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Maffei MF, Chenausky KV, Haenssler A, Abbiati C, Tager-Flusberg H, Green JR. Exploring Motor Speech Disorders in Low and Minimally Verbal Autistic Individuals: An Auditory-Perceptual Analysis. Am J Speech Lang Pathol 2024; 33:1485-1503. [PMID: 38512040 DOI: 10.1044/2024_ajslp-23-00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE Motor deficits are widely documented among autistic individuals, and speech characteristics consistent with a motor speech disorder have been reported in prior literature. We conducted an auditory-perceptual analysis of speech production skills in low and minimally verbal autistic individuals as a step toward clarifying the nature of speech production impairments in this population and the potential link between oromotor functioning and language development. METHOD Fifty-four low or minimally verbal autistic individuals aged 4-18 years were video-recorded performing nonspeech oromotor tasks and producing phonemes, syllables, and words in imitation. Three trained speech-language pathologists provided auditory perceptual ratings of 11 speech features reflecting speech subsystem performance and overall speech production ability. The presence, attributes, and severity of signs of oromotor dysfunction were analyzed, as were relative performance on nonspeech and speech tasks and correlations between perceptual speech features and language skills. RESULTS AND CONCLUSIONS Our findings provide evidence of a motor speech disorder in this population, characterized by perceptual speech features including reduced intelligibility, decreased consonant and vowel precision, and impairments of speech coordination and consistency. Speech deficits were more associated with articulation than with other speech subsystems. Speech production was more impaired than nonspeech oromotor abilities in a subgroup of the sample. Oromotor deficits were significantly associated with expressive and receptive language skills. Findings are interpreted in the context of known characteristics of the pediatric motor speech disorders childhood apraxia of speech and childhood dysarthria. These results, if replicated in future studies, have significant potential to improve the early detection of language impairments, inform the development of speech and language interventions, and aid in the identification of neurobiological mechanisms influencing communication development.
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Affiliation(s)
- Marc F Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Karen V Chenausky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Abigail Haenssler
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Claudia Abbiati
- College of Nursing and Health Sciences, The University of Vermont, Burlington
| | | | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
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Rowe HP, Stipancic KL, Campbell TF, Yunusova Y, Green JR. The association between longitudinal declines in speech sound accuracy and speech intelligibility in speakers with amyotrophic lateral sclerosis. Clin Linguist Phon 2024; 38:227-248. [PMID: 37122073 PMCID: PMC10613582 DOI: 10.1080/02699206.2023.2202297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to examine how neurodegeneration secondary to amyotrophic lateral sclerosis (ALS) impacts speech sound accuracy over time and how speech sound accuracy, in turn, is related to speech intelligibility. Twenty-one participants with ALS read the Bamboo Passage over multiple data collection sessions across several months. Phonemic and orthographic transcriptions were completed for all speech samples. The percentage of phonemes accurately produced was calculated across each phoneme, sound class (i.e. consonants versus vowels), and distinctive feature (i.e. features involved in Manner of Articulation, Place of Articulation, Laryngeal Voicing, Tongue Height, and Tongue Advancement). Intelligibility was determined by calculating the percentage of words correctly transcribed orthographically by naive listeners. Linear mixed effects models were conducted to assess the decline of each distinctive feature over time and its impact on intelligibility. The results demonstrated that overall phonemic production accuracy had a nonlinear relationship with speech intelligibility and that a subset of features (i.e. those dependent on precise lingual and labial constriction and/or extensive lingual and labial movement) were more important for intelligibility and were more impacted over time than other features. Furthermore, findings revealed that consonants were more strongly associated with intelligibility than vowels, but consonants did not significantly differ from vowels in their decline over time. These findings have the potential to (1) strengthen mechanistic understanding of the physiological constraints imposed by neuronal degeneration on speech production and (2) inform the timing and selection of treatment and assessment targets for individuals with ALS.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Kaila L Stipancic
- Department of Communicative Disorders and Sciences, The State University of New York, Buffalo, New York, USA
| | - Thomas F Campbell
- Callier Center for Communication Disorders, University of Texas, Dallas, Texas, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Kao TH, Rowe HP, Green JR, Stipancic KL, Sharma N, de Guzman JK, Supnet-Wells ML, Acuna P, Perry BJ. Oral diadochokinetic markers of X-linked dystonia-parkinsonism. Parkinsonism Relat Disord 2024; 120:105991. [PMID: 38184995 PMCID: PMC10922526 DOI: 10.1016/j.parkreldis.2024.105991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION X-linked dystonia-parkinsonism (XDP) is a neurodegenerative disorder that may result in severe speech impairment. The literature suggests that there are differences in the speech of individuals with XDP and healthy controls. This study aims to examine the motor speech characteristics of the mixed dystonia-parkinsonism phase of XDP. METHOD We extracted acoustic features representing coordination, consistency, speed, precision, and rate from 26 individuals with XDP and 26 controls using Praat, MATLAB, and R software. Group demographics were compared using descriptive statistics. A one-way analysis of variance (ANOVA) with Tukey's post hoc test was used to test for acoustic differences between the two groups. RESULTS The XDP group had significantly lower consistency, speed, precision, and rate than controls (p < 0.05). For coordination, the XDP group had a smaller ratio of pause duration during transitions when compared to controls. DISCUSSION To our knowledge, this study is the first to describe the motor speech characteristics of the mixed dystonia-parkinsonism phase of XDP. The motor speech of mixed dystonia-parkinsonism XDP is similar to prior characterizations of mixed hyperkinetic-hypokinetic dysarthria with noted differences in articulatory coordination, consistency, speed, precision, and rate from healthy controls. Identifying the motor speech components of all three phenotypes of XDP (i.e., dystonia-dominant phase, parkinsonism-dominant phase, and mixed dystonia-parkinsonism phase) is needed to establish markers of speech impairment to track disease progression.
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Affiliation(s)
- Tabitha H Kao
- MGH Institute of Health Professions, 36 1st Ave, Charlestown Navy Yard, Boston, MA, 02129, United States.
| | - Hannah P Rowe
- Department of Speech, Language, and Hearing Sciences, Boston University, 677 Beacon St, Boston, MA, 02215, United States.
| | - Jordan R Green
- MGH Institute of Health Professions, 36 1st Ave, Charlestown Navy Yard, Boston, MA, 02129, United States.
| | - Kaila L Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, 14214, United States.
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, United States; The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital, Charlestown, MA, 02129, United States.
| | - Jan K de Guzman
- Department of Neurology, Jose Reyes Memorial Medical Center, Manila, Metro Manila, 1012, Philippines; Sunshine Care Foundation, The Health Centrum, Roxas City, Capiz, 5800, Philippines.
| | - Melanie L Supnet-Wells
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, United States; The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital, Charlestown, MA, 02129, United States.
| | - Patrick Acuna
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, United States; The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital, Charlestown, MA, 02129, United States.
| | - Bridget J Perry
- MGH Institute of Health Professions, 36 1st Ave, Charlestown Navy Yard, Boston, MA, 02129, United States.
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Lankinen K, Wang R, Tian Q, Wang QM, Perry BJ, Green JR, Kimberley TJ, Ahveninen J, Li S. Individualized white matter connectivity of the articulatory pathway: An ultra-high field study. Brain Lang 2024; 250:105391. [PMID: 38354542 PMCID: PMC10940181 DOI: 10.1016/j.bandl.2024.105391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
In current sensorimotor theories pertaining to speech perception, there is a notable emphasis on the involvement of the articulatory-motor system in the processing of speech sounds. Using ultra-high field diffusion-weighted imaging at 7 Tesla, we visualized the white matter tracts connected to areas activated during a simple speech-sound production task in 18 healthy right-handed adults. Regions of interest for white matter tractography were individually determined through 7T functional MRI (fMRI) analyses, based on activations during silent vocalization tasks. These precentral seed regions, activated during the silent production of a lip-vowel sound, demonstrated anatomical connectivity with posterior superior temporal gyrus areas linked to the auditory perception of phonetic sounds. Our study provides a macrostructural foundation for understanding connections in speech production and underscores the central role of the articulatory motor system in speech perception. These findings highlight the value of ultra-high field 7T MR acquisition in unraveling the neural underpinnings of speech.
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Affiliation(s)
- Kaisu Lankinen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Ruopeng Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Qiyuan Tian
- Harvard Medical School, Boston, MA, United States
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the teaching affiliate of Harvard Medical School, Charlestown, MA, United States
| | - Bridget J Perry
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions Boston, MA, United States
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions Boston, MA, United States
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, United States
| | - Jyrki Ahveninen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Shasha Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Simeone PJ, Green JR, Tager-Flusberg H, Chenausky KV. Vowel distinctiveness as a concurrent predictor of expressive language function in autistic children. Autism Res 2024; 17:419-431. [PMID: 38348589 DOI: 10.1002/aur.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Speech ability may limit spoken language development in some minimally verbal autistic children. In this study, we aimed to determine whether an acoustic measure of speech production, vowel distinctiveness, is concurrently related to expressive language (EL) for autistic children. Syllables containing the vowels [i] and [a] were recorded remotely from 27 autistic children (4;1-7;11) with a range of spoken language abilities. Vowel distinctiveness was calculated using automatic formant tracking software. Robust hierarchical regressions were conducted with receptive language (RL) and vowel distinctiveness as predictors of EL. Hierarchical regressions were also conducted within a High EL and a Low EL subgroup. Vowel distinctiveness accounted for 29% of the variance in EL for the entire group, RL for 38%. For the Low EL group, only vowel distinctiveness was significant, accounting for 38% of variance in EL. Conversely, in the High EL group, only RL was significant and accounted for 26% of variance in EL. Replicating previous results, speech production and RL significantly predicted concurrent EL in autistic children, with speech production being the sole significant predictor for the Low EL group and RL the sole significant predictor for the High EL group. Further work is needed to determine whether vowel distinctiveness longitudinally, as well as concurrently, predicts EL. Findings have important implications for the early identification of language impairment and in developing language interventions for autistic children.
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Affiliation(s)
- Paul J Simeone
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Division of Allied health and Supportive Technology, May Institute, Randolph, Massachusetts, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Department of Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, College of Arts and Sciences, Boston University, Boston, Massachusetts, USA
| | - Karen V Chenausky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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Lankinen K, Ahveninen J, Uluç I, Daneshzand M, Mareyam A, Kirsch JE, Polimeni JR, Healy BC, Tian Q, Khan S, Nummenmaa A, Wang QM, Green JR, Kimberley TJ, Li S. Role of articulatory motor networks in perceptual categorization of speech signals: a 7T fMRI study. Cereb Cortex 2023; 33:11517-11525. [PMID: 37851854 PMCID: PMC10724868 DOI: 10.1093/cercor/bhad384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Speech and language processing involve complex interactions between cortical areas necessary for articulatory movements and auditory perception and a range of areas through which these are connected and interact. Despite their fundamental importance, the precise mechanisms underlying these processes are not fully elucidated. We measured BOLD signals from normal hearing participants using high-field 7 Tesla fMRI with 1-mm isotropic voxel resolution. The subjects performed 2 speech perception tasks (discrimination and classification) and a speech production task during the scan. By employing univariate and multivariate pattern analyses, we identified the neural signatures associated with speech production and perception. The left precentral, premotor, and inferior frontal cortex regions showed significant activations that correlated with phoneme category variability during perceptual discrimination tasks. In addition, the perceived sound categories could be decoded from signals in a region of interest defined based on activation related to production task. The results support the hypothesis that articulatory motor networks in the left hemisphere, typically associated with speech production, may also play a critical role in the perceptual categorization of syllables. The study provides valuable insights into the intricate neural mechanisms that underlie speech processing.
