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Manes JL, Kurani AS, Herschel E, Roberts AC, Tjaden K, Parrish T, Corcos DM. Premotor cortex is hypoactive during sustained vowel production in individuals with Parkinson's disease and hypophonia. Front Hum Neurosci 2023; 17:1250114. [PMID: 37941570 PMCID: PMC10629592 DOI: 10.3389/fnhum.2023.1250114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Hypophonia is a common feature of Parkinson's disease (PD); however, the contribution of motor cortical activity to reduced phonatory scaling in PD is still not clear. Methods In this study, we employed a sustained vowel production task during functional magnetic resonance imaging to compare brain activity between individuals with PD and hypophonia and an older healthy control (OHC) group. Results When comparing vowel production versus rest, the PD group showed fewer regions with significant BOLD activity compared to OHCs. Within the motor cortices, both OHC and PD groups showed bilateral activation of the laryngeal/phonatory area (LPA) of the primary motor cortex as well as activation of the supplementary motor area. The OHC group also recruited additional activity in the bilateral trunk motor area and right dorsal premotor cortex (PMd). A voxel-wise comparison of PD and HC groups showed that activity in right PMd was significantly lower in the PD group compared to OHC (p < 0.001, uncorrected). Right PMd activity was positively correlated with maximum phonation time in the PD group and negatively correlated with perceptual severity ratings of loudness and pitch. Discussion Our findings suggest that hypoactivation of PMd may be associated with abnormal phonatory control in PD.
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Ajay S. Kurani
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, United States
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Ellen Herschel
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
| | - Angela C. Roberts
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Canadian Centre for Activity and Aging, Western University, London, ON, Canada
- Department of Computer Science, Western University, London, ON, Canada
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Todd Parrish
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
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Cavallieri F, Di Rauso G, Gessani A, Budriesi C, Fioravanti V, Contardi S, Menozzi E, Pinto S, Moro E, Antonelli F, Valzania F. A study on the correlations between acoustic speech variables and bradykinesia in advanced Parkinson's disease. Front Neurol 2023; 14:1213772. [PMID: 37533469 PMCID: PMC10393249 DOI: 10.3389/fneur.2023.1213772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/15/2023] [Indexed: 08/04/2023] Open
Abstract
Background Very few studies have assessed the presence of a possible correlation between speech variables and limb bradykinesia in patients with Parkinson's disease (PD). The objective of this study was to find correlations between different speech variables and upper extremity bradykinesia under different medication conditions in advanced PD patients. Methods Retrospective data were collected from a cohort of advanced PD patients before and after an acute levodopa challenge. Each patient was assessed with a perceptual-acoustic analysis of speech, which included several quantitative parameters [i.e., maximum phonation time (MPT) and intensity (dB)]; the Unified Parkinson's Disease Rating Scale (UPDRS) (total scores, subscores, and items); and a timed test (a tapping test for 20 s) to quantify upper extremity bradykinesia. Pearson's correlation coefficient was applied to find correlations between the different speech variables and the tapping rate. Results A total of 53 PD patients [men: 34; disease duration: 10.66 (SD 4.37) years; age at PD onset: 49.81 years (SD 6.12)] were included. Levodopa intake increased the MPT of sustained phonation (p < 0.01), but it reduced the speech rate (p = 0.05). In the defined-OFF condition, MPT of sustained phonation positively correlated with both bilateral mean (p = 0.044, r-value:0.299) and left (p = 0.033, r-value:0.314) tapping. In the defined-ON condition, the MPT correlated positively with bilateral mean tapping (p = 0.003), left tapping (p = 0.003), and right tapping (p = 0.008). Conclusion This study confirms the presence of correlations between speech acoustic variables and upper extremity bradykinesia in advanced PD patients. These findings suggest common pathophysiological mechanisms.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Di Rauso
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Annalisa Gessani
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carla Budriesi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Contardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Serge Pinto
- Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Francesca Antonelli
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Kim GH, Lim DW, Kim JW, Park HJ, Lee YW. A Cepstral Analysis of Pathological Voice Quality in the Korean Population using Praat. J Voice 2022:S0892-1997(22)00319-8. [PMID: 36464574 DOI: 10.1016/j.jvoice.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study aimed to investigate the reference values for cepstral peak prominence (CPP) and smoothed CPP (CPPS) measured using Praat in Korean speakers with the normal, healthy and pathological voice. METHODS A total of 4,524 Korean participants with vocally healthy (n = 410) and dysphonic voices (n = 4,114) participated in this study. The speech task consisted of a sustained vowel /a/ and a sentence reading the Korean passage "Walk". CPP and CPPS values were quickly and automatically measured in sustained vowel and continuous speech tasks using Praat script. Furthermore, three veteran speech language pathologists (SLPs) scored the severity of dysphonia using the GRBAS scale (grade, roughness, breathiness, asthenia, strain) and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). RESULTS Three SLPs showed high inter- and intra-rater reliabilities (IRR) in auditory-perceptual (A-P) evaluation. Significant differences were confirmed in CPP and CPPS between the normally healthy and pathological voice groups for both voice tasks (P < 0.01). The measured values of CPP and CPPS varied depending on the laryngeal pathology. In the receiver operating characteristic (ROC) curve analysis, the CPP_Vowel (CPP_V), CPPS_V, CPP_Sentence (CPP_S), and CPPS_S cut-off values were <21.5, <12.0, <19.7, and <10.1, respectively. Through ROC curve analysis, it was confirmed that CPP and CPPS had excellent diagnostic accuracy in distinguishing disordered voice (area under the ROC: 0.951-0.966). CONCLUSION We investigated the reference values for CPP and CPPS measured with Praat for Korean speakers and confirmed that cepstral analysis is a promising tool for differentiating pathological voice.
