Identifying depression-related topics in smartphone-collected free-response speech recordings using an automatic speech recognition system and a deep learning topic model

BACKGROUND

Prior research has associated spoken language use with depression, yet studies often involve small or non-clinical samples and face challenges in the manual transcription of speech. This paper aimed to automatically identify depression-related topics in speech recordings collected from clinical samples.

METHODS

The data included 3919 English free-response speech recordings collected via smartphones from 265 participants with a depression history. We transcribed speech recordings via automatic speech recognition (Whisper tool, OpenAI) and identified principal topics from transcriptions using a deep learning topic model (BERTopic). To identify depression risk topics and understand the context, we compared participants' depression severity and behavioral (extracted from wearable devices) and linguistic (extracted from transcribed texts) characteristics across identified topics.

RESULTS

From the 29 topics identified, we identified 6 risk topics for depression: 'No Expectations', 'Sleep', 'Mental Therapy', 'Haircut', 'Studying', and 'Coursework'. Participants mentioning depression risk topics exhibited higher sleep variability, later sleep onset, and fewer daily steps and used fewer words, more negative language, and fewer leisure-related words in their speech recordings.

LIMITATIONS

Our findings were derived from a depressed cohort with a specific speech task, potentially limiting the generalizability to non-clinical populations or other speech tasks. Additionally, some topics had small sample sizes, necessitating further validation in larger datasets.

CONCLUSION

This study demonstrates that specific speech topics can indicate depression severity. The employed data-driven workflow provides a practical approach for analyzing large-scale speech data collected from real-world settings.

Weighting of cues to categorization of song versus speech in tone-language and non-tone-language speakers

One of the most important auditory categorization tasks a listener faces is determining a sound's domain, a process which is a prerequisite for successful within-domain categorization tasks such as recognizing different speech sounds or musical tones. Speech and song are universal in human cultures: how do listeners categorize a sequence of words as belonging to one or the other of these domains? There is growing interest in the acoustic cues that distinguish speech and song, but it remains unclear whether there are cross-cultural differences in the evidence upon which listeners rely when making this fundamental perceptual categorization. Here we use the speech-to-song illusion, in which some spoken phrases perceptually transform into song when repeated, to investigate cues to this domain-level categorization in native speakers of tone languages (Mandarin and Cantonese speakers residing in the United Kingdom and China) and in native speakers of a non-tone language (English). We find that native tone-language and non-tone-language listeners largely agree on which spoken phrases sound like song after repetition, and we also find that the strength of this transformation is not significantly different across language backgrounds or countries of residence. Furthermore, we find a striking similarity in the cues upon which listeners rely when perceiving word sequences as singing versus speech, including small pitch intervals, flat within-syllable pitch contours, and steady beats. These findings support the view that there are certain widespread cross-cultural similarities in the mechanisms by which listeners judge if a word sequence is spoken or sung.

The Role of Verbal Fluency in the Cerebellar Cognitive Affective Syndrome Scale in Friedreich Ataxia

Cerebellar pathology engenders the disturbance of movement that characterizes Friedreich ataxia (FRDA), yet the impact of cerebellar pathology on cognition in FRDA remains unclear. Numerous studies have unequivocally demonstrated the role of the cerebellar pathology in disturbed cognitive, language and affective regulation, referred to as Cerebellar Cognitive Affective Syndrome (CCAS), and quantified by the CCAS-Scale (CCAS-S). The presence of dysarthria in many individuals with ataxia, particularly FRDA, may confound results on some items of the CCAS-S resulting in false-positive scores. This study explored the relationship between performance on the CCAS-S and clinical metrics of disease severity in 57 adults with FRDA. In addition, this study explored the relationship between measures of intelligibility and naturalness of speech and scores on the CCAS-S in a subgroup of 39 individuals with FRDA. We demonstrated a significant relationship between clinical metrics and performance on the CCAS-S. In addition, we confirmed the items that returned the greatest rate of failure were based on Verbal Fluency Tasks, revealing a significant relationship between these items and measures of speech. Measures of speech explained over half of the variance in the CCAS-S score suggesting the role of dysarthria in the performance on the CCAS-S is not clear. Further work is required prior to adopting the CCAS-S as a cognitive screening tool for individuals with FRDA.

Comment on Ombashi, van der Goes, Versnel, Khonsari, van der Molen: guidance to develop a multidisciplinary, international, pediatric registry: a systematic review, Orphanet Journal of Rare diseases, 2023

Recently, Ombashi et al. published a systematic review aiming to identify the pitfalls in the development and implementation as well as factors influencing long-term success of a multidisciplinary, international registry for cleft care on a global scale. The purpose of this letter to the editor is to highlight that the review failed to include the Swedish quality registry for patients born with cleft lip and palate, which fulfils the inclusion criteria. The Swedish cleft lip and palate registry is multidisciplinary, has a high coverage and reporting degree, and most outcome measures have been checked for reliability and validity. It is regularly used for open comparisons between treatment centers. Several research studies have been published based on the Swedish cleft lip and palate registry, and more are ongoing. The information we provide about the Swedish cleft lip and palate registry complements and expands the information of the results reported by Ombashi et al. in their research.