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Affiliation(s)
- Kaisu Lankinen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Jyrki Ahveninen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Işıl Uluç
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Mohammad Daneshzand
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Azma Mareyam
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
| | - John E Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Jonathan R Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA 02115, United States
- Department of Neurology, Harvard Medical School, Boston, MA 02115, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Qiyuan Tian
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Sheraz Khan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Aapo Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, The Teaching Affiliate of Harvard Medical School, Charlestown, MA 02129, United States
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129, United States
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, United States
| | - Shasha Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, United States
- Harvard Medical School, Boston, MA 02115, United States
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Gutz SE, Maffei MF, Green JR. Feedback From Automatic Speech Recognition to Elicit Clear Speech in Healthy Speakers. Am J Speech Lang Pathol 2023; 32:2940-2959. [PMID: 37824377 PMCID: PMC10721250 DOI: 10.1044/2023_ajslp-23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/10/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study assessed the effectiveness of feedback generated by automatic speech recognition (ASR) for eliciting clear speech from young, healthy individuals. As a preliminary step toward exploring a novel method for eliciting clear speech in patients with dysarthria, we investigated the effects of ASR feedback in healthy controls. If successful, ASR feedback has the potential to facilitate independent, at-home clear speech practice. METHOD Twenty-three healthy control speakers (ages 23-40 years) read sentences aloud in three speaking modes: Habitual, Clear (over-enunciated), and in response to ASR feedback (ASR). In the ASR condition, we used Mozilla DeepSpeech to transcribe speech samples and provide participants with a value indicating the accuracy of the ASR's transcription. For speakers who achieved sufficiently high ASR accuracy, noise was added to their speech at a participant-specific signal-to-noise ratio to ensure that each participant had to over-enunciate to achieve high ASR accuracy. RESULTS Compared to habitual speech, speech produced in the ASR and Clear conditions was clearer, as rated by speech-language pathologists, and more intelligible, per speech-language pathologist transcriptions. Speech in the Clear and ASR conditions aligned on several acoustic measures, particularly those associated with increased vowel distinctiveness and decreased speaking rate. However, ASR accuracy, intelligibility, and clarity were each correlated with different speech features, which may have implications for how people change their speech for ASR feedback. CONCLUSIONS ASR successfully elicited outcomes similar to clear speech in healthy speakers. Future work should investigate its efficacy in eliciting clear speech in people with dysarthria.
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Affiliation(s)
- Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
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Huynh DT, Tsolova KN, Watson AJ, Khal SK, Green JR, Li D, Hu J, Soderblom EJ, Chi JT, Evans CS, Boyce M. O-GlcNAcylation regulates neurofilament-light assembly and function and is perturbed by Charcot-Marie-Tooth disease mutations. Nat Commun 2023; 14:6558. [PMID: 37848414 PMCID: PMC10582078 DOI: 10.1038/s41467-023-42227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
The neurofilament (NF) cytoskeleton is critical for neuronal morphology and function. In particular, the neurofilament-light (NF-L) subunit is required for NF assembly in vivo and is mutated in subtypes of Charcot-Marie-Tooth (CMT) disease. NFs are highly dynamic, and the regulation of NF assembly state is incompletely understood. Here, we demonstrate that human NF-L is modified in a nutrient-sensitive manner by O-linked-β-N-acetylglucosamine (O-GlcNAc), a ubiquitous form of intracellular glycosylation. We identify five NF-L O-GlcNAc sites and show that they regulate NF assembly state. NF-L engages in O-GlcNAc-mediated protein-protein interactions with itself and with the NF component α-internexin, implying that O-GlcNAc may be a general regulator of NF architecture. We further show that NF-L O-GlcNAcylation is required for normal organelle trafficking in primary neurons. Finally, several CMT-causative NF-L mutants exhibit perturbed O-GlcNAc levels and resist the effects of O-GlcNAcylation on NF assembly state, suggesting a potential link between dysregulated O-GlcNAcylation and pathological NF aggregation. Our results demonstrate that site-specific glycosylation regulates NF-L assembly and function, and aberrant NF O-GlcNAcylation may contribute to CMT and other neurodegenerative disorders.
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Affiliation(s)
- Duc T Huynh
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kalina N Tsolova
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Abigail J Watson
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Sai Kwan Khal
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jordan R Green
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Di Li
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jimin Hu
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Erik J Soderblom
- Proteomics and Metabolomics Shared Resource, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jen-Tsan Chi
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Chantell S Evans
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Michael Boyce
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, 27710, USA.
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Daneshzand M, Lankinen K, Ahveninen J, Wang QM, Green JR, Kimberley TJ, Li S. Personalized 7T fMRI-Guided navigation TMS targeting: Preliminary data of speech-motor cortex in speech perception. Brain Stimul 2023; 16:1455-1457. [PMID: 37774914 PMCID: PMC10810261 DOI: 10.1016/j.brs.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Mohammad Daneshzand
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kaisu Lankinen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jyrki Ahveninen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, The Teaching Affiliate of Harvard Medical School, Charlestown, MA, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions Boston, MA, USA
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Shasha Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Bouvier L, Green JR, Tapia CB, Tilton-Bolowsky V, Maffei MF, Fless Z, Seaver K, Huynh A, Gutz SE, Martino R, Abrahao A, Berry J, Zinman L, Yunusova Y. Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote: Test-Retest and Interrater Reliability of Candidate Items. Am J Speech Lang Pathol 2023; 32:1884-1900. [PMID: 37494887 PMCID: PMC10561957 DOI: 10.1044/2023_ajslp-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/27/2022] [Accepted: 06/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The primary aim of this study was to establish the reliability of candidate items as a step in the development of the Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote (ALS-BDI-Remote), a novel tool being developed for the detection and monitoring of bulbar signs and symptoms in remote settings. METHOD The set of candidate items included 40 items covering three domains: cranial nerve examination, auditory-perceptual evaluation, and functional assessment. Forty-eight participants diagnosed with ALS and exhibiting a range of bulbar disease severity were included. Data collection for each participant took place on Zoom over three sessions. During Session 1, the participants were instructed to adjust their Zoom settings and to optimize their recording environment (e.g., lighting, background noise). Their cognition and eating were screened to determine their ability to follow instructions and their eligibility to perform the swallowing and chewing tasks. During Session 2, two speech-language pathologists (SLPs) administered the tool consecutively to determine the items' interrater reliability. During Session 3, one of the SLPs readministered the tool within 2 weeks of Session 1 to assess test-retest reliability. The reliability of each item was estimated using weighted kappa and the percentage of agreement. To be considered reliable, the items had to reach a threshold of 0.5 weighted kappa or 80% percentage agreement (if skewed distribution of the scores) for both interrater and test-retest reliability. RESULTS In total, 33 of the 40 candidate items reached the reliability cutoff for both reliability analyses. All assessment domains included reliable items. Items requiring very good visualization of structures or movements were generally less reliable. CONCLUSIONS This study resulted in the selection of reliable items to be included in the next version of the ALS-BDI-Remote, which will undergo psychometric evaluation (reliability, validity, and responsiveness analyses). Additionally, the results contributed to our understanding of the remote administration of SLP assessments for telehealth applications.
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Affiliation(s)
- Liziane Bouvier
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Carolina Barnett Tapia
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Victoria Tilton-Bolowsky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Zuzana Fless
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Katie Seaver
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Anna Huynh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Rosemary Martino
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Lorne Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yana Yunusova
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
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11
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Teplansky KJ, Wisler A, Green JR, Heitzman D, Austin S, Wang J. Measuring Articulatory Patterns in Amyotrophic Lateral Sclerosis Using a Data-Driven Articulatory Consonant Distinctiveness Space Approach. J Speech Lang Hear Res 2023; 66:3076-3088. [PMID: 36787156 PMCID: PMC10555455 DOI: 10.1044/2022_jslhr-22-00320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 05/20/2023]
Abstract
PURPOSE The aim of this study was to leverage data-driven approaches, including a novel articulatory consonant distinctiveness space (ACDS) approach, to better understand speech motor control in amyotrophic lateral sclerosis (ALS). METHOD Electromagnetic articulography was used to record tongue and lip movement data during the production of 10 consonants from healthy controls (n = 15) and individuals with ALS (n = 47). To assess phoneme distinctness, speech data were analyzed using two classification algorithms, Procrustes matching (PM) and support vector machine (SVM), and the area/volume of the ACDS. Pearson's correlation coefficient was used to examine the relationship between bulbar impairment and the ACDS. Analysis of variance was used to examine the effects of bulbar impairment on consonant distinctiveness and consonant classification accuracies in clinical subgroups. RESULTS There was a significant relationship between the ACDS and intelligible speaking rate (area, p = .003; volume, p = .010), and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore (area, p = .009; volume, p = .027). Consonant classification performance followed a consistent pattern with bulbar severity, where consonants produced by speakers with more severe ALS were classified less accurately (SVM = 75.27%; PM = 74.54%) than the healthy, asymptomatic, and mild-moderate groups. In severe ALS, area of the ACDS was significantly condensed compared to both asymptomatic (p = .004) and mild-moderate (p = .013) groups. There was no statistically significant difference in area between the severe ALS group and healthy speakers (p = .292). CONCLUSIONS Our comprehensive approach is sensitive to early oromotor changes in response due to disease progression. The preserved articulatory consonant space may capture the use of compensatory adaptations to counteract influences of neurodegeneration. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22044320.
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Affiliation(s)
- Kristin J. Teplansky
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Alan Wisler
- Mathematics and Statistics Department, Utah State University, Logan
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Boston, MA
| | | | - Sara Austin
- Department of Neurology, The University of Texas at Austin
| | - Jun Wang
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Department of Neurology, The University of Texas at Austin
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12
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Rowe HP, Shellikeri S, Yunusova Y, Chenausky KV, Green JR. Quantifying articulatory impairments in neurodegenerative motor diseases: A scoping review and meta-analysis of interpretable acoustic features. Int J Speech Lang Pathol 2023; 25:486-499. [PMID: 36001500 PMCID: PMC9950294 DOI: 10.1080/17549507.2022.2089234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Neurodegenerative motor diseases (NMDs) have devastating effects on the lives of patients and their loved ones, in part due to the impact of neurologic abnormalities on speech, which significantly limits functional communication. Clinical speech researchers have thus spent decades investigating speech features in populations suffering from NMDs. Features of impaired articulatory function are of particular interest given their detrimental impact on intelligibility, their ability to encode a variety of distinct movement disorders, and their potential as diagnostic indicators of neurodegenerative diseases. The objectives of this scoping review were to identify (1) which components of articulation (i.e. coordination, consistency, speed, precision, and repetition rate) are the most represented in the acoustic literature on NMDs; (2) which acoustic articulatory features demonstrate the most potential for detecting speech motor dysfunction in NMDs; and (3) which articulatory components are the most impaired within each NMD. METHOD This review examined literature published between 1976 and 2020. Studies were identified from six electronic databases using predefined key search terms. The first research objective was addressed using a frequency count of studies investigating each articulatory component, while the second and third objectives were addressed using meta-analyses. RESULT Findings from 126 studies revealed a considerable emphasis on articulatory precision. Of the 24 features included in the meta-analyses, vowel dispersion/distance and stop gap duration exhibited the largest effects when comparing the NMD population to controls. The meta-analyses also revealed divergent patterns of articulatory performance across disease types, providing evidence of unique profiles of articulatory impairment. CONCLUSION This review illustrates the current state of the literature on acoustic articulatory features in NMDs. By highlighting the areas of need within each articulatory component and disease group, this work provides a foundation on which clinical researchers, speech scientists, neurologists, and computer science engineers can develop research questions that will both broaden and deepen the understanding of articulatory impairments in NMDs.