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Affiliation(s)
- Geun-Hyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Dong-Won Lim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae-Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea
| | - Hee-June Park
- Department of Speech and Hearing Therapy, Catholic University of Pusan, Busan, Korea
| | - Yeon-Woo Lee
- Department of Speech-Language Pathology, Kosin University, Busan, South Korea.
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Chen CL, Lin CH, Su CS, Cheng HC, Chen LM, Cherng RJ. Evaluation of the Psychometric Properties of a Newly Developed Chinese Screening Tool for Speech Disorders in Patients With Parkinson's Disease. Eval Health Prof 2022; 46:127-134. [PMID: 35722661 DOI: 10.1177/01632787221108458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study aimed to analyze the psychometric properties of a newly developed Chinese screening tool, the Chinese Version of the Speech Disorders in Parkinson's Disease Questionnaire (SDPD-C). The SDPD-C contains a 24-item questionnaire with four assessment domains. Overall, 93 patients with idiopathic Parkinson's disease (PD) (age 70.1 ± 8.9 years) and 76 healthy older adults (age 67.2 ± 8.1 years) participated in the psychometric analysis study. The internal consistency of the SDPD-C was .91 (four dimensions: .69-.85), and test-retest reliability was .91 (four dimensions: .85-.88). The SDPD-C was highly correlated with the Voice Handicap Index-10 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale II 2.1 (r = .83 and .78, respectively). The SDPD-C scores also differed significantly between stages 1 and 4 of the Hoehn and Yahr Scale (p < .05). The area under the receiver operating characteristic curve was .955 (95% confidence interval, .927-.983; asymptotic significance p < .001), and the optimal cut-off score of this study was 36, with a sensitivity of .849 and specificity of .947. The results indicate that SDPD-C showed good reliability, validity, accuracy, and discrimination. It can be used as a screening tool for speech disorders in patients with PD.
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Affiliation(s)
- Chi-Lin Chen
- Institute of Allied Health Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Ching-Huang Lin
- Section of Neurology, 38024Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Hsiang-Chun Cheng
- Department of Speech Language Pathology and Audiology, 34905HungKuang University, Taichung, Taiwan
| | - Li-Mei Chen
- Department of Foreign Languages and Literature, National Cheng Kung University, Tainan, Taiwan
| | - Rong-Ju Cherng
- Institute of Allied Health Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
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Ryu J, Torres EB. Motor Signatures in Digitized Cognitive and Memory Tests Enhances Characterization of Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2022; 22:4434. [PMID: 35746215 PMCID: PMC9231034 DOI: 10.3390/s22124434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Although interest in using wearable sensors to characterize movement disorders is growing, there is a lack of methodology for developing clinically interpretable biomarkers. Such digital biomarkers would provide a more objective diagnosis, capturing finer degrees of motor deficits, while retaining the information of traditional clinical tests. We aim at digitizing traditional tests of cognitive and memory performance to derive motor biometrics of pen-strokes and voice, thereby complementing clinical tests with objective criteria, while enhancing the overall characterization of Parkinson's disease (PD). 35 participants including patients with PD, healthy young and age-matched controls performed a series of drawing and memory tasks, while their pen movement and voice were digitized. We examined the moment-to-moment variability of time series reflecting the pen speed and voice amplitude. The stochastic signatures of the fluctuations in pen drawing speed and voice amplitude of patients with PD show a higher signal-to-noise ratio compared to those of neurotypical controls. It appears that contact motions of the pen strokes on a tablet evoke sensory feedback for more immediate and predictable control in PD, while voice amplitude loses its neurotypical richness. We offer new standardized data types and analytics to discover the hidden motor aspects within the cognitive and memory clinical assays.
