemisphere in linguistic prosody, and the concept of "subtle phonetic deficit" in fluent aphasia.

Speech timing subsequent to brain damage: effects of utterance length and complexity

Acoustic analyses of syllable durations were conducted in order to address several hypotheses concerning deficits in the control of speech timing subsequent to focal brain damage. Groups of nonfluent and fluent aphasics, right-hemisphere-damaged patients, and normal controls produced monosyllabic root syllables in medial and final position in the context of short and long sentences and syntactically simple and complex sentences. Durations of the target syllable as a proportion of the utterance were compared across contexts and groups. Somewhat surprisingly, the results revealed relatively normal temporal patterns in all subject groups, with the main exception emerging for the nonfluent aphasic patients who failed to demonstrate normal phrase-final lengthening effects. Implications of the findings for theories of temporal control in brain-damaged patients are considered.

Locus of functional impairment in the production of speech rhythm after brain damage: a preliminary study

This acoustic-perceptual, multiple-case study of the Rhythm Rule (RR) in English, a phonological phenomenon whereby adjacent stresses are adjusted to avoid "stress clash" (e.g., thirTEEN vs THIRteen MEN), was undertaken to identify the locus of functional impairments in speech prosody in different aphasic syndromes. Subjects included two left brain-damaged aphasic patients (1 fluent, 1 nonfluent), one right brain-damaged nonaphasic patient, and one nonneurological control. They were instructed to read sentences including experimental (bisyllabic "double-stressed" words) and matching control (bisyllabic "initial-stressed" words) phrases of increasing length. Results of acoustic and perceptual measures indicated that rhythmic disturbances associated with the RR emerged regardless of lesion site. The locus of functional impairment was isolated to phonetic implementation of the RR, as opposed to either loss of word-level stress or loss of the RR. Findings suggest that neural substrates of speech prosody are broadly distributed in the left and right cerebral hemispheres.

Consonant and vowel production of right hemisphere patients

Recent reports of subclinical phonetic deficits in posterior and most particularly in Wernicke's aphasics have challenged the traditional dichotomy which characterized speech deficits in aphasia as anterior/phonetic and posterior/phonological. It is unclear whether the basis of the phonetic deficit in posterior aphasics reflects the fact that the speech production system extends to more posterior regions of the left hemisphere than previously thought or alternatively is the result of generalized brain damage effects. The present study explores the latter possibility by investigating the patterns of speech production in right hemisphere brain-damaged, non-aphasic patients with anterior and posterior lesions. Acoustic analyses conducted on a range of consonant and vowel parameters showed differences between the speech patterns of both anterior and posterior right hemisphere patients and that of Wernicke's aphasics. These findings suggest that the subclinical deficit of Wernicke's aphasics can not simply be ascribed to a generalized brain-damage effect and raise the possibility that the right hemisphere also plays some role, if only a minor one, in the phonetic implementation of speech.

Interaction between tone and intonation in Thai after unilateral brain damage

Intonational characteristics of Thai sentences were used to evaluate fundamental frequency (F(0)) control in brain-damaged patients with unilateral left and right hemisphere lesions. Subjects (n = 41) included 9 young and 10 old normal adults, 12 right hemisphere patients, and 10 left hemisphere aphasic patients (7 fluent and 3 nonfluent). Sentences were comprised of six words, three of which were keywords occurring in sentence-initial, -medial, and -final positions. All 125 possible sequences of three of the five Thai tones (mid, low, falling, high, rising) were superimposed on monosyllabic keywords. Utterances were produced at a conversational speaking rate. Average F(0) of keywords was analyzed as a function of sentence position, tone, and group. For both normal and brain-damaged speakers, results indicated that tones in sentence-final position were significantly lower in F(0) than in either sentence-initial or -medial position; falling and high tones were significantly higher in F(0) than mid, low, and rising tones. Findings are discussed in relation to issues pertaining to hemispheric specialization and the nature of F(0) deficits in nonfluent and fluent aphasic patients.