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Affiliation(s)
- Hannah P Rowe
- MGH Institute of Health Professions, Boston, MA, USA
| | - Sanjana Shellikeri
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Karen V Chenausky
- MGH Institute of Health Professions, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA, and
| | - Jordan R Green
- MGH Institute of Health Professions, Boston, MA, USA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, USA
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13
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Richter V, Neumann M, Green JR, Richburg B, Roesler O, Kothare H, Ramanarayanan V. Remote Assessment for ALS using Multimodal Dialog Agents: Data Quality, Feasibility and Task Compliance. Interspeech 2023; 2023:5441-5445. [PMID: 37791043 PMCID: PMC10547018 DOI: 10.21437/interspeech.2023-2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We investigate the feasibility, task compliance and audiovisual data quality of a multimodal dialog-based solution for remote assessment of Amyotrophic Lateral Sclerosis (ALS). 53 people with ALS and 52 healthy controls interacted with Tina, a cloud-based conversational agent, in performing speech tasks designed to probe various aspects of motor speech function while their audio and video was recorded. We rated a total of 250 recordings for audio/video quality and participant task compliance, along with the relative frequency of different issues observed. We observed excellent compliance (98%) and audio (95.2%) and visual quality rates (84.8%), resulting in an overall yield of 80.8% recordings that were both compliant and of high quality. Furthermore, recording quality and compliance were not affected by level of speech severity and did not differ significantly across end devices. These findings support the utility of dialog systems for remote monitoring of speech in ALS.
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14
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Lankinen K, Ahveninen J, Uluç I, Daneshzand M, Mareyam A, Kirsch JE, Polimeni JR, Healy BC, Tian Q, Khan S, Nummenmaa A, Wang QM, Green JR, Kimberley TJ, Li S. Role of Articulatory Motor Networks in Perceptual Categorization of Speech Signals: A 7 T fMRI Study. bioRxiv 2023:2023.07.02.547409. [PMID: 37461673 PMCID: PMC10349975 DOI: 10.1101/2023.07.02.547409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
BACKGROUND The association between brain regions involved in speech production and those that play a role in speech perception is not yet fully understood. We compared speech production related brain activity with activations resulting from perceptual categorization of syllables using high field 7 Tesla functional magnetic resonance imaging (fMRI) at 1-mm isotropic voxel resolution, enabling high localization accuracy compared to previous studies. METHODS Blood oxygenation level dependent (BOLD) signals were obtained in 20 normal hearing subjects using a simultaneous multi-slice (SMS) 7T echo-planar imaging (EPI) acquisition with whole-head coverage and 1 mm isotropic resolution. In a speech production localizer task, subjects were asked to produce a silent lip-round vowel /u/ in response to the visual cue "U" or purse their lips when they saw the cue "P". In a phoneme discrimination task, subjects were presented with pairs of syllables, which were equiprobably identical or different along an 8-step continuum between the prototypic /ba/ and /da/ sounds. After the presentation of each stimulus pair, the subjects were asked to indicate whether the two syllables they heard were identical or different by pressing one of two buttons. In a phoneme classification task, the subjects heard only one syllable and asked to indicate whether it was /ba/ or /da/. RESULTS Univariate fMRI analyses using a parametric modulation approach suggested that left motor, premotor, and frontal cortex BOLD activations correlate with phoneme category variability in the /ba/-/da/ discrimination task. In contrast, the variability related to acoustic features of the phonemes were the highest in the right primary auditory cortex. Our multivariate pattern analysis (MVPA) suggested that left precentral/inferior frontal cortex areas, which were associated with speech production according to the localizer task, play a role also in perceptual categorization of the syllables. CONCLUSIONS The results support the hypothesis that articulatory motor networks in the left hemisphere that are activated during speech production could also have a role in perceptual categorization of syllables. Importantly, high voxel-resolution combined with advanced coil technology allowed us to pinpoint the exact brain regions involved in both perception and production tasks.
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Affiliation(s)
- Kaisu Lankinen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Jyrki Ahveninen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Işıl Uluç
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Mohammad Daneshzand
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Azma Mareyam
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
| | - John E. Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Jonathan R. Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Brian C. Healy
- Harvard Medical School, Boston, MA, US
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the teaching affiliate of Harvard Medical School, Charlestown, MA, US
| | - Qiyuan Tian
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Sheraz Khan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Aapo Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Qing-mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the teaching affiliate of Harvard Medical School, Charlestown, MA, US
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions Boston, MA, US
| | - Teresa J. Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, US
| | - Shasha Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
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15
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Acuna P, Supnet-Wells ML, Spencer NA, de Guzman JK, Russo M, Hunt A, Stephen C, Go C, Carr S, Ganza NG, Lagarde JB, Begalan S, Multhaupt-Buell T, Aldykiewicz G, Paul L, Ozelius L, Bragg DC, Perry B, Green JR, Miller JW, Sharma N. Establishing a natural history of X-linked dystonia parkinsonism. Brain Commun 2023. [DOI: 10.1093/braincomms/fcad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Abstract
X-linked dystonia parkinsonism is a neurodegenerative movement disorder that affects men whose mothers originate from the island of Panay, Philippines. Current evidence indicates that the most likely cause is an expansion in the TAF1 gene that may be amenable to treatment. To prepare for clinical trials of therapeutic candidates for X-linked dystonia parkinsonism, we focused on the identification of quantitative phenotypic measures that are most strongly associated with disease progression. Our main objective is to establish a comprehensive, quantitative assessment of movement dysfunction and bulbar motor impairments that are sensitive and specific to disease progression in persons with X-linked dystonia parkinsonism. These measures will set the stage for future treatment trials. We enrolled patients with X-linked dystonia parkinsonism and performed a comprehensive oromotor, speech, and neurological assessment. Measurements included patient-reported questionnaires regarding daily living activities and both neurologist-rated movement scales and objective quantitative measures of bulbar function and nutritional status. Patients were followed for 18 months from the date of enrollment and evaluated every 6 months during that period. We analyzed a total of 87 men: 29 were gene positive and had symptoms at enrollment, 7 were gene positive and had no symptoms at enrollment, and 51 were gene negative. We identified measures that displayed a significant change over the study. We used principal variables analysis to identify a minimal battery of 21 measures that explains 67.3% of the variance over the course of the study. These measures included patient-reported, clinician-rated, and objective quantitative outcomes that may serve as endpoints in future clinical trials.
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Affiliation(s)
- Patrick Acuna
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
- Sunshine Care Foundation , The Health Centrum, Roxas City, Capiz, 5800 Philippines
| | - Melanie Leigh Supnet-Wells
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
| | - Neil A Spencer
- Department of Statistics, University of Connecticut , Storrs, CT, 06269 , USA
| | - Jan Kristoper de Guzman
- Department of Neurology, Jose Reyes Memorial Medical Center , Manila, Metro Manila, 1012 Philippines
- Sunshine Care Foundation , The Health Centrum, Roxas City, Capiz, 5800 Philippines
| | - Massimiliano Russo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School , Boston, MA, 02115 , USA
| | - Ann Hunt
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
| | - Christopher Stephen
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
| | - Criscely Go
- Department of Neurology, Jose Reyes Memorial Medical Center , Manila, Metro Manila, 1012 Philippines
| | - Samuel Carr
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
| | - Niecy Grace Ganza
- Sunshine Care Foundation , The Health Centrum, Roxas City, Capiz, 5800 Philippines
| | | | - Shin Begalan
- Sunshine Care Foundation , The Health Centrum, Roxas City, Capiz, 5800 Philippines
| | - Trisha Multhaupt-Buell
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
| | - Gabrielle Aldykiewicz
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
| | - Lisa Paul
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
| | - D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
| | - Bridget Perry
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions , Charlestown, MA, 02129 , USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions , Charlestown, MA, 02129 , USA
| | - Jeffrey W Miller
- Department of Biostatistics, Harvard T.H. Chan School of Public Health , Boston, MA, 02115 , USA
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, MA, 02114 , USA
- The Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital , Charlestown, MA, 02129 , USA
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Maffei MF, Chenausky KV, Gill SV, Tager-Flusberg H, Green JR. Oromotor skills in autism spectrum disorder: A scoping review. Autism Res 2023; 16:879-917. [PMID: 37010327 PMCID: PMC10365059 DOI: 10.1002/aur.2923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
Oromotor functioning plays a foundational role in spoken communication and feeding, two areas of significant difficulty for many autistic individuals. However, despite years of research and established differences in gross and fine motor skills in this population, there is currently no clear consensus regarding the presence or nature of oral motor control deficits in autistic individuals. In this scoping review, we summarize research published between 1994 and 2022 to answer the following research questions: (1) What methods have been used to investigate oromotor functioning in autistic individuals? (2) Which oromotor behaviors have been investigated in this population? and (3) What conclusions can be drawn regarding oromotor skills in this population? Seven online databases were searched resulting in 107 studies meeting our inclusion criteria. Included studies varied widely in sample characteristics, behaviors analyzed, and research methodology. The large majority (81%) of included studies report a significant oromotor abnormality related to speech production, nonspeech oromotor skills, or feeding within a sample of autistic individuals based on age norms or in comparison to a control group. We examine these findings to identify trends, address methodological aspects hindering cross-study synthesis and generalization, and provide suggestions for future research.
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Affiliation(s)
- Marc F Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Karen V Chenausky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Neurology Department, Harvard Medical School, Boston, Massachusetts, USA
| | - Simone V Gill
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, Massachusetts, USA
| | - Helen Tager-Flusberg
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, Massachusetts, USA
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17
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Maffei MF, Green JR, Murton O, Yunusova Y, Rowe HP, Wehbe F, Diana K, Nicholson K, Berry JD, Connaghan KP. Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2023; 66:872-887. [PMID: 36802910 PMCID: PMC10205101 DOI: 10.1044/2022_jslhr-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.
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Affiliation(s)
- Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
| | - Olivia Murton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kathleen Diana
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - James D. Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Chenausky KV, Baas B, Stoeckel R, Brown T, Green JR, Runke C, Schimmenti L, Clark H. Comorbidity and Severity in Childhood Apraxia of Speech: A Retrospective Chart Review. J Speech Lang Hear Res 2023; 66:791-803. [PMID: 36795544 PMCID: PMC10205100 DOI: 10.1044/2022_jslhr-22-00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate comorbidity prevalence and patterns in childhood apraxia of speech (CAS) and their relationship to severity. METHOD In this retroactive cross-sectional study, medical records for 375 children with CAS (M age = 4;9 [years;months], SD = 2;9) were examined for comorbid conditions. The total number of comorbid conditions and the number of communication-related comorbidities were regressed on CAS severity as rated by speech-language pathologists during diagnosis. The relationship between CAS severity and the presence of four common comorbid conditions was also examined using ordinal or multinomial regressions. RESULTS Overall, 83 children were classified with mild CAS; 35, with moderate CAS; and 257, with severe CAS. Only one child had no comorbidities. The average number of comorbid conditions was 8.4 (SD = 3.4), and the average number of communication-related comorbidities was 5.6 (SD = 2.2). Over 95% of children had comorbid expressive language impairment. Children with comorbid intellectual disability (78.1%), receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia) were significantly more likely to have severe CAS than children without these comorbidities. However, children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism. CONCLUSIONS Comorbidity appears to be the rule, rather than the exception, for children with CAS. Comorbid intellectual disability, receptive language impairment, and nonspeech apraxia confer additional risk for more severe forms of CAS. Findings are limited by being from a convenience sample of participants but inform future models of comorbidity. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22096622.
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Affiliation(s)
- Karen V. Chenausky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Becky Baas
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Ruth Stoeckel
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Taylor Brown
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
| | - Cassandra Runke
- Departments of Clinical Genomics, Otolaryngology—Head and Neck Surgery, Ophthalmology, and Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN
| | - Lisa Schimmenti
- Departments of Clinical Genomics, Otolaryngology—Head and Neck Surgery, Ophthalmology, and Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN
| | - Heather Clark
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, MN
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Chenausky KV, Maffei M, Tager-Flusberg H, Green JR. Review of methods for conducting speech research with minimally verbal individuals with autism spectrum disorder. Augment Altern Commun 2023; 39:33-44. [PMID: 36345836 PMCID: PMC10364318 DOI: 10.1080/07434618.2022.2120071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this paper was to review best-practice methods of collecting and analyzing speech production data from minimally verbal autistic speakers. Data on speech production data in minimally verbal individuals are valuable for a variety of purposes, including phenotyping, clinical assessment, and treatment monitoring. Both perceptual ("by ear") and acoustic analyses of speech can reveal subtle improvements as a result of therapy that may not be apparent when correct/incorrect judgments are used. Key considerations for collecting and analyzing speech production data from this population are reviewed. The definition of "minimally verbal" that is chosen will vary depending on the specific hypotheses investigated, as will the stimuli to be collected and the task(s) used to elicit them. Perceptual judgments are ecologically valid but subject to known sources of bias; therefore, training and reliability procedures for perceptual analyses are addressed, including guidelines on how to select vocalizations for inclusion or exclusion. Factors to consider when recording and acoustically analyzing speech are also briefly discussed. In summary, the tasks, stimuli, training methods, analysis type(s), and level of detail that yield the most reliable data to answer the question should be selected. It is possible to obtain rich high-quality data even from speakers with very little speech output. This information is useful not only for research but also for clinical decision-making and progress monitoring.