The effects of irrelevant speech on physiological stress, cognitive performance, and subjective experience - Focus on heart rate variability

Irrelevant speech impairs cognitive performance, especially in tasks requiring verbal short-term memory. Working on these tasks during irrelevant speech can also cause a physiological stress reaction. The aim of this study was to examine heart rate variability (HRV) as a non-invasive and easy-to-use stress measure in an irrelevant speech paradigm. Thirty participants performed cognitive tasks (n-back and serial recall) during two sound conditions: irrelevant speech (50 dB) and quiet (33 dB steady-state noise). The influence of conditions as well as presentation orders of conditions were examined on performance, subjective experience, and physiological stress. Working during irrelevant speech compared to working during quiet reduced performance, namely accuracy, in the serial recall task. It was more annoying, heightened the perceived workload, and lowered acoustic satisfaction. It was related to higher physiological stress by causing faster heart rate and changes in HRV frequency-domain analysis (LF, HF and LF/HF). The order of conditions showed some additional effects. When speech was the first condition, 3-back performance was less accurate, and serial recall response times were longer, heart rate was faster, and successive heart beats had less variability (lower RMSSD) during speech than during quiet. When quiet was the first condition, heart rate was faster and reaction times in 3-back were slower during quiet than during speech. The negative effect of irrelevant speech was clear in experience, performance, and physiological stress. The study shows that HRV can be used as a physiological stress measure in irrelevant speech studies.

Auditory and motor priming of metric structure improves understanding of degraded speech

Speech comprehension is enhanced when preceded (or accompanied) by a congruent rhythmic prime reflecting the metrical sentence structure. Although these phenomena have been described for auditory and motor primes separately, their respective and synergistic contribution has not been addressed. In this experiment, participants performed a speech comprehension task on degraded speech signals that were preceded by a rhythmic prime that could be auditory, motor or audiomotor. Both auditory and audiomotor rhythmic primes facilitated speech comprehension speed. While the presence of a purely motor prime (unpaced tapping) did not globally benefit speech comprehension, comprehension accuracy scaled with the regularity of motor tapping. In order to investigate inter-individual variability, participants also performed a Spontaneous Speech Synchronization test. The strength of the estimated perception-production coupling correlated positively with overall speech comprehension scores. These findings are discussed in the framework of the dynamic attending and active sensing theories.

Sound symbolism in manual and vocal responses: phoneme-response interactions associated with grasping as well as vertical and size dimensions of keypresses

It has been shown that reading the vowel [i] and consonant [t] facilitates precision grip responses, while [ɑ] and [k] are associated with faster power grip responses. A similar effect has been observed when participants perform responses with small or large response keys. The present study investigated whether the vowels and consonants could produce different effects with the grip responses and keypresses when the speech units are read aloud (Experiment 1) or silently (Experiment 2). As a second objective, the study investigated whether the recently observed effect, in which the upper position of a visual stimulus is associated with faster vocalizations of the high vowel and the lower position is associated with the low vowel, can be observed in manual responses linking, for example, the [i] with responses of the upper key and [ɑ] with lower responses. Firstly, the study showed that when the consonants are overtly articulated, the interaction effect can be observed only with the grip responses, while the vowel production was shown to systematically influence small/large keypresses, as well as precision/power grip responses. Secondly, the vowel [i] and consonant [t] were associated with the upper responses, while [ɑ] and [k] were associated with the lower responses, particularly in the overt articulation task. The paper delves into the potential sound-symbolic implications of these phonetic elements, suggesting that their acoustic and articulatory characteristics might implicitly align them with specific response magnitudes, vertical positions, and grip types.

Quantifying abnormal emotion processing: A novel computational assessment method and application in schizophrenia

Abnormal emotion processing is a core feature of schizophrenia spectrum disorders (SSDs) that encompasses multiple operations. While deficits in some areas have been well-characterized, we understand less about abnormalities in the emotion processing that happens through language, which is highly relevant for social life. Here, we introduce a novel method using deep learning to estimate emotion processing rapidly from spoken language, testing this approach in male-identified patients with SSDs (n = 37) and healthy controls (n = 51). Using free responses to evocative stimuli, we derived a measure of appropriateness, or "emotional alignment" (EA). We examined psychometric characteristics of EA and its sensitivity to a single-dose challenge of oxytocin, a neuropeptide shown to enhance the salience of socioemotional information in SSDs. Patients showed impaired EA relative to controls, and impairment correlated with poorer social cognitive skill and more severe motivation and pleasure deficits. Adding EA to a logistic regression model with language-based measures of formal thought disorder (FTD) improved classification of patients versus controls. Lastly, oxytocin administration improved EA but not FTD among patients. While additional validation work is needed, these initial results suggest that an automated assay using spoken language may be a promising approach to assess emotion processing in SSDs.

Brain Structural Network Connectivity of Formal Thought Disorder Dimensions in Affective and Psychotic Disorders

BACKGROUND

The psychopathological syndrome of formal thought disorder (FTD) is not only present in schizophrenia (SZ), but also highly prevalent in major depressive disorder and bipolar disorder. It remains unknown how alterations in the structural white matter connectome of the brain correlate with psychopathological FTD dimensions across affective and psychotic disorders.

METHODS

Using FTD items of the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms, we performed exploratory and confirmatory factor analyses in 864 patients with major depressive disorder (n= 689), bipolar disorder (n = 108), or SZ (n = 67) to identify psychopathological FTD dimensions. We used T1- and diffusion-weighted magnetic resonance imaging to reconstruct the structural connectome of the brain. To investigate the association of FTD subdimensions and global structural connectome measures, we employed linear regression models. We used network-based statistic to identify subnetworks of white matter fiber tracts associated with FTD symptomatology.

RESULTS

Three psychopathological FTD dimensions were delineated, i.e., disorganization, emptiness, and incoherence. Disorganization and incoherence were associated with global dysconnectivity. Network-based statistics identified subnetworks associated with the FTD dimensions disorganization and emptiness but not with the FTD dimension incoherence. Post hoc analyses on subnetworks did not reveal diagnosis × FTD dimension interaction effects. Results remained stable after correcting for medication and disease severity. Confirmatory analyses showed a substantial overlap of nodes from both subnetworks with cortical brain regions previously associated with FTD in SZ.