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Affiliation(s)
- Jihye Ryu
- Department of Psychology, Rutgers University, New Brunswick, NJ 08854, USA;
| | - Elizabeth B. Torres
- Rutgers University Center for Cognitive Science, Computational Biomedicine Imaging and Modeling Center at Computer Science Department, Psychology Department, Rutgers University, Piscataway, NJ 08854, USA
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Objective vowel sound characteristics and their relationship with motor dysfunction in Asian Parkinson's disease patients. J Neurol Sci 2021; 426:117487. [PMID: 34004464 DOI: 10.1016/j.jns.2021.117487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Speech impairments are very common in patients with Parkinson's disease (PD). However, knowledge of their objective characteristics and relationship to other motor symptoms amongst Asian PD patients is limited. OBJECTIVES To identify objective vowel sound characteristics in Thai PD patients and correlate with disease severity, as determined by UPDRS and various sub-scores. METHOD We evaluated 100 Thai PD patients, with a mean age of 66.56 years (±7.52) and HY of 2.7 (±1.08), and 101 age-matched controls. Phonatory evaluation, comprising of 15 objective parameters, was conducted using the Multi-Dimensional Voice Programme with a sustained /a/ phonation. RESULTS PD patients exhibited significantly higher values of all dimensions of the phonatory parameters evaluated compared to controls (All, p < 0.001) except for duration of sustained phonation, which was significantly shorter in PD patients. When early- and advanced-stage patients were compared, significantly different parameters were limited to frequency perturbation parameters (Jitt, p = 0.01; RAP, p = 0.013; PPQ, p = 0.01; sPPQ, p = 0.001; vF0, p = 0.011), and NHR (p = 0.028). Several significant and moderate correlations were observed between both STD and frequency perturbation parameters and UPDRS-III, bradykinesia sub-score, and gait and postural instability sub-score. Both vF0, and STD significantly correlated with UPDRS-III and sub-scores in advanced stage patients. CONCLUSION Our study provides objective evidence of phonatory dysfunction in Asian PD patients with certain characteristics correlated with advanced stage or different motor dysfunction. Sustained vowel phonation is a promising digital outcome for global phenotyping a large number of PD patients.
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Advances in Parkinson's Disease detection and assessment using voice and speech: A review of the articulatory and phonatory aspects. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Byeon H. Comparing Ensemble-Based Machine Learning Classifiers Developed for Distinguishing Hypokinetic Dysarthria from Presbyphonia. APPLIED SCIENCES 2021; 11:2235. [DOI: 10.3390/app11052235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
It is essential to understand the voice characteristics in the normal aging process to accurately distinguish presbyphonia from neurological voice disorders. This study developed the best ensemble-based machine learning classifier that could distinguish hypokinetic dysarthria from presbyphonia using classification and regression tree (CART), random forest, gradient boosting algorithm (GBM), and XGBoost and compared the prediction performance of models. The subjects of this study were 76 elderly patients diagnosed with hypokinetic dysarthria and 174 patients with presbyopia. This study developed prediction models for distinguishing hypokinetic dysarthria from presbyphonia by using CART, GBM, XGBoost, and random forest and compared the accuracy, sensitivity, and specificity of the development models to identify the prediction performance of them. The results of this study showed that random forest had the best prediction performance when it was tested with the test dataset (accuracy = 0.83, sensitivity = 0.90, and specificity = 0.80, and area under the curve (AUC) = 0.85). The main predictors for detecting hypokinetic dysarthria were Cepstral peak prominence (CPP), jitter, shimmer, L/H ratio, L/H ratio_SD, CPP max (dB), CPP min (dB), and CPPF0 in the order of magnitude. Among them, CPP was the most important predictor for identifying hypokinetic dysarthria.
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Panzone L, Watts CR. Regulation of Transglottal Airflow in Speakers With Parkinson's Disease. J Voice 2020; 34:961.e1-961.e7. [DOI: 10.1016/j.jvoice.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022]
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Lira ZSD, Lemos ILLD, Cardoso NSV, Paulino CEB, Vieira ACC, Lucena JA, Gomes ADOC. Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease. J Voice 2020; 36:585.e15-585.e25. [PMID: 32829982 DOI: 10.1016/j.jvoice.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease. METHOD Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed. RESULTS After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise. CONCLUSION In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.
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Affiliation(s)
- Zulina Souza de Lira
- Health Sciences Center. Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco, Recife, Pernambuco, Brazil. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde - Departamento de Fonoaudiologia). Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE,- CEP 50670-420, Brazil
| | - Izabela Lara Leite de Lemos
- Speech-Languague Pathology and Audiology Department at the Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil
| | - Nathália Suellen Valeriano Cardoso
- Health Sciences Center. Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco, Recife, Pernambuco, Brazil. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde - Departamento de Fonoaudiologia). Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE,- CEP 50670-420, Brazil
| | - Clarissa Evelyn Bandeira Paulino
- Health Sciences Center. Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco, Recife, Pernambuco, Brazil. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde - Departamento de Fonoaudiologia). Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE,- CEP 50670-420, Brazil
| | - Ana Cláudia Carvalho Vieira
- Speech-Languague Pathology and Audiology Department at the Federal University of Pernambuco. Health Sciences Center. Recife, Pernambuco, Brazil
| | - Jonia Alves Lucena
- Health Sciences Center. Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco, Recife, Pernambuco, Brazil. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde - Departamento de Fonoaudiologia). Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE,- CEP 50670-420, Brazil
| | - Adriana de Oliveira Camargo Gomes
- Health Sciences Center. Speech-Languague Pathology and Audiology Departament, Federal University of Pernambuco, Recife, Pernambuco, Brazil. (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco - Centro de Ciências da Saúde - Departamento de Fonoaudiologia). Av. Prof. Artur de Sá, s/n - Cidade Universitária - Recife/PE,- CEP 50670-420, Brazil..