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Affiliation(s)
- Karen V. Chenausky
- MGH Institute of Health Professions, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Marc Maffei
- MGH Institute of Health Professions, Charlestown, MA, USA
| | - Helen Tager-Flusberg
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jordan R. Green
- MGH Institute of Health Professions, Charlestown, MA, USA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Boston, MA, USA
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Yunusova Y, Waito A, Barnett Tapia C, Huynh A, Martino R, Abrahao A, Pattee GL, Berry JD, Zinman L, Green JR. Face and content validation of the amyotrophic lateral sclerosis-Bulbar dysfunction index (ALS-BDI). Front Neurol 2023; 13:1078612. [PMID: 36686519 PMCID: PMC9849694 DOI: 10.3389/fneur.2022.1078612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Early detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Existing physiological assessments of bulbar dysfunction are often inaccessible and cost-prohibitive for clinical application. Existing clinical assessments are limited. The overall goal of our research is to develop a brief and reliable, clinician-administered assessment tool, the ALS Bulbar Dysfunction Index (ALS-BDI) to evaluate bulbar dysfunction. The aim of this study was to establish content and face validity of the ALS-BDI through item generation and reduction, including item scoring. Methods The design of the ALS-BDI followed guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The design stage of the ALS-BDI involved two steps: (Step 1) the generation of candidate items from a literature review of commonly used clinical tools, and selection of items following a review of item reliability and item relevance and expert consensus; (Step 2) the assessment of their content and face validity via online survey feedback from experts (n = 35). The initial design was followed by a semi-structured cognitive interview with Speech-Language Pathologists (n = 5) to finalize a testable draft of the instrument. Results Two drafts of the ALS-BDI were developed. The first draft contained 48 items, after a review of existing clinical tools for their relevance to bulbar dysfunction in ALS. Of the 48 items, 35 items were retained after surveying experts and clinician users for their relevance, feasibility, interpretability, and appropriateness. The second draft of the ALS-BDI contained 37 items, due to one item splitting, based on users cognitive interviews. Conclusions The ALS-BDI described in this study aims to provide a brief and reliable, clinician-administered assessment tool to evaluate bulbar dysfunction in patients with ALS. Future research will evaluate the psychometric properties of this tool including its reliability, validity, and responsiveness to change over time.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,KITE – University Health Network, Toronto, ON, Canada,*Correspondence: Yana Yunusova ✉
| | - Ashley Waito
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Carolina Barnett Tapia
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anna Huynh
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,KITE – University Health Network, Toronto, ON, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, ON, Canada,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, MA, United States
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States,Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA, United States
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Matsumoto R, Murakumo K, Nozu R, Acuña-Marrero D, Green JR, Pierce SJ, Rohner CA, Reyes H, Green SM, Dove ADM, Torres ML, Hearn AR. Underwater ultrasonography and blood sampling provide the first observations of reproductive biology in free-swimming whale sharks. ENDANGER SPECIES RES 2023. [DOI: 10.3354/esr01226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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22
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Perry BJ, Eshghi M, Stipancic KL, Richburg B, Ventresca H, Pomahac B, Green JR. Longitudinal Recovery of Speech Motor Function Following Facial Transplantation: A Prospective Observational Study. Laryngoscope 2022; 132:2359-2367. [PMID: 35218215 PMCID: PMC9402794 DOI: 10.1002/lary.30068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Although facial transplantation is considered effective for restoring facial appearance, research on speech outcomes following surgery is limited. More research is critically needed to inform patients of expected rates and extent of recovery, and to develop interventions aimed at improving speech outcomes. METHODS Four patients in early recovery (3 weeks-24 months postsurgery) and three patients in late recovery (36-60 months postsurgery) were included. Clinical measures of speech recovery, including speech intelligibility measured using the Sentence Intelligibility Test, a lip strength testing device (Iowa Oral Performance Instrument), and kinematic measures of lip and jaw function measured using high-resolution 3D optical motion capture were used to describe the rate and extent of functional speech and lip recovery, describe and compare the rate of functional speech recovery and kinematic lip and jaw changes in early and late stages of recovery, and explore the association between kinematic measures and functional speech. RESULTS Speech intelligibility, speaking rate, and lip strength were below normative values in the first 2 years of postsurgery. Participants in the first 2 years of recovery demonstrated steeper slopes of improvement in clinical and kinematic measures than participants in the later stages of recovery (36-64 months). Gains in jaw range of movement and gains in lip speed and range of movement were significantly correlated with rates of sentence intelligibility improvement. Gains in lip strength were not associated with functional speech improvement. CONCLUSIONS These findings motivate ongoing work aimed at developing interventions for improving motor speech function in this population. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2359-2367, 2022.
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Affiliation(s)
- Bridget J. Perry
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.,Brigham and Women's HospitalDepartment of Plastic and Reconstructive Surgery, BostonBostonMassachusettsU.S.A.
| | - Marziye Eshghi
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.,Massachusetts General HospitalAthinoula A. Martinos Center for Biomedical Imaging, MGHBostonMassachusettsU.S.A.
| | - Kaila L. Stipancic
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.,University at BuffaloDepartment of Communication Sciences and DisordersBuffaloNew YorkU.S.A.
| | - Brian Richburg
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.
| | - Hayden Ventresca
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.
| | - Bohdan Pomahac
- Brigham and Women's HospitalDepartment of Plastic and Reconstructive Surgery, BostonBostonMassachusettsU.S.A.
| | - Jordan R. Green
- MGH Institute of Health ProfessionsDepartment of Communication Sciences and DisordersBostonMassachusettsU.S.A.
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Gutz SE, Rowe HP, Tilton-Bolowsky VE, Green JR. Speaking with a KN95 face mask: a within-subjects study on speaker adaptation and strategies to improve intelligibility. Cogn Res Princ Implic 2022; 7:73. [PMID: 35907167 PMCID: PMC9339031 DOI: 10.1186/s41235-022-00423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Mask-wearing during the COVID-19 pandemic has prompted a growing interest in the functional impact of masks on speech and communication. Prior work has shown that masks dampen sound, impede visual communication cues, and reduce intelligibility. However, more work is needed to understand how speakers change their speech while wearing a mask and to identify strategies to overcome the impact of wearing a mask. Data were collected from 19 healthy adults during a single in-person session. We investigated the effects of wearing a KN95 mask on speech intelligibility, as judged by two speech-language pathologists, examined speech kinematics and acoustics associated with mask-wearing, and explored KN95 acoustic filtering. We then considered the efficacy of three speaking strategies to improve speech intelligibility: Loud, Clear, and Slow speech. To inform speaker strategy recommendations, we related findings to self-reported speaker effort. Results indicated that healthy speakers could compensate for the presence of a mask and achieve normal speech intelligibility. Additionally, we showed that speaking loudly or clearly—and, to a lesser extent, slowly—improved speech intelligibility. However, using these strategies may require increased physical and cognitive effort and should be used only when necessary. These results can inform recommendations for speakers wearing masks, particularly those with communication disorders (e.g., dysarthria) who may struggle to adapt to a mask but can respond to explicit instructions. Such recommendations may further help non-native speakers and those communicating in a noisy environment or with listeners with hearing loss.
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Rowe HP, Gochyyev P, Lammert AC, Lowit A, Spencer KA, Dickerson BC, Berry JD, Green JR. The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates. J Neural Transm (Vienna) 2022; 129:1487-1511. [PMID: 36305960 PMCID: PMC9859630 DOI: 10.1007/s00702-022-02550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023]
Abstract
Despite the impacts of neurodegeneration on speech function, little is known about how to comprehensively characterize the resulting speech abnormalities using a set of objective measures. Quantitative phenotyping of speech motor impairments may have important implications for identifying clinical syndromes and their underlying etiologies, monitoring disease progression over time, and improving treatment efficacy. The goal of this research was to investigate the validity and classification accuracy of comprehensive acoustic-based articulatory phenotypes in speakers with distinct neurodegenerative diseases. Articulatory phenotypes were characterized based on acoustic features that were selected to represent five components of motor performance: Coordination, Consistency, Speed, Precision, and Rate. The phenotypes were first used to characterize the articulatory abnormalities across four progressive neurologic diseases known to have divergent speech motor deficits: amyotrophic lateral sclerosis (ALS), progressive ataxia (PA), Parkinson's disease (PD), and the nonfluent variant of primary progressive aphasia and progressive apraxia of speech (nfPPA + PAOS). We then examined the efficacy of articulatory phenotyping for disease classification. Acoustic analyses were conducted on audio recordings of 217 participants (i.e., 46 ALS, 52 PA, 60 PD, 20 nfPPA + PAOS, and 39 controls) during a sequential speech task. Results revealed evidence of distinct articulatory phenotypes for the four clinical groups and that the phenotypes demonstrated strong classification accuracy for all groups except ALS. Our results highlight the phenotypic variability present across neurodegenerative diseases, which, in turn, may inform (1) the differential diagnosis of neurological diseases and (2) the development of sensitive outcome measures for monitoring disease progression or assessing treatment efficacy.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA
| | - Perman Gochyyev
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA, USA
- Berkeley Evaluation and Assessment Research Center, University of California at Berkeley, Berkeley, CA, USA
| | - Adam C Lammert
- Department of Biomedical Engineering, Worchester Polytechnic Institute, Worcester, MA, USA
| | - Anja Lowit
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, Scotland, UK
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James D Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA.
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Cordella C, Gutz SE, Eshghi M, Stipancic KL, Schliep M, Dickerson BC, Green JR. Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies. J Speech Lang Hear Res 2022; 65:4112-4132. [PMID: 36306508 PMCID: PMC9940887 DOI: 10.1044/2022_jslhr-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21401778.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | | | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Teplansky KJ, Wisler A, Green JR, Campbell T, Heitzman D, Austin SG, Wang J. Tongue and Lip Acceleration as a Measure of Speech Decline in Amyotrophic Lateral Sclerosis. Folia Phoniatr Logop 2022; 75:23-34. [PMID: 35760064 PMCID: PMC9792632 DOI: 10.1159/000525514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/02/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The goal of this study was to examine the efficacy of acceleration-based articulatory measures in characterizing the decline in speech motor control due to amyotrophic lateral sclerosis (ALS). METHOD Electromagnetic articulography was used to record tongue and lip movements during the production of 20 phrases. Data were collected from 50 individuals diagnosed with ALS. Articulatory kinematic variability was measured using the spatiotemporal index of both instantaneous acceleration and speed signals. Linear regression models were used to analyze the relationship between variability measures and intelligible speaking rate (a clinical measure of disease progression). A machine learning algorithm (support vector regression, SVR) was used to assess whether acceleration or speed features (e.g., mean, median, maximum) showed better performance at predicting speech severity in patients with ALS. RESULTS As intelligible speaking rate declined, the variability of acceleration of tongue and lip movement patterns significantly increased (p < 0.001). The variability of speed and vertical displacement did not significantly predict speech performance measures. Additionally, based on R2 and root mean square error (RMSE) values, the SVR model was able to predict speech severity more accurately from acceleration features (R2 = 0.601, RMSE = 38.453) and displacement features (R2 = 0.218, RMSE = 52.700) than from speed features (R2 = 0.554, RMSE = 40.772). CONCLUSION Results from these models highlight differences in speech motor control in participants with ALS. The variability in acceleration of tongue and lip movements increases as speech performance declines, potentially reflecting physiological deviations due to the progression of ALS. Our findings suggest that acceleration is a more sensitive indicator of speech deterioration due to ALS than displacement and speed and may contribute to improved algorithm designs for monitoring disease progression from speech signals.
