Functional Speech and Voice Disorders: Approaches to Diagnosis and Treatment

Using Digital Speech Markers to Classify Functional Speech Disorder: A Proof-of-Concept Pilot Study

BACKGROUND

Functional speech disorder (FND-speech) is a subtype of functional neurological disorder, yet quantitative characterization of its motor and cognitive-linguistic features remains underexplored.

OBJECTIVE

This study aimed to quantitatively characterize FND-speech by comparing acoustic and linguistic features in individuals with FND-speech with healthy control subjects (HCs). The potential of digital speech features to serve as adjunctive diagnostic markers was also evaluated.

METHODS

Thirty adults with FND-speech (females, n = 25; males, n = 5) and 47 age-, sex-, education-, and handedness-matched HCs (females, n = 29; males, n = 18) were compared using lexicosyntactic, rate-based, and acoustic markers extracted from a structured picture description task. Supervised machine learning was employed to classify FND-speech versus HCs.

RESULTS

Lexicosyntactic features showed moderate predictive power (area under the curve [AUC] = 0.80), as did rate-based features (AUC = 0.81). Acoustic features demonstrated high discrimination (AUC = 0.98), and a combined model incorporating all feature categories achieved similar performance (AUC = 0.98).

CONCLUSIONS

This proof-of-principle pilot study successfully classified FND-speech versus HCs, highlighting the potential of digital speech markers to serve as adjunctive diagnostic markers for FND-speech. Out-of-sample replication and larger-scale classifier efforts incorporating neurological controls are needed. © 2025 International Parkinson and Movement Disorder Society.

Is Partial Deafness Dysphonia Gender Related?

Partial deafness (PD) is a hearing impairment that presents with normal hearing thresholds at low frequencies (up to 1 kHz), and deep hypoacusis at high frequencies. For many years, this type of hypoacusis has not been treated with typical hearing aids because of a low level of speech understanding improvement. Since the first worldwide PD cochlear implantation conducted in 2002, this type of hearing impairment became a subject of research also in the aspect of its influence on the patient's voice.

PURPOSE

This study aimed to examine whether voice disorders accompanying postlingual PD in adults present gender differences.

METHODS

The study group involved 30 patients with post lingual PD (15 females and 15 males) in whom pre existing voice disorders were excluded. Voice samples were recorded and analyzed using Multi-dimensional Voice Program by Kay Pentax.

CONCLUSIONS

The study showed that adults with PD develop voice dysfunctions; however, no major differences between females and males were found.

PURPOSE

This study aimed to examine whether voice disorders accompanying postlingual PD in adults present gender differences. The word gender in the paper is understood as a set of biological attributes associated with physical and physiological features; therefore, is used as the equivalent of sex.

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey

BACKGROUND

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs.

AIM

To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken.

METHODS & PROCEDURES

An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks.

OUTCOMES & RESULTS

There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues.

CONCLUSIONS & IMPLICATIONS

Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care.

WHAT THIS PAPER ADDS

What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.