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Enver N, Borders JC, Curtis JA, Sevitz JS, Vanegas-Arroyave N, Troche MS. The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy. Laryngoscope 2020; 131:1217-1222. [PMID: 32687232 DOI: 10.1002/lary.28885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP. STUDY DESIGN Prospective Cohort Study. METHODS Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP. RESULTS Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05). CONCLUSIONS Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP. LEVEL OF EVIDENCE 3 (Prospective Observational Study) Laryngoscope, 131:1217-1222, 2021.
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Affiliation(s)
- Necati Enver
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, U.S.A.,Department of Otolaryngology Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.,The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - James C Borders
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - James A Curtis
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Jordanna S Sevitz
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Nora Vanegas-Arroyave
- Department of Neurology, Division of Movement Disorders, Columbia University Medical Center, New York, New York, U.S.A
| | - Michelle S Troche
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
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Yang S, Wang F, Yang L, Xu F, Luo M, Chen X, Feng X, Zou X. The physical significance of acoustic parameters and its clinical significance of dysarthria in Parkinson's disease. Sci Rep 2020; 10:11776. [PMID: 32678256 PMCID: PMC7366911 DOI: 10.1038/s41598-020-68754-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
Dysarthria is universal in Parkinson’s disease (PD) during disease progression; however, the quality of vocalization changes is often ignored. Furthermore, the role of changes in the acoustic parameters of phonation in PD patients remains unclear. We recruited 35 PD patients and 26 healthy controls to perform single, double, and multiple syllable tests. A logistic regression was performed to differentiate between protective and risk factors among the acoustic parameters. The results indicated that the mean f0, max f0, min f0, jitter, duration of speech and median intensity of speaking for the PD patients were significantly different from those of the healthy controls. These results reveal some promising indicators of dysarthric symptoms consisting of acoustic parameters, and they strengthen our understanding about the significance of changes in phonation by PD patients, which may accelerate the discovery of novel PD biomarkers.
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Affiliation(s)
- Shu Yang
- College of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China.,Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Fengbo Wang
- Department of Rehabilitation, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Liqiong Yang
- Department of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Man Luo
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xiaqing Chen
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| | - Xianwei Zou
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China.
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Lechien JR, Delsaut B, Abderrakib A, Huet K, Delvaux V, Piccaluga M, Khalife M, Harmegnies B, Saussez S, Blecic S. Orofacial Strength and Voice Quality as Outcome of Levodopa Challenge Test in Parkinson Disease. Laryngoscope 2020; 130:E896-E903. [PMID: 32239775 DOI: 10.1002/lary.28645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the usefulness of orofacial strength and voice quality as assessment of response to levodopa challenge test (LCT) used in the diagnosis of early idiopathic Parkinson disease (IPD). STUDY DESIGN Controlled Prospective Study. METHODS From January 2014 to April 2019, patients with early IPD and healthy individuals were recruited and evaluated for clinical findings (Hoehn and Yahr scale; Unified Parkinson's Disease Rating Scale); Voice Handicap Index (VHI); grade of dysphonia, roughness, breathiness, asthenia, and strain and instability (GRBASI); maximal phonation time; phonation quotient; acoustic parameters; and orofacial muscle strength Oral Performance Instrument (IOPI; IOPI Medical, Woodinville, WA, USA) t) at baseline and 45 minutes after the levodopa intake (LCT). RESULTS A total of 32 IPD patients and 20 healthy individuals completed the study. Healthy individuals exhibited better VHI, grade of dysphonia, breathiness, asthenia, strain, instability, and acoustic measurements (noise-related, tremor, F0 short- and mid-term and intensity short-term parameters) than healthy subjects. The mean values of muscle strength of lips, cheeks, fundamental frequency (F0), highest F0, and shimmer significantly improved from pre- to post-LCT in IPD patients. Healthy individuals did not exhibit significant changes of orofacial strength and voice quality assessment from pre- to post-LCT. Significant associations were found between clinical, orofacial strength, and some aerodynamic and acoustic measurements. CONCLUSION Orofacial strength and acoustic voice quality measurements may be used as objective outcomes of the LCT responsiveness in patients with early IPD. LEVEL OF EVIDENCE 3A. Laryngoscope, 2020.