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Affiliation(s)
- Kristin J Teplansky
- Speech, Language, and Hearing Sciences, University of Texas, Austin, Texas, USA,
| | - Alan Wisler
- Mathematics and Statistics, Utah State University, Logan, Utah, USA
| | - Jordan R Green
- Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Boston, Massachusetts, USA
| | - Thomas Campbell
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, Texas, USA
| | | | - Sara G Austin
- Neurology, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Jun Wang
- Speech, Language, and Hearing Sciences, University of Texas, Austin, Texas, USA
- Neurology, Dell Medical School, University of Texas, Austin, Texas, USA
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Gutz SE, Stipancic KL, Yunusova Y, Berry JD, Green JR. Validity of Off-the-Shelf Automatic Speech Recognition for Assessing Speech Intelligibility and Speech Severity in Speakers With Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2022; 65:2128-2143. [PMID: 35623334 PMCID: PMC9567308 DOI: 10.1044/2022_jslhr-21-00589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE There is increasing interest in using automatic speech recognition (ASR) systems to evaluate impairment severity or speech intelligibility in speakers with dysarthria. We assessed the clinical validity of one currently available off-the-shelf (OTS) ASR system (i.e., a Google Cloud ASR API) for indexing sentence-level speech intelligibility and impairment severity in individuals with amyotrophic lateral sclerosis (ALS), and we provided guidance for potential users of such systems in research and clinic. METHOD Using speech samples collected from 52 individuals with ALS and 20 healthy control speakers, we compared word recognition rate (WRR) from the commercially available Google Cloud ASR API (Machine WRR) to clinician-provided judgments of impairment severity, as well as sentence intelligibility (Human WRR). We assessed the internal reliability of Machine and Human WRR by comparing the standard deviation of WRR across sentences to the minimally detectable change (MDC), a clinical benchmark that indicates whether results are within measurement error. We also evaluated Machine and Human WRR diagnostic accuracy for classifying speakers into clinically established categories. RESULTS Human WRR achieved better accuracy than Machine WRR when indexing speech severity, and, although related, Human and Machine WRR were not strongly correlated. When the speech signal was mixed with noise (noise-augmented ASR) to reduce a ceiling effect, Machine WRR performance improved. Internal reliability metrics were worse for Machine than Human WRR, particularly for typical and mildly impaired severity groups, although sentence length significantly impacted both Machine and Human WRRs. CONCLUSIONS Results indicated that the OTS ASR system was inadequate for early detection of speech impairment and grading overall speech severity. While Machine and Human WRR were correlated, ASR should not be used as a one-to-one proxy for transcription speech intelligibility or clinician severity ratings. Overall, findings suggested that the tested OTS ASR system, Google Cloud ASR, has limited utility for grading clinical speech impairment in speakers with ALS.
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Affiliation(s)
- Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston
| | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Rowe HP, Gutz SE, Maffei MF, Tomanek K, Green JR. Characterizing Dysarthria Diversity for Automatic Speech Recognition: A Tutorial from the Clinical Perspective. Front Comput Sci 2022; 4:770210. [PMID: 37860708 PMCID: PMC10586392 DOI: 10.3389/fcomp.2022.770210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Despite significant advancements in automatic speech recognition (ASR) technology, even the best performing ASR systems are inadequate for speakers with impaired speech. This inadequacy may be, in part, due to the challenges associated with acquiring a sufficiently diverse training sample of disordered speech. Speakers with dysarthria, which refers to a group of divergent speech disorders secondary to neurologic injury, exhibit highly variable speech patterns both within and across individuals. This diversity is currently poorly characterized and, consequently, difficult to adequately represent in disordered speech ASR corpora. In this paper, we consider the variable expressions of dysarthria within the context of established clinical taxonomies (e.g., Darley, Aronson, and Brown dysarthria subtypes). We also briefly consider past and recent efforts to capture this diversity quantitatively using speech analytics. Understanding dysarthria diversity from the clinical perspective and how this diversity may impact ASR performance could aid in (1) optimizing data collection strategies for minimizing bias; (2) ensuring representative ASR training sets; and (3) improving generalization of ASR across users and performance for difficult-to-recognize speakers. Our overarching goal is to facilitate the development of robust ASR systems for dysarthric speech using clinical knowledge.
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Affiliation(s)
- Hannah P. Rowe
- MGH Institute of Health Professions, Department of Rehabilitation Sciences, Boston, MA, United States
| | - Sarah E. Gutz
- Harvard University, Department of Speech and Hearing Bioscience and Technology, Boston, MA, United States
| | - Marc F. Maffei
- MGH Institute of Health Professions, Department of Rehabilitation Sciences, Boston, MA, United States
| | | | - Jordan R. Green
- MGH Institute of Health Professions, Department of Rehabilitation Sciences, Boston, MA, United States
- Harvard University, Department of Speech and Hearing Bioscience and Technology, Boston, MA, United States
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Tanchip C, Guarin DL, McKinlay S, Barnett C, Kalra S, Genge A, Korngut L, Green JR, Berry J, Zinman L, Yadollahi A, Abrahao A, Yunusova Y. Validating Automatic Diadochokinesis Analysis Methods Across Dysarthria Severity and Syllable Task in Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2022; 65:940-953. [PMID: 35171700 PMCID: PMC9150739 DOI: 10.1044/2021_jslhr-21-00503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Oral diadochokinesis (DDK) is a standard dysarthria assessment task. To extract automatic and semi-automatic DDK measurements, numerous DDK analysis algorithms based on acoustic signal processing are available, including amplitude based, spectral based, and hybrid. However, these algorithms have been predominantly validated in individuals with no perceptible to mild dysarthria. The behavior of these algorithms across dysarthria severity is largely unknown. Likewise, these algorithms have not been tested equally for various syllable types. The goal of this study was to evaluate the performance of five common DDK algorithms as a function of dysarthria severity, considering syllable types. METHOD We analyzed 282 DDK recordings of /ba/, /pa/, and /ta/ from 145 participants with amyotrophic lateral sclerosis. Recordings were stratified into mild, moderate, or severe dysarthria groups based on individual performance on the Speech Intelligibility Test. Analysis included manual and automatic estimation of the number of syllables, DDK rate, and cycle-to-cycle temporal variability (cTV). Validation metrics included Bland-Altman mixed-effects limits of agreement between manual and automatic syllable counts, recall and precision between manual and automatic syllable boundary detection, and Kendall's tau-b correlations between manual and algorithm-detected DDK rate and cTV. RESULTS The amplitude-based algorithm (absolute energy) yielded the strongest correlations with manual analysis across all severity groups for DDK rate (τ b = 0.7-0.84) and cTV (τ b = 0.7-0.84) and the narrowest limits of agreement (-5.92 to 7.12 syllable difference). Moreover, this algorithm also provided the highest mean recall and precision across severity groups for /ba/ and /pa/, but with significantly more variation for/ta/. CONCLUSIONS Algorithms based on signal energy analysis appeared to be the most robust for DDK analysis across dysarthria severity and syllable types; however, it remains prone to error against severe dysarthria and alveolar syllable context. Further development is needed to address this important issue.
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Affiliation(s)
- Chelsea Tanchip
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Diego L. Guarin
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne
| | - Scotia McKinlay
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Ontario, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Division of Neurology, University of Alberta, Edmonton, Canada
| | - Angela Genge
- Clinical Research Unit, Montreal Neurological Institute & Hospital, and Department of Neurology and Neurosurgery, McGill University, Québec, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - James Berry
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Azadeh Yadollahi
- KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Yunusova Y, Waito A, Barnett C, Huynh A, Martino R, Abrahao A, Pattee GL, Berry JD, Zinman L, Green JR. Protocol for psychometric evaluation of the Amyotrophic Lateral Sclerosis - Bulbar Dysfunction Index (ALS-BDI): a prospective longitudinal study. BMJ Open 2022; 12:e060102. [PMID: 35260465 PMCID: PMC8905936 DOI: 10.1136/bmjopen-2021-060102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Current clinical bulbar assessment tools are lacking, while existing physiological instrumental assessments are often inaccessible and cost-prohibitive for clinical application. The goal of our research is to develop and validate a brief and reliable, clinician-administered assessment tool-the ALS-Bulbar Dysfunction Index (ALS-BDI). This publication describes the study protocol that has been established to ascertain the tools' psychometric properties. METHODS AND ANALYSIS The ALD-BDI's development closely follows guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Through the proposed study protocol, we expect to establish psychometric properties of both individual test items of the ALS-BDI as well as the final version of the entire tool, including test-retest and inter-rater reliability, construct validity using gold-standard assessment methods and responsiveness. ETHICS AND DISSEMINATION This study has been reviewed and approved by research ethics boards at two data collection sites: Sunnybrook Health Science Centre, primary (Toronto, Canada; ID3080) and Mass General Brigham (#2013P001746, Boston, USA). Prior to participation in the study, the participants sign the informed consent in accordance with the Declaration of Helsinki. Once validated, the ALS-BDI will be disseminated to key stakeholders. Following validation, the ALS-BDI and any required training material will be implemented for clinical use in a context of a multidisciplinary ALS clinic and used as an outcome measure for clinical trials in ALS research.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ashley Waito
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Carolina Barnett
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Anna Huynh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - James D Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Speech and Hearing Biosciences and Technology, Harvard University, Cambridge, Massachusetts, USA
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Chenausky KV, Gagné D, Stipancic KL, Shield A, Green JR. The Relationship Between Single-Word Speech Severity and Intelligibility in Childhood Apraxia of Speech. J Speech Lang Hear Res 2022; 65:843-857. [PMID: 35133873 PMCID: PMC9150686 DOI: 10.1044/2021_jslhr-21-00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/29/2021] [Accepted: 10/24/2021] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this study was to investigate the association between perceived single-word speech severity and intelligibility in children with childhood apraxia of speech (CAS), with and without comorbid language impairment (LI), and to investigate the contribution of different CAS signs to perceived single-word speech severity and single-word intelligibility. METHOD Thirty children with CAS, 18 with comorbid LI, completed the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2). Trained judges coded children's responses for signs of CAS and percent phonemes correct. Nine listeners, blind to diagnoses, rated speech severity using a visual analog scale. Intelligibility was assessed by comparing listeners' orthographic transcriptions of children's responses to target responses. RESULTS Measures of speech severity (GFTA-2 standard score, number of unique CAS signs, total CAS signs, and mean severity rating) were significantly correlated with measures of intelligibility (GFTA-2 raw score, percent phonemes correct, and mean intelligibility score). Speech severity and intelligibility did not differ significantly between children with and without LI. Only consonant errors contributed significant variability to speech severity. Consonant errors and stress errors contributed significant variability to intelligibility. CONCLUSIONS Findings suggest that visual analog scale ratings are a valid and convenient measure of single-word speech severity and that GFTA-2 raw score is an equally convenient measure of single-word intelligibility. The result that consonant errors were by far the major contributor to single-word speech severity and intelligibility in children with CAS, with stress errors also making a small contribution to intelligibility, suggests that consonant accuracy and appropriate lexical stress should be prime therapeutic targets for these children in the context of treatment addressing motor planning/programming, self-monitoring, and self-correcting. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19119350.