CONCLUSIONS

We demonstrated white matter subnetwork dysconnectivity in major depressive disorder, bipolar disorder, and SZ associated with FTD dimensions that predominantly comprise brain regions implicated in speech. Results open an avenue for transdiagnostic, psychopathology-informed, dimensional studies in pathogenetic research.

Differences of people with visual disabilities in the perceived intensity of emotion inferred from speech of sighted people in online communication settings

PURPOSE

As humans convey information about emotions by speech signals, emotion recognition via auditory information is often employed to assess one's affective states. There are numerous ways of applying the knowledge of emotional vocal expressions to system designs that accommodate users' needs adequately. Yet, little is known about how people with visual disabilities infer emotions from speech stimuli, especially via online platforms (e.g., Zoom). This study focussed on examining the degree to which they perceive emotions strongly or weakly, i.e., perceived intensity but also investigating the degree to which their sociodemographic backgrounds affect them perceiving different intensity levels of emotions when exposed to a set of emotional speech stimuli via Zoom.

MATERIALS AND METHODS

A convenience sample of 30 individuals with visual disabilities participated in zoom interviews. Participants were given a set of emotional speech stimuli and reported the intensity level of the perceived emotions on a rating scale from 1 (weak) to 8 (strong).

RESULTS

When the participants were exposed to the emotional speech stimuli, calm, happy, fearful, sad, and neutral, they reported that neutral was the dominant emotion they perceived with the greatest intensity. Individual differences were also observed in the perceived intensity of emotions, associated with sociodemographic backgrounds, such as health, vision, job, and age.

CONCLUSIONS

The results of this study are anticipated to contribute to the fundamental knowledge that will be helpful for many stakeholders such as voice technology engineers, user experience designers, health professionals, and social workers providing support to people with visual disabilities.IMPLICATIONS FOR REHABILITATIONTechnologies equipped with alternative user interfaces (e.g., Siri, Alexa, and Google Voice Assistant) meeting the needs of people with visual disabilities can promote independent living and quality of life.Such technologies can also be equipped with systems that can recognize emotions via users' voice, such that users can obtain services customized to fit their emotional needs or adequately address their emotional challenges (e.g., early detection of onset, provision of advice, and so on).The results of this study can be beneficial to health professionals (e.g., social workers) who work closely with clients who have visual disabilities (e.g., virtual telehealth sessions) as they could gain insights or learn how to recognize and understand the clients' emotional struggle by hearing their voice, which is contributing to enhancement of emotional intelligence. Thus, they can provide better services to their clients, leading to building a strong bond and trust between health professionals and clients with visual disabilities even they meet virtually (e.g., Zoom).

Reconsidering Luria's speech mediation: Verbalization and haptic picture identification in children with congenital total blindness

Current accounts of behavioral and neurocognitive correlates of plasticity in blindness are just beginning to incorporate the role of speech and verbal production. We assessed Vygotsky/Luria's speech mediation hypothesis, according to which speech activity can become a mediating tool for perception of complex stimuli, specifically, for encoding tactual/haptic spatial patterns which convey pictorial information (haptic pictures). We compared verbalization in congenitally totally blind (CTB) and age-matched sighted but visually impaired (VI) children during a haptic picture naming task which included two repeated, test-retest, identifications. The children were instructed to explore 10 haptic schematic pictures of objects (e.g., cup) and body parts (e.g., face) and provide (without experimenter's feedback) their typical name. Children's explorations and verbalizations were videorecorded and transcribed into audio segments. Using the Computerized Analysis of Language (CLAN) program, we extracted several measurements from the observed verbalizations, including number of utterances and words, utterance/word duration, and exploration time. Using the Word2Vec natural language processing technique we operationalized semantic content from the relative distances between the names provided. Furthermore, we conducted an observational content analysis in which three judges categorized verbalizations according to a rating scale assessing verbalization content. Results consistently indicated across all measures that the CTB children were faster and semantically more precise than their VI counterparts in the first identification test, however, the VI children reached the same level of precision and speed as the CTB children at retest. Overall, the task was harder for the VI group. Consistent with current neuroscience literature, the prominent role of speech in CTB and VI children's data suggests that an underlying cross-modal involvement of integrated brain networks, notably associated with Broca's network, likely also influenced by Braille, could play a key role in compensatory plasticity via the mediational mechanism postulated by Luria.

Beyond 'speech delay': Expanding the phenotype of BRPF1-related disorder

Pathogenic variants in BRPF1 cause intellectual disability, ptosis and facial dysmorphism. Speech and language deficits have been identified as a manifestation of BRPF1-related disorder but have not been systematically characterized. We provide a comprehensive delineation of speech and language abilities in BRPF1-related disorder and expand the phenotype. Speech and language, and health and medical history were assessed in 15 participants (male = 10, median age = 7 years 4 months) with 14 BRPF1 variants. Language disorders were common (11/12), and most had mild to moderate deficits across receptive, expressive, written, and social-pragmatic domains. Speech disorders were frequent (7/9), including phonological delay (6/9) and disorder (3/9), and childhood apraxia of speech (3/9). All those tested for cognitive abilities had a FSIQ ≥70 (4/4). Participants had vision impairment (13/15), fine (8/15) and gross motor delay (10/15) which often resolved in later childhood, infant feeding impairment (8/15), and infant hypotonia (9/15). We have implicated BRPF1-related disorder as causative for speech and language disorder, including childhood apraxia of speech. Adaptive behavior and cognition were strengths when compared to other monogenic neurodevelopmental chromatin-related disorders. The universal involvement of speech and language impairment is noteable, relative to the high degree of phenotypic variability in BRPF1-related disorder.