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Affiliation(s)
- Jérôme R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Bertil Delsaut
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Neurology, EpiCURA Hospital, Baudour, Belgium
| | - Anissa Abderrakib
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Neurology, EpiCURA Hospital, Baudour, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Veronique Delvaux
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Myriam Piccaluga
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Mohamad Khalife
- Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Serge Blecic
- Department of Neurology, EpiCURA Hospital, Baudour, Belgium
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Ma A, Lau KK, Thyagarajan D. Voice changes in Parkinson's disease: What are they telling us? J Clin Neurosci 2020; 72:1-7. [PMID: 31952969 DOI: 10.1016/j.jocn.2019.12.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Emerging evidence suggests voice dysfunction is the earliest sign of motor impairment in Parkinson's disease (PD). The complexity and fine motor control involved in vocalization may result in dysfunction here before the limbs. The voice in PD demonstrates characteristic changes on perceptual and acoustic analyses. The physiological and anatomical correlates of these have been investigated through laryngoscopy, stroboscopy, photoglottography, laryngeal electromyography, computed-tomography, pulmonary function testing and aerodynamic assessments. These have revealed numerous abnormalities including incomplete glottic closure and vocal fold hypoadduction/bowing to account for these voice changes. Many of these phenomena are likely related to rigidity or bradykinesia of the laryngeal muscles. The early onset of voice changes is resonant with the pathophysiological insights offered by Braak's hypothesis and murine models of the disease. These physiological abnormalities and pathological models largely stand to support dopaminergic and non-dopaminergic mechanisms being implicated in the pathogenesis of voice dysfunction. This review focuses on characterizing the voice changes in PD. These stand as a promising area of enquiry to further our understanding of the pathophysiology of the disease and offer potential to be utilized as an early diagnostic biomarker or marker of disease progression.
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Affiliation(s)
- Andrew Ma
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Kenneth K Lau
- Monash Imaging, Monash Health, Melbourne, Victoria 3168, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dominic Thyagarajan
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia.
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15
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Yiu Y, Curtis JA, Perry SE, Troche MS. Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease. Laryngoscope 2019; 130:303-308. [DOI: 10.1002/lary.28158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Yin Yiu
- Voice and Swallowing InstituteDepartment of Otolaryngology–Head & Neck Surgery, Columbia University Irving Medical Center New York New York U.S.A
| | - James A. Curtis
- Division of Communication Sciences and DisordersDepartment of Biobehavioral Sciences, Teachers College, Columbia University New York New York U.S.A
| | - Sarah E. Perry
- Division of Communication Sciences and DisordersDepartment of Biobehavioral Sciences, Teachers College, Columbia University New York New York U.S.A
| | - Michelle S. Troche
- Voice and Swallowing InstituteDepartment of Otolaryngology–Head & Neck Surgery, Columbia University Irving Medical Center New York New York U.S.A
- Division of Communication Sciences and DisordersDepartment of Biobehavioral Sciences, Teachers College, Columbia University New York New York U.S.A
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Lechien J, Blecic S, Huet K, Delvaux V, Piccaluga M, Roland V, Harmegnies B, Saussez S. Voice quality outcomes of idiopathic Parkinson's disease medical treatment: A systematic review. Clin Otolaryngol 2018; 43:882-903. [DOI: 10.1111/coa.13082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J.R. Lechien
- Laboratory of Anatomy and Cell Biology; Faculty of Medicine; UMONS Research Institute for Health Sciences and Technology; University of Mons; Mons Belgium
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery; RHMS Baudour, EpiCURA Hospital; Baudour Belgium
| | - S. Blecic
- Department of Neurology; EpiCURA Hospital; Baudour Belgium
| | - K. Huet
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
| | - V. Delvaux
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
| | - M. Piccaluga
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
| | - V. Roland
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
| | - B. Harmegnies
- Laboratory of Phonetics; Faculty of Psychology; Research Institute for Language sciences and Technology; University of Mons; Mons Belgium
| | - S. Saussez
- Laboratory of Anatomy and Cell Biology; Faculty of Medicine; UMONS Research Institute for Health Sciences and Technology; University of Mons; Mons Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery; RHMS Baudour, EpiCURA Hospital; Baudour Belgium
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17
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Perju-Dumbrava L, Lau K, Phyland D, Papanikolaou V, Finlay P, Beare R, Bardin P, Stuckey S, Kempster P, Thyagarajan D. Arytenoid cartilage movements are hypokinetic in Parkinson's disease: A quantitative dynamic computerised tomographic study. PLoS One 2017; 12:e0186611. [PMID: 29099841 PMCID: PMC5669420 DOI: 10.1371/journal.pone.0186611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 10/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few. METHODS We therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson's disease (symptom duration < 6 years) and 19 controls, with 320-slice computerised tomography (CT). We related these measures to perceptual voice evaluations and spirometry. We hypothesised that Parkinson's disease patients have a smaller inter-arytenoid distance, a preserved or larger glottic area because vocal cord bowing has previously been reported, less variability in loudness, more voice dysdiadochokinesis and breathiness and a shortened phonation time because of arytenoid hypokinesis relative to glottic area. RESULTS Inter-arytenoid distance in Parkinson's disease patients was moderately smaller (Mdn = 0.106, IQR = 0.091-0.116) than in controls (Mdn = 0.132, IQR = 0.116-0.166) (W = 212, P = 0.015, r = -0.42), normalised for anatomical and other inter-subject variance, analysed with two-tailed Wilcoxon's rank sum test. This finding was confirmed in a linear mixed model analysis-Parkinson's disease significantly predicted a reduction in the dependent variable, inter-arytenoid distance (b = -0.87, SEb = 0.39, 95% CI [-1.66, -0.08], t(31) = -2.24, P = 0.032). There was no difference in glottic area. On perceptual voice evaluation, patients had more breathiness and dysdiadochokinesis, a shorter maximum phonation time, and less variability in loudness than controls. There was no difference in spirometry after adjustment for smoking history. CONCLUSIONS As predicted, vocal fold adduction movements are reduced in Parkinson's disease on repeated phonation but glottic area is maintained. Some perceptual characteristics of Parkinsonian speech reflect these changes. We are the first to use 320-slice CT to study laryngeal motion. Our findings indicate how Parkinson's disease affects intrinsic laryngeal muscle position and excursion.