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Affiliation(s)
- Karen V. Chenausky
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychological and Brain Sciences, Boston University, MA
| | | | - Kaila L. Stipancic
- MGH Institute of Health Professions, Boston, MA
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Aaron Shield
- Department of Speech Pathology & Audiology, Miami University, Oxford, OH
| | - Jordan R. Green
- MGH Institute of Health Professions, Boston, MA
- Speech and Hearing and Biosciences and Technology Program, Harvard University, Boston, MA
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Prudente CN, Chen M, Stipancic KL, Marks KL, Samargia-Grivette S, Goding GS, Green JR, Kimberley TJ. Effects of low-frequency repetitive transcranial magnetic stimulation in adductor laryngeal dystonia: a safety, feasibility, and pilot study. Exp Brain Res 2022; 240:561-574. [PMID: 34859288 PMCID: PMC8858301 DOI: 10.1007/s00221-021-06277-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The effects of neuromodulation are virtually unexplored in adductor laryngeal dystonia (AdLD), a disorder characterized by involuntary contraction of intrinsic laryngeal muscles. Recent findings indicated that intracortical inhibition is reduced in people with AdLD. Low-frequency repetitive transcranial magnetic stimulation (rTMS) induces prolonged intracortical inhibition, but the effects in AdLD are unexplored. This pilot and feasibility study aimed to examine the safety, feasibility, and effects of a single session 1 Hz rTMS over the laryngeal motor cortex (LMC) in people with AdLD and healthy individuals. METHODS The stimulation location was individualized and determined through TMS-evoked responses in the thyroarytenoid muscles using fine-wire electrodes. 1200 pulses of 1 Hz rTMS were delivered to the left LMC in two groups: Control (n = 6) and AdLD (n = 7). Tolerance, adverse effects, intracortical inhibition, and voice recordings were collected immediately before and after rTMS. Voice quality was assessed with acoustic-based and auditory-perceptual measures. RESULTS All participants tolerated the procedures, with no unexpected adverse events or worsening of symptoms. No significant effects on intracortical inhibition were observed. In the AdLD group, there was a large-effect size after rTMS in vocal perturbation measures and a small-effect size in decreased phonatory breaks. CONCLUSIONS One rTMS session over the LMC is safe and feasible, and demonstrated trends of beneficial effects on voice quality and phonatory function in AdLD. These preliminary findings support further investigation to assess clinical benefits in a future randomized sham-controlled trial. CLINICALTRIALS.GOV: NCT02957942, registered on November 8, 2016.
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Affiliation(s)
- Cecília N Prudente
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA
- MicroTransponder Inc., Austin, TX, USA
| | - Mo Chen
- Non-Invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kaila L Stipancic
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Communicative Sciences and Disorders, University at Buffalo, Buffalo, NY, USA
| | - Katherine L Marks
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Speech Language Hearing Sciences, Boston University, Boston, MA, USA
| | - Sharyl Samargia-Grivette
- Department of Communication Sciences and Disorders, University of Minnesota-Duluth, Duluth, MN, USA
| | - George S Goding
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Teresa J Kimberley
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, 36 First Ave, Boston, MA, 02129, USA.
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Stipancic KL, Palmer KM, Rowe HP, Yunusova Y, Berry JD, Green JR. "You Say Severe, I Say Mild": Toward an Empirical Classification of Dysarthria Severity. J Speech Lang Hear Res 2021; 64:4718-4735. [PMID: 34762814 PMCID: PMC9150682 DOI: 10.1044/2021_jslhr-21-00197] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/07/2021] [Accepted: 08/12/2021] [Indexed: 05/19/2023]
Abstract
PURPOSE The main purpose of this study was to create an empirical classification system for speech severity in patients with dysarthria secondary to amyotrophic lateral sclerosis (ALS) by exploring the reliability and validity of speech-language pathologists' (SLPs') ratings of dysarthric speech. METHOD Ten SLPs listened to speech samples from 52 speakers with ALS and 20 healthy control speakers. SLPs were asked to rate the speech severity of the speakers using five response options: normal, mild, moderate, severe, and profound. Four severity-surrogate measures were also calculated: SLPs transcribed the speech samples for the calculation of speech intelligibility and rated the effort it took to understand the speakers on a visual analog scale. In addition, speaking rate and intelligible speaking rate were calculated for each speaker. Intrarater and interrater reliability were calculated for each measure. We explored the validity of clinician-based severity ratings by comparing them to the severity-surrogate measures. Receiver operating characteristic (ROC) curves were conducted to create optimal cutoff points for defining dysarthria severity categories. RESULTS Intrarater and interrater reliability for the clinician-based severity ratings were excellent and were comparable to reliability for the severity-surrogate measures explored. Clinician severity ratings were strongly associated with all severity-surrogate measures, suggesting strong construct validity. We also provided a range of values for each severity-surrogate measure within each severity category based on the cutoff points obtained from the ROC analyses. CONCLUSIONS Clinician severity ratings of dysarthric speech are reliable and valid. We discuss the underlying challenges that arise when selecting a stratification measure and offer recommendations for a classification scheme when stratifying patients and research participants into speech severity categories.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Kira M. Palmer
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Eshghi M, Connaghan KP, Gutz SE, Berry JD, Yunusova Y, Green JR. Co-Occurrence of Hypernasality and Voice Impairment in Amyotrophic Lateral Sclerosis: Acoustic Quantification. J Speech Lang Hear Res 2021; 64:4772-4783. [PMID: 34714698 PMCID: PMC9150680 DOI: 10.1044/2021_jslhr-21-00123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Hypernasality and atypical voice characteristics are common features of dysarthric speech due to amyotrophic lateral sclerosis (ALS). Existing acoustic measures have been developed to primarily target either hypernasality or voice impairment, and the effects of co-occurring hypernasality-voice problems on these measures are unknown. This report explores (a) the extent to which acoustic measures are affected by concurrent perceptually identified hypernasality and voice impairment due to ALS and (b) candidate acoustic measures of early indicators of hypernasality and voice impairment in the presence of multisystem involvement in individuals with ALS. METHOD Two expert listeners rated severity of hypernasality and voice impairment in sentences produced by individuals with ALS (n = 27). The samples were stratified based on perceptual ratings: voice/hypernasality asymptomatic, predominantly hypernasal, predominantly voice impairment, and mixed (co-occurring hypernasality and voice impairment). Groups were compared using established acoustic measures of hypernasality (one-third octave analysis) and voice (cepstral/spectral analysis) impairment. RESULTS The one-third octave analysis differentiated all groups; the cepstral peak prominence differentiated all groups except asymptomatic versus mixed, whereas the low-to-high spectral ratio did not differ among groups. Additionally, one-third octave analyses demonstrated promising speech diagnostic potential. CONCLUSIONS The results highlight the need to consider the validity of measures in the context of multisubsystem involvement. Our preliminary findings further suggest that the one-third octave analysis may be an optimal approach to quantify hypernasality and voice abnormalities in the presence of multisystem speech impairment. Future evaluation of the diagnostic accuracy of the one-third octave analysis is warranted.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Kathryn P. Connaghan
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Ontario, Canada
| | - Jordan R. Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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Rowe HP, Stipancic KL, Lammert AC, Green JR. Validation of an Acoustic-Based Framework of Speech Motor Control: Assessing Criterion and Construct Validity Using Kinematic and Perceptual Measures. J Speech Lang Hear Res 2021; 64:4736-4753. [PMID: 34735295 PMCID: PMC9150673 DOI: 10.1044/2021_jslhr-21-00201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/29/2021] [Accepted: 08/16/2021] [Indexed: 05/19/2023]
Abstract
PURPOSE This study investigated the criterion (analytical and clinical) and construct (divergent) validity of a novel, acoustic-based framework composed of five key components of motor control: Coordination, Consistency, Speed, Precision, and Rate. METHOD Acoustic and kinematic analyses were performed on audio recordings from 22 subjects with amyotrophic lateral sclerosis during a sequential motion rate task. Perceptual analyses were completed by two licensed speech-language pathologists, who rated each subject's speech on the five framework components and their overall severity. Analytical and clinical validity were assessed by comparing performance on the acoustic features to their kinematic correlates and to clinician ratings of the five components, respectively. Divergent validity of the acoustic-based framework was then assessed by comparing performance on each pair of acoustic features to determine whether the features represent distinct articulatory constructs. Bivariate correlations and partial correlations with severity as a covariate were conducted for each comparison. RESULTS Results revealed moderate-to-strong analytical validity for every acoustic feature, both with and without controlling for severity, and moderate-to-strong clinical validity for all acoustic features except Coordination, without controlling for severity. When severity was included as a covariate, the strong associations for Speed and Precision became weak. Divergent validity was supported by weak-to-moderate pairwise associations between all acoustic features except Speed (second-formant [F2] slope of consonant transition) and Precision (between-consonant variability in F2 slope). CONCLUSIONS This study demonstrated that the acoustic-based framework has potential as an objective, valid, and clinically useful tool for profiling articulatory deficits in individuals with speech motor disorders. The findings also suggest that compared to clinician ratings, instrumental measures are more sensitive to subtle differences in articulatory function. With further research, this framework could provide more accurate and reliable characterizations of articulatory impairment, which may eventually increase clinical confidence in the diagnosis and treatment of patients with different articulatory phenotypes.
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Affiliation(s)
| | - Kaila L. Stipancic
- MGH Institute of Health Professions, Boston, MA
- Department of Communicative Disorders and Sciences, The State University of New York at Buffalo
| | - Adam C. Lammert
- Department of Biomedical Engineering, Worcester Polytechnic Institute, MA
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Stipancic KL, Kuo YL, Miller A, Ventresca HM, Sternad D, Kimberley TJ, Green JR. The effects of continuous oromotor activity on speech motor learning: speech biomechanics and neurophysiologic correlates. Exp Brain Res 2021; 239:3487-3505. [PMID: 34524491 PMCID: PMC8599312 DOI: 10.1007/s00221-021-06206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Sustained limb motor activity has been used as a therapeutic tool for improving rehabilitation outcomes and is thought to be mediated by neuroplastic changes associated with activity-induced cortical excitability. Although prior research has reported enhancing effects of continuous chewing and swallowing activity on learning, the potential beneficial effects of sustained oromotor activity on speech improvements is not well-documented. This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning. Twenty neurologically healthy young adults engaged in periods of continuous chewing and speech after which they completed a novel speech motor learning task. The motor learning task was designed to elicit improvements in accuracy and efficiency of speech performance across repetitions of eight-syllable nonwords. In addition, transcranial magnetic stimulation was used to measure the cortical silent period (cSP) of the lip motor cortex before and after the periods of continuous oromotor behaviors. All repetitions of the nonword task were recorded acoustically and kinematically using a three-dimensional motion capture system. Productions were analyzed for accuracy and duration, as well as lip movement distance and speed. A control condition estimated baseline improvement rates in speech performance. Results revealed improved speech performance following 10 min of chewing. In contrast, speech performance following 10 min of continuous speech was degraded. There was no change in the cSP as a result of either oromotor activity. The clinical implications of these findings are discussed in the context of speech rehabilitation and neuromodulation.
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Affiliation(s)
- Kaila L Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Yi-Ling Kuo
- Department of Physical Therapy, Upstate Medical University, Syracuse, NY, USA
| | - Amanda Miller
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Hayden M Ventresca
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Dagmar Sternad
- Department of Biology, Northeastern University, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA.