Syllabic rhythm and prior linguistic knowledge interact with individual differences to modulate phonological statistical learning

Phonological statistical learning - our ability to extract meaningful regularities from spoken language - is considered critical in the early stages of language acquisition, in particular for helping to identify discrete words in continuous speech. Most phonological statistical learning studies use an experimental task introduced by Saffran et al. (1996), in which the syllables forming the words to be learned are presented continuously and isochronously. This raises the question of the extent to which this purportedly powerful learning mechanism is robust to the kinds of rhythmic variability that characterize natural speech. Here, we tested participants with arhythmic, semi-rhythmic, and isochronous speech during learning. In addition, we investigated how input rhythmicity interacts with two other factors previously shown to modulate learning: prior knowledge (syllable order plausibility with respect to participants' first language) and learners' speech auditory-motor synchronization ability. We show that words are extracted by all learners even when the speech input is completely arhythmic. Interestingly, high auditory-motor synchronization ability increases statistical learning when the speech input is temporally more predictable but only when prior knowledge can also be used. This suggests an additional mechanism for learning based on predictions not only about when but also about what upcoming speech will be.

Natural language processing for defining linguistic features in schizophrenia: A sample from Turkish speakers

Natural language processing (NLP) provides fast and accurate extraction of features related to the language of schizophrenia. We utilized NLP methods to test the hypothesis that schizophrenia is associated with altered linguistic features in Turkish, a non-Indo-European language, compared to controls. We also explored whether these possible altered linguistic features were language-dependent or -independent. We extracted and compared speech in schizophrenia (SZ, N = 38) and healthy well-matched control (HC, N = 38) participants using NLP. The analysis was conducted in two parts. In the first one, mean sentence length, total completed words, moving average type-token ratio to measure the lexical diversity, and first-person singular pronoun usage were calculated. In the second one, we used parts-of-speech tagging (POS) and Word2Vec in schizophrenia and control. We found that SZ had lower mean sentence length and moving average type-token ratio but higher use of first-person singular pronoun. All these significant results were correlated with the Thought and Language Disorder Scale score. The POS approach demonstrated that SZ used fewer coordinating conjunctions. Our methodology using Word2Vec detected that SZ had higher semantic similarity than HC and K-Means could differentiate between SZ and HC into two distinct groups with high accuracy, 86.84 %. Our findings showed that altered linguistic features in SZ are mostly language-independent. They are promising to describe language patterns in schizophrenia which proposes that NLP measurements may allow for rapid and objective measurements of linguistic features.

Mechanisms of Swallowing, Speech and Voice Disorders in Parkinson's Disease: Literature Review with Our First Evidence for the Periperal Nervous System Involvement

The majority of patients with Parkinson's disease (PD) develop swallowing, speech, and voice (SSV) disorders. Importantly, swallowing difficulty or dysphagia and related aspiration are life-threatening conditions for PD patients. Although PD treatments have significant therapeutic effects on limb motor function, their effects on SSV disorders are less impressive. A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. PD was long considered to be a central nervous system disorder caused by the death of dopaminergic neurons in the basal ganglia. Aggregates of phosphorylated α-synuclein (PAS) underlie PD pathology. SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. The pharynx, larynx, and tongue play a critical role in performing upper airway (UA) motor tasks and their dysfunction results in disordered SSV. This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.

Extending the Architecture of Language From a Multimodal Perspective

Language is inherently multimodal. In spoken languages, combined spoken and visual signals (e.g., co-speech gestures) are an integral part of linguistic structure and language representation. This requires an extension of the parallel architecture, which needs to include the visual signals concomitant to speech. We present the evidence for the multimodality of language. In addition, we propose that distributional semantics might provide a format for integrating speech and co-speech gestures in a common semantic representation.

Processing of auditory novelty in human cortex during a semantic categorization task

Auditory semantic novelty - a new meaningful sound in the context of a predictable acoustical environment - can probe neural circuits involved in language processing. Aberrant novelty detection is a feature of many neuropsychiatric disorders. This large-scale human intracranial electrophysiology study examined the spatial distribution of gamma and alpha power and auditory evoked potentials (AEP) associated with responses to unexpected words during performance of semantic categorization tasks. Participants were neurosurgical patients undergoing monitoring for medically intractable epilepsy. Each task included repeatedly presented monosyllabic words from different talkers ("common") and ten words presented only once ("novel"). Targets were words belonging to a specific semantic category. Novelty effects were defined as differences between neural responses to novel and common words. Novelty increased task difficulty and was associated with augmented gamma, suppressed alpha power, and AEP differences broadly distributed across the cortex. Gamma novelty effect had the highest prevalence in planum temporale, posterior superior temporal gyrus (STG) and pars triangularis of the inferior frontal gyrus; alpha in anterolateral Heschl's gyrus (HG), anterior STG and middle anterior cingulate cortex; AEP in posteromedial HG, lower bank of the superior temporal sulcus, and planum polare. Gamma novelty effect had a higher prevalence in dorsal than ventral auditory-related areas. Novelty effects were more pronounced in the left hemisphere. Better novel target detection was associated with reduced gamma novelty effect within auditory cortex and enhanced gamma effect within prefrontal and sensorimotor cortex. Alpha and AEP novelty effects were generally more prevalent in better performing participants. Multiple areas, including auditory cortex on the superior temporal plane, featured AEP novelty effect within the time frame of P3a and N400 scalp-recorded novelty-related potentials. This work provides a detailed account of auditory novelty in a paradigm that directly examined brain regions associated with semantic processing. Future studies may aid in the development of objective measures to assess the integrity of semantic novelty processing in clinical populations.

Improved emotion differentiation under reduced acoustic variability of speech in autism

BACKGROUND

Socio-emotional impairments are among the diagnostic criteria for autism spectrum disorder (ASD), but the actual knowledge has substantiated both altered and intact emotional prosodies recognition. Here, a Bayesian framework of perception is considered suggesting that the oversampling of sensory evidence would impair perception within highly variable environments. However, reliable hierarchical structures for spectral and temporal cues would foster emotion discrimination by autistics.