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Affiliation(s)
| | - Ken Lau
- Department of Medical Imaging, Monash Medical Center, Clayton, Victoria, Australia
| | - Debbie Phyland
- Department of Surgery, Monash Medical Center, Clayton, Victoria, Australia
| | - Vicki Papanikolaou
- Department of Respiratory Medicine, Monash Medical Center, Clayton, Victoria, Australia
| | - Paul Finlay
- Department of Respiratory Medicine, Monash Medical Center, Clayton, Victoria, Australia
| | - Richard Beare
- Department of Neuroscience, Monash Medical Center, Clayton, Victoria, Australia
| | - Philip Bardin
- Department of Respiratory Medicine, Monash Medical Center, Clayton, Victoria, Australia
| | - Stephen Stuckey
- Department of Medical Imaging, Monash Medical Center, Clayton, Victoria, Australia
| | - Peter Kempster
- Department of Neuroscience, Monash Medical Center, Clayton, Victoria, Australia
| | - Dominic Thyagarajan
- Department of Neuroscience, Monash Medical Center, Clayton, Victoria, Australia
- * E-mail:
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18
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Gibbins N, Awad R, Harris S, Aymat A. The diagnosis, clinical findings and treatment options for Parkinson's disease patients attending a tertiary referral voice clinic. J Laryngol Otol 2017; 131:357-362. [PMID: 28137335 DOI: 10.1017/s0022215117000159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parkinson's disease is a degenerative disorder of the central nervous system, mainly affecting motor functions including the voice. The aetiology of dysphonia changes throughout the course of disease progression. OBJECTIVES This study aimed to determine the laryngeal changes seen in early-, mid- and late-stage Parkinson's disease. Thirteen patients with Parkinson's disease are presented, representing the largest series of voice patients with Parkinson's disease seen in a voice clinic in the literature. METHOD Age, gender, severity of handicap caused by voice disorder and possible associated reflux symptoms were examined. RESULTS Laryngeal function appeared to change gradually with progression of the disease, and may have been affected by the presence of pre-existing laryngeal pathology. CONCLUSION Laryngeal function in Parkinson's disease appears to go through a series of changes that may be helped by both therapeutic and surgical interventions. These patients should be treated within the confines of a voice clinic multidisciplinary model.
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Affiliation(s)
- N Gibbins
- Department of Otolaryngology,University Hospital Lewisham,London,UK
| | - R Awad
- Department of Speech Therapy,University Hospital Lewisham,London,UK
| | - S Harris
- Department of Speech Therapy,University Hospital Lewisham,London,UK
| | - A Aymat
- Department of Otolaryngology,University Hospital Lewisham,London,UK
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19
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De Keyser K, Santens P, Bockstael A, Botteldooren D, Talsma D, De Vos S, Van Cauwenberghe M, Verheugen F, Corthals P, De Letter M. The Relationship Between Speech Production and Speech Perception Deficits in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:915-931. [PMID: 27617884 DOI: 10.1044/2016_jslhr-s-15-0197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/17/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE This study investigated the possible relationship between hypokinetic speech production and speech intensity perception in patients with Parkinson's disease (PD). METHOD Participants included 14 patients with idiopathic PD and 14 matched healthy controls (HCs) with normal hearing and cognition. First, speech production was objectified through a standardized speech intelligibility assessment, acoustic analysis, and speech intensity measurements. Second, an overall estimation task and an intensity estimation task were addressed to evaluate overall speech perception and speech intensity perception, respectively. Finally, correlation analysis was performed between the speech characteristics of the overall estimation task and the corresponding acoustic analysis. The interaction between speech production and speech intensity perception was investigated by an intensity imitation task. RESULTS Acoustic analysis and speech intensity measurements demonstrated significant differences in speech production between patients with PD and the HCs. A different pattern in the auditory perception of speech and speech intensity was found in the PD group. CONCLUSIONS Auditory perceptual deficits may influence speech production in patients with PD. The present results suggest a disturbed auditory perception related to an automatic monitoring deficit in PD.