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Eshghi M, Riphagen JM, Green JR, Salat DH. Distinct association between white matter hyperintensity load and cortical thickness in speech motor regions of individuals with Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.051921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Joost M Riphagen
- Athinoula A. Martinos Center for Biomedical Imaging/Massachusetts General Hospital Charlestown MA USA
| | | | - David H Salat
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System Boston MA USA
- Massachusetts General Hospital Charlestown MA USA
- Harvard Medical School Boston MA USA
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Shellikeri S, Marzouqah R, Brooks BR, Zinman L, Green JR, Yunusova Y. Psychometric Properties of Rapid Word-Based Rate Measures in the Assessment of Bulbar Amyotrophic Lateral Sclerosis: Comparisons With Syllable-Based Rate Tasks. J Speech Lang Hear Res 2021; 64:4178-4191. [PMID: 34699273 PMCID: PMC9499363 DOI: 10.1044/2021_jslhr-21-00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
Purpose Rapid maximum performance repetition tasks have increasingly demonstrated their utility as clinimetric markers supporting diagnosis and monitoring of bulbar disease in amyotrophic lateral sclerosis (ALS). A recently developed protocol uses novel real-word repetitions instead of traditional nonword/syllable sequences in hopes of improving sensitivity to motor speech impairments by adding a phonological target constraint that would activate a greater expanse of the motor speech neuroanatomy. This study established the psychometric properties of this novel clinimetric protocol in its assessment of bulbar ALS and compared performance to traditional syllable sequence dysdiadochokinetic (DDK) tasks. Specific objectives were to (a) compare rates between controls and speakers with symptomatic versus presymptomatic bulbar disease, (b) characterize their discriminatory ability in detecting presymptomatic bulbar disease compared to healthy speech, (c) determine their articulatory movement underpinnings, and (d) establish within-individual longitudinal changes. Method DDK and novel tongue ("ticker"-TAR) and labial ("pepper"-LAR) articulatory rates were compared between n = 18 speakers with presymptomatic bulbar disease, n = 10 speakers with symptomatic bulbar disease, and n = 13 healthy controls. Bulbar disease groups were determined by a previously validated speaking rate cutoff. Discriminatory ability was determined using receiver operating characteristic analysis. Within-individual change over time was characterized in a subset of 16 participants with available longitudinal data using linear mixed-effects models. Real-time articulatory movements of the tongue front, tongue dorsum, jaw, and lips were captured using 3-D electromagnetic articulography; effects of movement displacement and speed on clinimetric rates were determined using stepwise linear regressions. Results All clinimetric rates (traditional DDK tasks and novel tasks) were reduced in speakers with symptomatic bulbar disease; only TAR was reduced in speakers with presymptomatic bulbar disease and was able to detect this group with an excellent discrimination ability (area under the curve = 0.83). Kinematic analyses revealed associations with expected articulators, greater motor complexity, and differential articulatory patterns for the novel real-word repetitions than their DDK counterparts. Only LAR significantly declined longitudinally over the disease course. Conclusion Novel real-word clinimetric rate tasks evaluating tongue and labial articulatory dysfunction are valid and effective markers for early detection and tracking of bulbar disease in ALS.
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Affiliation(s)
- Sanjana Shellikeri
- Penn Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Benjamin Rix Brooks
- Department of Neurology, Carolinas Medical Center, Carolinas Neuromuscular/ALS-MDA Care Center Atrium Health Neurosciences Institute, University of North Carolina, Charlotte
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Ontario, Canada
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Rong P, Usler E, Rowe LM, Allison K, Woo J, El Fakhri G, Green JR. Speech intelligibility loss due to amyotrophic lateral sclerosis: the effect of tongue movement reduction on vowel and consonant acoustic features. Clin Linguist Phon 2021; 35:1091-1112. [PMID: 33427505 DOI: 10.1080/02699206.2020.1868021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to identify aspects of impaired tongue motor performance that limit the ability to produce distinct speech sounds and contribute to reduced speech intelligibility in individuals with dysarthria secondary to amyotrophic lateral sclerosis (ALS). We analyzed simultaneously recorded tongue kinematic and acoustic data from 22 subjects during three target words (cat, dog, and took). The subjects included 11 participants with ALS and 11 healthy controls from the X-ray microbeam dysarthria database (Westbury, 1994). Novel measures were derived based on the range and speed of relative movement between two quasi-independent regions of the tongue - blade and dorsum - to characterize the global pattern of tongue dynamics. These "whole tongue" measures, along with the range and speed of single tongue regions, were compared across words, groups (ALS vs. control), and measure types (whole tongue vs. tongue blade vs. tongue dorsum). Reduced range and speed of both global and regional tongue movements were found in participants with ALS relative to healthy controls, reflecting impaired tongue motor performance in ALS. The extent of impairment, however, varied across words and measure types. Compared with the regional tongue measures, the whole tongue measures showed more consistent disease-related changes across the target words and were more robust predictors of speech intelligibility. Furthermore, these whole tongue measures were correlated with various word-specific acoustic features associated with intelligibility decline in ALS, suggesting that impaired tongue movement likely contributes to reduced phonetic distinctiveness of both vowels and consonants that underlie speech intelligibility decline in ALS.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KS, USA
| | - Evan Usler
- Department of Communication Sciences & Disorders, University of Delaware, Newark, DE USA
| | - Linda M Rowe
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Department of Surgery-Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristen Allison
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Jonghye Woo
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | | | - Jordan R Green
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, Boston, MA, USA
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Stipancic KL, Yunusova Y, Campbell TF, Wang J, Berry JD, Green JR. Two Distinct Clinical Phenotypes of Bulbar Motor Impairment in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:664713. [PMID: 34220673 PMCID: PMC8244731 DOI: 10.3389/fneur.2021.664713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Understanding clinical variants of motor neuron diseases such as amyotrophic lateral sclerosis (ALS) is critical for discovering disease mechanisms and across-patient differences in therapeutic response. The current work describes two clinical subgroups of patients with ALS that, despite similar levels of bulbar motor involvement, have disparate clinical and functional speech presentations. Methods: Participants included 47 healthy control speakers and 126 speakers with ALS. Participants with ALS were stratified into three clinical subgroups (i.e., bulbar asymptomatic, bulbar symptomatic high speech function, and bulbar symptomatic low speech function) based on clinical metrics of bulbar motor impairment. Acoustic and lip kinematic analytics were derived from each participant's recordings of reading samples and a rapid syllable repetition task. Group differences were reported on clinical scales of ALS and bulbar motor severity and on multiple speech measures. Results: The high and low speech-function subgroups were found to be similar on many of the dependent measures explored. However, these two groups were differentiated on the basis of an acoustic measure used as a proxy for tongue movement. Conclusion: This study supports the hypothesis that high and low speech-function subgroups do not differ solely in overall severity, but rather, constitute two distinct bulbar motor phenotypes. The findings suggest that the low speech-function group exhibited more global involvement of the bulbar muscles than the high speech-function group that had relatively intact lingual function. This work has implications for clinical measures used to grade bulbar motor involvement, suggesting that a single bulbar measure is inadequate for capturing differences among phenotypes.
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Affiliation(s)
- Kaila L Stipancic
- Speech and Feeding Disorders Lab, Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States.,UB Motor Speech Disorders Lab, Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Yana Yunusova
- Speech Production Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Thomas F Campbell
- Speech, Language, Cognition, and Communication Lab, Department of Communication Sciences and Disorders, University of Texas at Dallas, Dallas, TX, United States
| | - Jun Wang
- Speech Disorders and Technology Lab, Department of Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, United States
| | - James D Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, MA, United States
| | - Jordan R Green
- Speech and Feeding Disorders Lab, Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States
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Waito AA, Wehbe F, Marzouqah R, Barnett C, Shellikeri S, Cui C, Abrahao A, Zinman L, Green JR, Yunusova Y. Validation of Articulatory Rate and Imprecision Judgments in Speech of Individuals With Amyotrophic Lateral Sclerosis. Am J Speech Lang Pathol 2021; 30:137-149. [PMID: 33290086 PMCID: PMC8740582 DOI: 10.1044/2020_ajslp-20-00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 05/29/2023]
Abstract
Purpose Perceptual judgments of articulatory function are commonly used by speech-language pathologists to evaluate articulatory performance in individuals with amyotrophic lateral sclerosis (ALS). The goal of this study was to evaluate the psychometric properties (e.g., reliability, validity) of these perceptual measures to inform their application as part of a comprehensive bulbar assessment tool in ALS. Method Preexisting data from 51 individuals with ALS were obtained from a larger longitudinal study. Five independent raters provided perceptual judgments of articulatory rate and imprecision in a sentence task. Inter- and intrarater reliability of these judgments were assessed. Perceptual ratings were correlated with an acoustic measure of articulatory rate, in syllables per second, obtained from passage-reading recordings. Both perceptual and acoustic measures were correlated with gold-standard kinematic tongue and jaw movement measures, recorded from sentences using electromagnetic articulography. Results The results revealed good inter- and intrarater reliability of perceptual judgments of articulatory function. Strong correlations were observed between perceptual ratings of articulatory rate and imprecision and acoustic measures of articulatory rate and kinematic measures of tongue speed. Conclusions These findings support the clinical application of perceptual judgments of articulatory function as valid and reliable measures of underlying articulatory changes in bulbar ALS. Additional research is needed to understand the responsiveness of these measures to clinical changes in articulatory function in ALS.
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Affiliation(s)
- Ashley A. Waito
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sanjana Shellikeri
- Department of Neurology, University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia
| | - Cindy Cui
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lorne Zinman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- L. C. Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA
| | - Yana Yunusova
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Eshghi M, Perry BJ, Richburg B, Ventresca HM, Pomahac B, Green JR. Neuromotor Speech Recovery Across Different Behavioral Speech Modifications in Individuals Following Facial Transplantation. Front Neurol 2021; 11:593153. [PMID: 33488496 PMCID: PMC7815523 DOI: 10.3389/fneur.2020.593153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Despite signs of facial nerve recovery within a few months following face transplantation, speech deficits persist for years. Behavioral speech modifications (e.g., slower-than-normal speaking rate and increased loudness) have shown promising potential to enhance speech intelligibility in populations with dysarthric speech. However, such evidence-based practice approach is lacking in clinical management of speech in individuals with facial transplantation. Because facial transplantation involves complex craniofacial reconstruction and facial nerve coaptation, it is unknown to what extent individuals with face transplant are capable of adapting their motor system to task-specific articulatory demands. The purpose of this study was to identify the underlying articulatory mechanisms employed by individuals with face transplantation in response to speech modification cues at early and late stages of neuromotor recovery. In addition, we aimed to identify speech modifications that conferred improved speech clarity. Participants were seven individuals who underwent full or partial facial vascularized composite allografts that included lips and muscles of facial animation and were in early (~2 months) or late (~42 months) stages of recovery. Participants produced repetitions of the sentence “Buy Bobby a puppy” in normal, fast, loud, and slow speech modifications. Articulatory movement traces were recorded using a 3D optical motion capture system. Kinematic measures of average speed (mm/s) and range of movement (mm3) were extracted from the lower lip (± jaw) marker. Two speech language pathologists rated speech clarity for each speaker using a visual analog scale (VAS) approach. Results demonstrated that facial motor capacity increased from early to late stages of recovery. While individuals in the early group exhibited restricted capabilities to adjust their motor system based on the articulatory demands of each speech modification, individuals in the late group demonstrated faster speed and larger-than-normal range of movement for loud speech, and slower speed and larger-than-normal range of movement for slow speech. In addition, subjects in both groups showed overreliance on jaw rather than lip articulatory function across all speech modifications, perhaps as a compensatory strategy to optimize articulatory stability and maximize speech function. Finally, improved speech clarity was associated with loud speech in both stages of recovery.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Profession, Boston, MA, United States
| | - Bridget J Perry
- Speech and Feeding Disorders Lab, MGH Institute of Health Profession, Boston, MA, United States
| | - Brian Richburg
- Speech and Feeding Disorders Lab, MGH Institute of Health Profession, Boston, MA, United States
| | - Hayden M Ventresca
- Speech and Feeding Disorders Lab, MGH Institute of Health Profession, Boston, MA, United States
| | - Bohdan Pomahac
- Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Profession, Boston, MA, United States
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Darwaish F, Selzler R, Law A, Chen E, Ibey A, Aubertin C, Greenwood K, Redpath S, Chan ADC, Green JR, Langlois RG. Preliminary Laboratory Vibration Testing of a Complete Neonatal Patient Transport System. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:6086-6089. [PMID: 33019359 DOI: 10.1109/embc44109.2020.9175852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Premature infants or neonates in need of advanced clinical care must be transported to specialized hospitals. Past studies have examined vibrations experienced by patients during transport; however, multiple confounding factors limit the utility of on-road data. Hence, the development of a standardized test environment is warranted. The overall purpose of this project is to characterize vibrations during neonatal patient transport and develop mitigation strategies to reduce exposure. This paper focusses on the development of a laboratory test environment and procedure that enables studying the equipment vibration in a comprehensive and repeatable manner. For the first time, a complete neonatal patient transport system, including a stretcher, has been mounted on an industrial shaker. Results largely validate the system's ability to simulate on-road vibrations with high repeatability.