METHODS

Event-related spectral perturbations (ERSP) extracted from electroencephalographic (EEG) data indexed the perception of anger, disgust, fear, happiness, neutral, and sadness prosodies while listening to speech uttered by (a) human or (b) synthesized voices characterized by reduced volatility and variability of acoustic environments. The assessment of mechanisms for perception was extended to the visual domain by analyzing the behavioral accuracy within a non-social task in which dynamics of precision weighting between bottom-up evidence and top-down inferences were emphasized. Eighty children (mean 9.7 years old; standard deviation 1.8) volunteered including 40 autistics. The symptomatology was assessed at the time of the study via the Autism Diagnostic Observation Schedule, Second Edition, and parents' responses on the Autism Spectrum Rating Scales. A mixed within-between analysis of variance was conducted to assess the effects of group (autism versus typical development), voice, emotions, and interaction between factors. A Bayesian analysis was implemented to quantify the evidence in favor of the null hypothesis in case of non-significance. Post hoc comparisons were corrected for multiple testing.

RESULTS

Autistic children presented impaired emotion differentiation while listening to speech uttered by human voices, which was improved when the acoustic volatility and variability of voices were reduced. Divergent neural patterns were observed from neurotypicals to autistics, emphasizing different mechanisms for perception. Accordingly, behavioral measurements on the visual task were consistent with the over-precision ascribed to the environmental variability (sensory processing) that weakened performance. Unlike autistic children, neurotypicals could differentiate emotions induced by all voices.

CONCLUSIONS

This study outlines behavioral and neurophysiological mechanisms that underpin responses to sensory variability. Neurobiological insights into the processing of emotional prosodies emphasized the potential of acoustically modified emotional prosodies to improve emotion differentiation by autistics.

TRIAL REGISTRATION

BioMed Central ISRCTN Registry, ISRCTN18117434. Registered on September 20, 2020.

Optimizing Communication in Ataxia: A Multifaceted Approach to Alternative and Augmentative Communication (AAC)

The progression of multisystem neurodegenerative diseases such as ataxia significantly impacts speech and communication, necessitating adaptive clinical care strategies. With the deterioration of speech, Alternative and Augmentative Communication (AAC) can play an ever increasing role in daily life for individuals with ataxia. This review describes the spectrum of AAC resources available, ranging from unaided gestures and sign language to high-tech solutions like speech-generating devices (SGDs) and eye-tracking technology. Despite the availability of various AAC tools, their efficacy is often compromised by the physical limitations inherent in ataxia, including upper limb ataxia and visual disturbances. Traditional speech-to-text algorithms and eye gaze technology face challenges in accuracy and efficiency due to the atypical speech and movement patterns associated with the disease.In addressing these challenges, maintaining existing speech abilities through rehabilitation is prioritized, complemented by advances in digital therapeutics to provide home-based treatments. Simultaneously, projects incorporating AI driven solutions aim to enhance the intelligibility of dysarthric speech through improved speech-to-text accuracy.This review discusses the complex needs assessment for AAC in ataxia, emphasizing the dynamic nature of the disease and the importance of regular reassessment to tailor communication strategies to the changing abilities of the individual. It also highlights the necessity of multidisciplinary involvement for effective AAC assessment and intervention. The future of AAC looks promising with developments in brain-computer interfaces and the potential of voice banking, although their application in ataxia requires further exploration.

Characterization of central manifestations in patients with Niemann-Pick disease type C

PURPOSE

Niemann-Pick disease type C (NPC) is a rare lysosomal storage disease characterized by progressive neurodegeneration and neuropsychiatric symptoms. This study investigated pathophysiological mechanisms underlying motor deficits, particularly speech production, and cognitive impairment.

METHODS

We prospectively phenotyped 8 adults with NPC and age-sex-matched healthy controls using a comprehensive assessment battery, encompassing clinical presentation, plasma biomarkers, hand-motor skills, speech production, cognitive tasks, and (micro-)structural and functional central nervous system properties through magnetic resonance imaging.

RESULTS

Patients with NPC demonstrated deficits in fine-motor skills, speech production timing and coordination, and cognitive performance. Magnetic resonance imaging revealed reduced cortical thickness and volume in cerebellar subdivisions (lobule VI and crus I), cortical (frontal, temporal, and cingulate gyri) and subcortical (thalamus and basal ganglia) regions, and increased choroid plexus volumes in NPC. White matter fractional anisotropy was reduced in specific pathways (intracerebellar input and Purkinje tracts), whereas diffusion tensor imaging graph theory analysis identified altered structural connectivity. Patients with NPC exhibited altered activity in sensorimotor and cognitive processing hubs during resting-state and speech production. Canonical component analysis highlighted the role of cerebellar-cerebral circuitry in NPC and its integration with behavioral performance and disease severity.

CONCLUSION

This deep phenotyping approach offers a comprehensive systems neuroscience understanding of NPC motor and cognitive impairments, identifying potential central nervous system biomarkers.

Systematic Review and Meta-Analyses of Word Production Abilities in Dysfunction of the Basal Ganglia: Stroke, Small Vessel Disease, Parkinson's Disease, and Huntington's Disease

Clinical populations with basal ganglia pathologies may present with language production impairments, which are often described in combination with comprehension measures or attributed to motor, memory, or processing-speed problems. In this systematic review and meta-analysis, we studied word production in four (vascular and non-vascular) pathologies of the basal ganglia: stroke affecting the basal ganglia, small vessel disease, Parkinson's disease, and Huntington's disease. We compared scores of these clinical populations with those of matched cognitively unimpaired adults on four well-established production tasks, namely picture naming, category fluency, letter fluency, and past-tense verb inflection. We conducted a systematic search in PubMed and PsycINFO with terms for basal ganglia structures, basal ganglia disorders and language production tasks. A total of 114 studies were included, containing results for one or more of the tasks of interest. For each pathology and task combination, effect sizes (Hedges' g) were extracted comparing patient versus control groups. For all four populations, performance was consistently worse than that of cognitively unimpaired adults across the four language production tasks (p-values < 0.010). Given that performance in picture naming and verb inflection across all pathologies was quantified in terms of accuracy, our results suggest that production impairments cannot be fully explained by motor or processing-speed deficits. Our review shows that while language production difficulties in these clinical populations are not negligible, more evidence is necessary to determine the exact mechanism that leads to these deficits and whether this mechanism is the same across different pathologies.