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Affiliation(s)
- Kim De Keyser
- Department of Neurology, Ghent University Hospital, BelgiumDepartment of Speech, Language, and Hearing Sciences, Ghent University, BelgiumParkinson Zorgwijzer Vlaanderen, Ghent University Hospital, Belgium
| | | | | | | | - Durk Talsma
- Department of Experimental Psychology, Ghent University, Belgium
| | - Stefanie De Vos
- Parkinson Zorgwijzer Vlaanderen, Ghent University Hospital, Belgium
| | | | - Femke Verheugen
- Parkinson Zorgwijzer Vlaanderen, Ghent University Hospital, Belgium
| | - Paul Corthals
- Department of Speech, Language, and Hearing Sciences, Ghent University, Belgium
| | - Miet De Letter
- Department of Neurology, Ghent University Hospital, BelgiumDepartment of Speech, Language, and Hearing Sciences, Ghent University, BelgiumParkinson Zorgwijzer Vlaanderen, Ghent University Hospital, Belgium
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20
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Jannetts S, Lowit A. Cepstral Analysis of Hypokinetic and Ataxic Voices: Correlations With Perceptual and Other Acoustic Measures. J Voice 2014; 28:673-80. [DOI: 10.1016/j.jvoice.2014.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Ferreira FV, Cielo CA, Trevisan ME. Aspectos respiratorios, posturais e vocais da Doença de Parkinson: considerações teóricas. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
TEMA: manifestações respiratórias, posturais e vocais, associadas aos estágios da Doença de Parkinson (DP) e suas possíveis inter-relações. OBJETIVO: revisar a literatura, a fim de descrever as características respiratórias, posturais e vocais associadas aos estágios na DP e suas possíveis inter-relações. CONCLUSÃO: Na DP, a etiologia das manifestações respiratórias é multifatorial, sendo obstrutivas; restritivas; relacionadas à bradicinesia, à rigidez e às alterações posturais; fraqueza da musculatura; anormalidades na musculatura laríngea; interferência da medicação antiparkisoniana. A postura em flexão altera a dinâmica corporal, interferindo nas funções estomatognáticas e na relação tóraco-abdominal. As alterações vocais podem estar presentes desde os estágios iniciais com diminuição dos tempos máximos de fonação e da intensidade vocal; adução glótica incompleta; fendas glóticas; tremor e instabilidade fonatória; perturbações de frequência e de intensidade; e qualidade vocal alterada. Os déficits na força muscular respiratória se refletem no menor suporte respiratório à emissão vocal e, por consequência, na diminuição da intensidade vocal e dos tempos máximos de fonação. Do mesmo modo, a postura em flexão gera desvantagem biomecânica à atividade respiratória, com menor expansão e redução dos volumes pulmonares, e déficit na excursão diafragmática. Os distúrbios respiratórios, posturais e/ou vocais, à medida que a DP evolui, de acordo com os seus estágios, tendem ao maior comprometimento, apresentando efeitos na comunicação verbal e não-verbal.
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22
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Pinto S, Ghio A, Teston B, Viallet F. [Dysarthria across Parkinson's disease progression. Natural history of its components: dysphonia, dysprosody and dysarthria]. Rev Neurol (Paris) 2010; 166:800-10. [PMID: 20800250 DOI: 10.1016/j.neurol.2010.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 07/20/2010] [Indexed: 11/16/2022]
Abstract
Dysarthria refers to a collective name for a group of neurologic motor speech disorders, resulting from central and/or peripheral nervous system abnormalities. Speech alteration in Parkinson's disease, so-called hypokinetic dysarthria, presents with prosodic insufficiency, related to a monotony of pitch and intensity, a reduction of accentuation, variable speech rate and possible phoneme imprecision. In most cases, voice is harsh and breathy. This symptom can affect both voice and speech quality, as well as prosody and intelligibility. As a consequence, many patients complain about speech impairments, which affect their communication in daily living activities. Perceptual and instrumental assessments require different and numerous investigation methods, which use may help to further understand the specific dysarthria pathophysiology. This is of importance in order to adjust treatments for dysarthria; as a matter of fact, dopa-therapy, functional neurosurgery or even behavioural speech therapy have variable effects on voice and speech quality in Parkinson's disease.
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Affiliation(s)
- S Pinto
- UMR 6057, Laboratoire Parole et Langage (LPL), CNRS, Université Aix-Marseille, BP 80975, 5 Avenue Pasteur, 13604 Aix-en-Provence Cedex 1, France.