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Allison KM, Cordella C, Iuzzini-Seigel J, Green JR. Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review. J Speech Lang Hear Res 2020; 63:2952-2994. [PMID: 32783767 PMCID: PMC7890226 DOI: 10.1044/2020_jslhr-20-00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Claire Cordella
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston
| | - Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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Chenausky KV, Brignell A, Morgan A, Gagné D, Norton A, Tager-Flusberg H, Schlaug G, Shield A, Green JR. Factor analysis of signs of childhood apraxia of speech. J Commun Disord 2020; 87:106033. [PMID: 32877838 PMCID: PMC7494519 DOI: 10.1016/j.jcomdis.2020.106033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 05/21/2023]
Abstract
PURPOSE To investigate the latent factors underlying signs of childhood apraxia of speech (CAS) in a group of 57 children with CAS. METHOD The speech of 57 children with CAS (aged 3;5-17;0) was coded for signs of CAS. All participants showed at least five signs of CAS and were judged to have CAS by speech pathologists experienced in pediatric speech disorders. Participants were selected to represent a range of severity of CAS: 30 children were verbal and 27 were minimally verbal with comorbid autism. Participants' scores for each sign (the number of times that sign appeared during a child's speech sample) were converted to z-scores, then entered as variables into an exploratory factor analysis. Models were compared using the Akaike Information Criterion (AIC). RESULTS The three-factor model had the lowest AIC and best fit the data. After oblique rotation, syllable segmentation, slow rate, and stress errors loaded most highly on Factor 1. Groping, addition of phonemes other than schwa, and difficulty with coarticulation loaded most highly on Factor 2. Variable errors loaded most highly on Factor 3. Thus, factors were interpreted as being associated with (1) prosody, (2) coarticulation, and (3) inconsistency. CONCLUSIONS Results are consistent with the three consensus criteria for CAS from the American Speech-Language-Hearing Association: Inappropriate prosody, disrupted coarticulatory transitions, and inconsistent errors on repeated tokens. High loading of the syllable segmentation sign on the inappropriate prosody factor also supports the use of a pause-related biomarker for CAS.
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Affiliation(s)
- Karen V Chenausky
- Speech and Feeding Disorders Lab, Massachusetts General Hospital Institute of Health Professions, Boston, USA; Department of Neurology, Harvard Medical School, Boston, USA; Center for Autism Research Excellence, Department of Pyschological and Brain Sciences, Boston University, Boston, USA.
| | - Amanda Brignell
- Speech and Language, Murdoch Children's Research Institute, Melbourne, Australia; Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia.
| | - Angela Morgan
- Speech and Language, Murdoch Children's Research Institute, Melbourne, Australia; Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia.
| | - Danielle Gagné
- Speech and Feeding Disorders Lab, Massachusetts General Hospital Institute of Health Professions, Boston, USA.
| | - Andrea Norton
- Brain Repair and Neurorestoration Center, Baystate Medical Center, Springfield Massachusetts, USA.
| | - Helen Tager-Flusberg
- Center for Autism Research Excellence, Department of Pyschological and Brain Sciences, Boston University, Boston, USA.
| | - Gottfried Schlaug
- Department of Neurology, Harvard Medical School, Boston, USA; Brain Repair and Neurorestoration Center, Baystate Medical Center, Springfield Massachusetts, USA.
| | - Aaron Shield
- Department of Speech Pathology & Audiology, Miami University, Oxford, Ohio, USA.
| | - Jordan R Green
- Speech and Feeding Disorders Lab, Massachusetts General Hospital Institute of Health Professions, Boston, USA.
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Usler ER, Wei X, Simione M, Richburg B, Stipancic KL, Green JR. Modulation of Intermuscular Beta Coherence in Different Rhythmic Mandibular Behaviors. Front Hum Neurosci 2020; 14:302. [PMID: 32848676 PMCID: PMC7406789 DOI: 10.3389/fnhum.2020.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Jaw movement during chewing and speech is facilitated by neural activation patterns for opening and closing movements of the mandible. This study investigated anatomic- and task-dependent differences in intermuscular coherence (IMC) and their association with the parameters of jaw muscle activity using surface electromyography (sEMG). Methods We recorded sEMG activation from bilateral and ipsilateral jaw-closing muscle pairs during non-nutritive and nutritive chewing, and during a syllable repetition task. IMC and cross-correlational analyses between bilateral and ipsilateral muscle pairs were performed. Results Intermuscular coherence in the beta band was statistically significant between agonist jaw-closing muscle pairs, with beta IMC weaker for rapid syllable repetition compared to chewing tasks. Cross-correlational analysis of muscle co-activation, as well as sEMG burst amplitude, was positively associated with beta IMC strength. Discussion Beta IMC was influenced heavily by task-dependent behavioral goals and physiologic demands, which was interpreted as evidence of shared neural drive among jaw-closing muscles.
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Affiliation(s)
- Evan R. Usler
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Delaware, Newark, DE, United States
- *Correspondence: Evan R. Usler,
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meg Simione
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Brian Richburg
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
| | - Kaila L. Stipancic
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
| | - Jordan R. Green
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
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Goswami I, Redpath S, Langlois RG, Green JR, Lee KS, Whyte HEA. Whole-body vibration in neonatal transport: a review of current knowledge and future research challenges. Early Hum Dev 2020; 146:105051. [PMID: 32464450 DOI: 10.1016/j.earlhumdev.2020.105051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
Interfacility transport to tertiary care for high-risk neonates has become an integral part of equitable access to optimal perinatal healthcare. Excellence in clinical care requires expertise in transport medicine and the coordination of safe transport processes. However, concerns remain regarding environmental stressors involved in the transportation of sick high-risk neonates, including noise and vibration. In order to mitigate the potential deleterious effects of these physical stressors during transport, further knowledge of the burden of exposure, injury mechanisms and engineering interventions/modifications as adjuncts during transport would be beneficial. We reviewed the current literature with a focus on the contribution of new and emerging technologies in the transport environment with particular reference to whole-body vibration. This review intends to highlight what is known about vibration as a physical stressor in neonates and areas for further research; with the goal to making recommendations for minimizing these stressors during transport.
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Affiliation(s)
- I Goswami
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - S Redpath
- Department of Paediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
| | - R G Langlois
- Department of Mechanical and Aerospace Engineering, Carleton University, Canada
| | - J R Green
- Department of Systems and Computer Engineering, Carleton University, Canada
| | - K S Lee
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - H E A Whyte
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
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Allison KM, Salehi S, Green JR. Effect of prosodic manipulation on articulatory kinematics and second formant trajectories in children. J Acoust Soc Am 2020; 147:769. [PMID: 32113329 PMCID: PMC7027399 DOI: 10.1121/10.0000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 05/19/2023]
Abstract
This study investigated effects of rate reduction and emphatic stress cues on second formant (F2) trajectories and articulatory movements during diphthong production in 11 typically developing school-aged children. F2 extent increased in slow and emphatic stress conditions, and tongue and jaw displacement increased in the emphatic stress condition compared to habitual speech. Tongue displacement significantly predicted F2 extent across speaking conditions. Results suggest that slow rate and emphatic stress cues induce articulatory and acoustic changes in children that may enhance clarity of the acoustic signal. Potential clinical implications for improving speech in children with dysarthria are discussed.
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Affiliation(s)
- Kristen M Allison
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue Boston, Massachusetts 02115, USA
| | - Sina Salehi
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue Boston, Massachusetts 02115, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, 36 1st Avenue, Charlestown, Massachusetts 02129, USA
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Barnett C, Green JR, Marzouqah R, Stipancic KL, Berry JD, Korngut L, Genge A, Shoesmith C, Briemberg H, Abrahao A, Kalra S, Zinman L, Yunusova Y. Reliability and validity of speech & pause measures during passage reading in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:42-50. [PMID: 32138555 DOI: 10.1080/21678421.2019.1697888] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The use of speech measures is becoming a common practice in the assessment of bulbar disease progression in amyotrophic lateral sclerosis (ALS). This study aimed to establish psychometric properties (e.g. reliability, validity, sensitivity, specificity) of speech and pause timing measures during a standardized passage. Methods: A large number of passage recordings (ALS N = 775; Neurotypical controls N = 323) was analyzed using a semi-automatic method (Speech and Pause Analysis, SPA). Results: The results revealed acceptable reliability of the speech and pause measures across repeated recording by the control participants. Strong construct validity was established via significant group differences between patients and controls and correlation statistics with clinical measures of overall ALS and bulbar disease severity. Speaking rate, pause events, and mean pause duration were able to detect ALS participants at the presymptomatic stage of bulbar disease with a good discrimination ability (AUC 0.81). Conclusions: Based on the current psychometric evaluation, performing passage recording and speech and pause timing analysis was deemed useful for detecting early and progressive changes associated with bulbar ALS.
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Affiliation(s)
- Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA.,Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, USA
| | - Reeman Marzouqah
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Kaila L Stipancic
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - James D Berry
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA,
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Angela Genge
- Montreal Neurological Institute, Neurosurgery, McGill University, Montreal, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Hannah Briemberg
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Agessandro Abrahao
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.,Division of Neurology, University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Toronto, Canada, and
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Eshghi M, Stipancic KL, Mefferd A, Rong P, Berry JD, Yunusova Y, Green JR. Assessing Oromotor Capacity in ALS: The Effect of a Fixed-Target Task on Lip Biomechanics. Front Neurol 2019; 10:1288. [PMID: 31866935 PMCID: PMC6906194 DOI: 10.3389/fneur.2019.01288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
Alternating motion rate (AMR) is a standard measure often included in neurological examinations to assess orofacial neuromuscular integrity. AMR is typically derived from recordings of patients producing repetitions of a single syllable as fast and clear as possible on one breath. Because the task places high demands on oromotor performance, particularly articulatory speed, AMRs are widely considered to be tests of maximum performance and, therefore, likely to reveal underlying neurologic deficits. Despite decades of widespread use, biomechanical studies have shown that speakers often circumvent the presumed speed challenge of the standard AMR task. Specifically, speakers are likely to manipulate their displacements (movement amplitude) instead of speed because this strategy requires less motor effort. The current study examined the effectiveness of a novel fixed-target paradigm for minimizing the truncation of articulatory excursions and maximizing motor effort. We compared the standard AMR task to that of a fixed-target AMR task and focused specifically on the tasks' potential to detect decrements in lip motor performance in persons with dysarthria due to amyotrophic lateral sclerosis (ALS). Our participants were 14 healthy controls and 17 individuals with ALS. For the standard AMR task, participants were instructed to produce the syllable /bα/ as quickly and accurately as possible on one breath. For the fixed-target AMR task, participants were given the same instructions, but were also required to strike a physical target placed under the jaw during the opening phase of each syllable. Lip kinematic data were obtained using 3D electromagnetic articulography. 16 kinematic features were extracted using an algorithmic approach. Findings revealed that compared to the standard task, the fixed-target AMR task placed increased motor demands on the oromotor system by eliciting larger excursions, faster speeds, and greater spatiotemporal variability. In addition, participants with ALS exhibited limited ability to adapt to the higher articulatory demands of the fixed-target task. Between the two AMR tasks, the maximum speed during the fixed-target task showed a moderate association with the ALSFRS-R bulbar subscore. Employment of both standard and fixed-target AMR tasks is, however, needed for comprehensive assessment of oromotor function and for elucidating profiles of task adaptation.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
| | - Kaila L Stipancic
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
| | - Antje Mefferd
- Speech Kinematics and Acoustics Lab, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Panying Rong
- Speech Science and Disorders Lab, Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, United States
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Yana Yunusova
- Speech Production Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
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