Surgical treatment of velopharyngeal dysfunction: Incidence and associated factors in the Swedish cleft palate population

INTRODUCTION

Speech in children with cleft palate can be affected by velopharyngeal dysfunction, which persists after primary palate repair. The incidence of surgery to correct velopharyngeal dysfunction in this patient group has previously been reported as 2.6-37%. We aimed to investigate the incidence of velopharyngeal dysfunction surgery in Swedish children with cleft palate and to examine potential associations of independent variables with this incidence.

METHODS

In this cohort study, we analysed data from the Swedish cleft lip and palate quality registry for 1093 children with cleft palate with or without cleft lip. Kaplan-Meier analysis was used to estimate the risk of having velopharyngeal dysfunction surgery. Multivariable Cox proportional hazards models were used to estimate the associated effect of cleft subtype, additional diagnoses, gender, and age at and number of stages for primary palate repair on the primary outcome.

RESULTS

The risk of having velopharyngeal dysfunction surgery was 25.6%. Complete primary palate repair after the age of 18 months or in more than one stage was associated with a higher risk, but it could not be determined which of these was the more significant factor. Cleft soft palate was associated with a significantly lower risk than other cleft subtypes.

CONCLUSIONS

Primary palate repair at a higher age or in more than one stage may increase the risk of having velopharyngeal dysfunction surgery. Further analysis of potential unknown confounding factors and the association between the incidence of velopharyngeal dysfunction and surgery to correct this condition is needed.

Generative Large Language Models for Detection of Speech Recognition Errors in Radiology Reports

This study evaluated the ability of generative large language models (LLMs) to detect speech recognition errors in radiology reports. A dataset of 3233 CT and MRI reports was assessed by radiologists for speech recognition errors. Errors were categorized as clinically significant or not clinically significant. Performances of five generative LLMs-GPT-3.5-turbo, GPT-4, text-davinci-003, Llama-v2-70B-chat, and Bard-were compared in detecting these errors, using manual error detection as the reference standard. Prompt engineering was used to optimize model performance. GPT-4 demonstrated high accuracy in detecting clinically significant errors (precision, 76.9%; recall, 100%; F1 score, 86.9%) and not clinically significant errors (precision, 93.9%; recall, 94.7%; F1 score, 94.3%). Text-davinci-003 achieved F1 scores of 72% and 46.6% for clinically significant and not clinically significant errors, respectively. GPT-3.5-turbo obtained 59.1% and 32.2% F1 scores, while Llama-v2-70B-chat scored 72.8% and 47.7%. Bard showed the lowest accuracy, with F1 scores of 47.5% and 20.9%. GPT-4 effectively identified challenging errors of nonsense phrases and internally inconsistent statements. Longer reports, resident dictation, and overnight shifts were associated with higher error rates. In conclusion, advanced generative LLMs show potential for automatic detection of speech recognition errors in radiology reports. Keywords: CT, Large Language Model, Machine Learning, MRI, Natural Language Processing, Radiology Reports, Speech, Unsupervised Learning Supplemental material is available for this article.

Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21

BACKGROUND

Increasing disability is of global and national concern. Lack of evidence on disability across socioeconomic groups and geographic levels (especially small areas) impeded interventions for these disadvantaged subgroups. We aimed to examine the socioeconomic and geographic variations in disabilities, namely hearing, speech, visual, mental, and locomotor, in Indian participants using cross-sectional data from the National Family Health Survey 2019-2021.

METHODS

Using data from 27,93,971 individuals, we estimated age-sex-adjusted disability rates at the national and sub-national levels. The extent of socioeconomic variations in disabilities was explored using the Erreygers Concentration Index and presented graphically through a concentration curve. We adopted a four-level random intercept logit model to compute the variance partitioning coefficient (VPC) to assess the significance of each geographical unit in total variability. We also calculated precision-weighted disability estimates of individuals across 707 districts and showed their correlation with within-district or between-cluster standard deviation.

RESULTS

We estimated the prevalence of any disability of 10 per 1000 population. The locomotor disability was common, followed by mental, speech, hearing, and visual. The concentration index of each type of disability was highest in the poorest wealth quintile households and illiterate 18 + individuals, confirming higher socioeconomic variations in disability rates. Clusters share the largest source of geographic variation for any disability (6.5%), hearing (5.8%), visual (24.3%), and locomotor (17.4%). However, States/Union Territories (UTs) account for the highest variation in speech (3.7%) and mental (6.5%) disabilities, where the variation at the cluster level becomes negligible. Districts with the highest disability rates were clustered in Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Telangana, and Punjab. Further, we found positive correlations between the district rates and cluster standard deviations (SDs) for disabilities.

CONCLUSIONS

Though the growing disability condition in India is itself a concerning issue, wide variations across socioeconomic groups and geographic locations indicate the implementation of several policy-relevant implications focusing on these vulnerable chunks of the population. Further, the critical importance of small-area variations within districts suggests the design of strategies targeting these high-burden areas of disabilities.