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Pitts T, Troche M, Mann G, Rosenbek J, Okun MS, Sapienza C. Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease. Chest 2010; 138:1426-31. [PMID: 20705802 DOI: 10.1378/chest.10-0342] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia. METHODS Fifty-eight consecutive patients (Hoehn and Yahr stage II-III; average age 72.3) were enrolled in the study. Measures of airflow during voluntary cough production and the degree of penetration/aspiration on a 3-oz oropharyngeal swallow task, derived from videofluorographic images, were examined. RESULTS To detect at-risk people (those with penetration and/or aspiration on the 3-oz swallow task), four objective measures of voluntary cough (compression phase duration [CPD], expiratory phase rise time [EPRT], expiratory phase peak flow [EPPF], and cough volume acceleration [CVA)]) were collected. CPD, EPRT, EPPF, and CVA measurements produced significant area under the curve (AUC) analyses and likelihood ratios equal to 0.83:2.72, 0.71:2.68, 0.69:1.75, and 0.78:18.42, respectively. CPD, EPRT, EPPF, and CVA measurements demonstrated sensitivities of 95.83%, 70.83%, 87.50%, and 84.53%, and specificities of 64.71%, 73.53%, 50.01%, and 97.06%, respectively. For detection of aspiration, EPPF was significantly associated with an AUC = 0.88 and with an EPPF < 5.24, which had a sensitivity of 57.15% and a specificity of 100%. CONCLUSIONS The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.
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Affiliation(s)
- Teresa Pitts
- Department of Physiological Sciences, Movement Disorders Center, Malcom Randall Veterans Administration Medical Center, Gainesville, FL 32610-0144, USA.
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Abstract
OBJECTIVES Nearly one third of patients with idiopathic Parkinson's disease (IPD) cite dysphonia, characterized subjectively as causing a harsh and breathy voice, as their most debilitating deficit. Medical or behavioral treatments may lead to voice improvement. The purpose of this study was 1) to determine whether vocal fold injection of Cymetra (micronized form of collagen, elastin, proteoglycans; Lifecell Co.) is associated with changes in dysphonic voice characteristics in subjects with IPD, as judged perceptually using a standard instrument Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and (2) which acoustic and aerodynamic measurements of voice are most reflective of any observed perceptual changes in voice. STUDY DESIGN Prospective clinical evaluation of patients with Parkinson's-related dysphonia (PRD). METHODS Six patients with PRD were evaluated before treatment for the presence of dysphonia and glottal gap. All subjects underwent transoral vocal fold collagen injection using topical anesthesia in the otolaryngology clinic as part of their clinical care. At the initial clinic visit, and 10 to14 days after vocal fold collagen injection, patients were asked to complete the Voice Handicap Index (VHI), a questionnaire concerning voice-related quality of life, and perceptual analyses of voice quality were performed. In addition, patients underwent acoustic (pitch/loudness range, maximum phonation time [MPT], and aerodynamic phonation threshold pressure [PTP]) voice analysis. RESULTS Five of six subjects had self-perceived improvements in voice after treatment, as determined by the VHI (range, +8 to -24). All five subjects who completed testing demonstrated decreased PTP (range, -1.3 to -2.7, P = .002). Five of six subjects demonstrated statistically significant improvements in MPT (range, -2-16 s, P = .05). Five of six subjects had improved pitch range (-26-343 Hz), whereas all subjects had increased intensity range (0.6-23 db) after injection. CONCLUSIONS Transoral collagen injection in patients with PRD is safe, well tolerated, and is an effective temporary method of subjectively improving voice and speech in selected patients with IPD. Reduction of glottal gap with collagen improves MPT and subglottal PTP. The resulting gain of vocal efficiency may reduce vocal fatigue and provide a useful adjunct to voice therapy for PRD.
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Affiliation(s)
- Gregory K Sewall
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
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Silveira DN, Brasolotto AG. Reabilitação vocal em pacientes com doença de Parkinson: fatores interferentes. ACTA ACUST UNITED AC 2005; 17:241-50. [PMID: 16909534 DOI: 10.1590/s0104-56872005000200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
TEMA: reabilitação vocal de pacientes com doença de Parkinson idiopática. OBJETIVO: descrever os fatores interferentes na reabilitação vocal de cinco indivíduos com doença de Parkinson e apresentar as modificações na comunicação oral. MÉTODO: foram realizadas entrevistas e avaliações pré e pós-tratamento vocal pelo método Lee SilvermanVoice Treatment (LSVT<FONT FACE=Symbol>Ò</FONT>) RESULTADOS: observou-se melhora na articulação, intensidade e qualidade vocais, gerando satisfação em pacientes e família. CONCLUSÃO: a análise dos fatores que contribuíram ou dificultaram o processo terapêutico aponta os aspectos que devem ser levados em consideração para atingir resultados eficazes.
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