Central Auditory Processing Impairment in Renal Failure

This study is the first to investigate central auditory processing impairment in patients with slight decrease in renal function (PSR), who had no risk factors, evidence of renal injury, and albuminuria. The aim was to determine the scores of dichotic digits test (DDT) and word-in-noise perception (WINP) test in PSR. The survey was cross-sectional-comparative. The case group consisted of 30 PSR, with an estimated glomerular filtration rate of 60-90 mL/min at 1.73 m2. The control group consisted of 60 normal participants. They were matched with the case group based on sex, education level, dominant hand and age. The measures were the 28-item general health questionnaire, mini-mental state examination, Petersburg sleep quality index, acoustic immittance assessment, pure tone audiometry, speech reception threshold evaluation, DDT and WINP test. Both groups had normal stress levels, night sleep, mental states, and hearing thresholds. The mean scores of the WINP test in the right and left ears of the case group were significantly different from the control group (PvRight = 0.026, PvLeft = 0.029 ). The mean difference of DDT scores in the right and left ears of the case group compared to the control group showed significant difference (PvRight = 0.039, PvLeft = 0.048 ). Therefore, slight decrease in renal function can be one of the causes of central auditory processing impairment. Affected patients with normal hearing thresholds may have difficulty in discrimination the pitch of words, and speech perception in competing situations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04345-5.

Childhood Apraxia of Speech: Exploring Gluten Sensitivity and Changes in Glutamate and Gamma-Aminobutyric Acid Plasma Levels

BACKGROUND

Individuals with childhood apraxia of speech (CAS) were reported to have genetic variations related to gluten sensitivity and some neuroanatomic changes, which could be associated with alterations in neurotransmitters levels such as glutamate and gamma-aminobutyric acid (GABA). The aim was to measure the levels of antigliadin immunoglobulin A (IgA) antibody, glutamate, and GABA in the plasma of children with CAS compared with children with delayed language development (DLD) and neurotypical (NT) children.

METHODS

The participants (N = 120) were in three groups: Group I for CAS (N = 30), Group II for DLD (N = 60), and Group III for NT (N = 30). The abilities of children in Groups I and II were evaluated. The plasma levels of antigliadin IgA, glutamate, and GABA were determined by enzyme-linked immunosorbent assay.

RESULTS

The intelligence quotient and expressive language age in Group I were low compared with Group II (P = 0.001; 0.004). The levels of antigliadin IgA and glutamate in Group I were higher compared with the other two groups, whereas the level of GABA was lower (P < 0.0001). An imbalance between glutamate and GABA was found in Group I. In Group II, no measures differed from NTs except lower GABA levels (P = 0.0007).

CONCLUSIONS

The elevated levels of antigliadin IgA antibody and glutamate demonstrated high sensitivity and specificity, differentiating children with CAS from children with DLD and NT children. The low levels of GABA contributed to the imbalance between the excitatory and inhibitory neurotransmitters' levels detected in children with CAS.

Putting it Together, Together

People are not as fast or as strong as many other creatures that evolved around us. What gives us an evolutionary advantage is working together to achieve common aims. Coordinating joint action begins at a tender age with such cooperative activities as alternating babbling and clapping games. Adult joint activities are far more complex and use multiple means of coordination. Joint action has attracted qualitative analyses by sociolinguists, cognitive scientists, and philosophers as well as empirical analyses and theories by cognitive scientists. Here, we analyze how joint action is spontaneously coordinated from start to finish in a novel complex real-life joint activity, assembling a piece of furniture, a task that captures the essentials of joint action, collaborators, things in the world, and communicative devices. Pairs of strangers assembled a TV cart from a stack of parts and a photo of the completed cart. Coordination prior to each assembly action was coded as explicit, using speech or gesture, or implicit, actions that both advanced the task and communicated the next step. Initial planning relied on explicit communication about structure, but not action nor division of labor, which were improvised. That served to establish a joint representation of the goal that informed actions and monitored progress. As assembly progressed, coordination was increasingly implicit, through actions alone. Joint action is a dynamic interplay of explicit and implicit signaling with respect to things in the world to coordinate ongoing progress, guided by a shared representation of the goal.

Perceptual and Acoustic Analysis of Speech in Spinocerebellar ataxia Type 1

This study characterizes the speech phenotype of spinocerebellar ataxia type 1 (SCA1) using both perceptual and objective acoustic analysis of speech in a cohort of SCA1 patients. Twenty-seven symptomatic SCA1 patients in various disease stages (SARA score range: 3-32 points) and 18 sex and age matched healthy controls underwent a clinical assessment addressing ataxia severity, non-ataxia signs, cognitive functioning, and speech. Speech samples were perceptually rated by trained speech therapists, and acoustic metrics representing speech timing, vocal control, and voice quality were extracted. Perceptual analysis revealed reduced intelligibility and naturalness in speech samples of SCA1 patients. Acoustically, SCA1 patients presented with slower speech rate and diadochokinetic rate as well as longer syllable duration compared to healthy controls. No distinct abnormalities in voice quality in the acoustic analysis were detected at group level. Both the affected perceptual and acoustic variables correlated with ataxia severity. Longitudinal assessment of speech is needed to place changes in speech in the context of disease progression and potential response to treatment.

Using voice biomarkers for frailty classification

Clinicians use the patient's voice intuitively to evaluate general health and frailty. Voice is an emerging health indicator but has been scarcely studied in the context of frailty. This study explored voice parameters as possible predictors of frailty in older adults. Fifty-three participants over 70 years old were recruited from rehabilitation wards at a tertiary medical center. Participants' frailty was assessed using Rockwood frailty index and they were classified as most-frail (n = 33, 68%) or less-frail (n = 20, 32%). Participants were recorded counting from 1 to 10 and backwards using a smartphone recording application. The following voice biomarkers were derived: peak and average volume, peak/average volume ratio, pauses' total length, and pause length standard deviation. The most-frail group had a higher peak volume/average volume ratio (p = 0.03) and greater variance in lengths of pauses between speech segments (p = 0.002). These parameters indicate greater speech irregularity in the most-frail, compared to the less-frail. The most-frail group also had a longer total duration of pauses (p = 0.02). No statistically significant difference was found in peak and average volume (p = 0.75 and 0.39). Most-frail participants' speech had different characteristics, compared to participants in the less-frail group. This is a first step to developing an AI-based frailty assessment tool that can assist in identifying our most vulnerable patients.

Harnessing Speech-Derived Digital Biomarkers to Detect and Quantify Cognitive Decline Severity in Older Adults

INTRODUCTION

Current cognitive assessments suffer from floor/ceiling and practice effects, poor psychometric performance in mild cases, and repeated assessment effects. This study explores the use of digital speech analysis as an alternative tool for determining cognitive impairment. The study specifically focuses on identifying the digital speech biomarkers associated with cognitive impairment and its severity.

METHODS

We recruited older adults with varying cognitive health. Their speech data, recorded via a wearable microphone during the reading aloud of a standard passage, were processed to derive digital biomarkers such as timing, pitch, and loudness. Cohen's d effect size highlighted group differences, and correlations were drawn to the Montreal Cognitive Assessment (MoCA). A stepwise approach using a Random Forest model was implemented to distinguish cognitive states using speech data and predict MoCA scores based on highly correlated features.

RESULTS

The study comprised 59 participants, with 36 demonstrating cognitive impairment and 23 serving as cognitively intact controls. Among all assessed parameters, similarity, as determined by Dynamic Time Warping (DTW), exhibited the most substantial positive correlation (rho = 0.529, p < 0.001), while timing parameters, specifically the ratio of extra words, revealed the strongest negative correlation (rho = -0.441, p < 0.001) with MoCA scores. Optimal discriminative performance was achieved with a combination of four speech parameters: total pause time, speech-to-pause ratio, similarity via DTW, and intelligibility via DTW. Precision and balanced accuracy scores were found to be 88.1 ± 1.2% and 76.3 ± 1.3%, respectively.

DISCUSSION

Our research proposes that reading-derived speech data facilitates the differentiation between cognitively impaired individuals and cognitively intact, age-matched older adults. Specifically, parameters based on timing and similarity within speech data provide an effective gauge of cognitive impairment severity. These results suggest speech analysis as a viable digital biomarker for early detection and monitoring of cognitive impairment, offering novel approaches in dementia care.

Development, feasibility testing, and preliminary evaluation of the Communication with an Artificial airway Tool (CAT): Results of the Crit-CAT pilot study

BACKGROUND

A purpose-built outcome measure for assessing communication effectiveness in patients with an artificial airway is needed.

OBJECTIVES

The objective of this study was to develop the Communication with an Artificial airway Tool (CAT) and to test the feasibility and to preliminary evaluate the clinical metrics of the tool.

METHODS

Eligible patients with an artificial airway in the Intensive Care Unit were enrolled in the pilot study (Crit-CAT). The CAT was administered at least twice before and after the communication intervention. Item correlation analysis was performed. Participant and family member acceptability ratings and feedback were solicited. A qualitative thematic analysis was undertaken.

RESULTS

Fifteen patients with a mean age of 53 years (standard deviation [SD]: 19.26) were included. The clinician-reported scale was administered on 50 attempts (100%) with a mean completion time of 4.5 (SD: 0.77) minutes. The patient-reported scale was administered on 46 out of 49 attempts (94%) and took a mean of 1.5 (SD: 0.39) minutes to complete. The CAT was feasible for use in the Intensive Care Unit, with patients with either an endotracheal or tracheostomy tube, whilst receiving invasive mechanical ventilation or not, and while using either verbal or nonverbal modes of communication. Preliminary establishment of responsiveness, validity, and reliability was made. The tool was acceptable to participants and their family members.

CONCLUSION

The clinician-reported and patient-reported components of the study were feasible for use. The CAT has the potential to enable quantifiable comparison of communication interventions for patients with an artificial airway. Future research is required to determine external validity and reliability.

Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients

BACKGROUND

DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments.

OBJECTIVE

To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients.

METHODS

We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere.

RESULTS

First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities.

CONCLUSIONS

STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.

Of words and whistles: Statistical learning operates similarly for identical sounds perceived as speech and non-speech

Statistical learning is an ability that allows individuals to effortlessly extract patterns from the environment, such as sound patterns in speech. Some prior evidence suggests that statistical learning operates more robustly for speech compared to non-speech stimuli, supporting the idea that humans are predisposed to learn language. However, any apparent statistical learning advantage for speech could be driven by signal acoustics, rather than the subjective perception per se of sounds as speech. To resolve this issue, the current study assessed whether there is a statistical learning advantage for ambiguous sounds that are subjectively perceived as speech-like compared to the same sounds perceived as non-speech, thereby controlling for acoustic features. We first induced participants to perceive sine-wave speech (SWS)-a degraded form of speech not immediately perceptible as speech-as either speech or non-speech. After this induction phase, participants were exposed to a continuous stream of repeating trisyllabic nonsense words, composed of SWS syllables, and then completed an explicit familiarity rating task and an implicit target detection task to assess learning. Critically, participants showed robust and equivalent performance on both measures, regardless of their subjective speech perception. In contrast, participants who perceived the SWS syllables as more speech-like showed better detection of individual syllables embedded in speech streams. These results suggest that speech perception facilitates processing of individual sounds, but not the ability to extract patterns across sounds. Our findings suggest that statistical learning is not influenced by the perceived linguistic relevance of sounds, and that it may be conceptualized largely as an automatic, stimulus-driven mechanism.

Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A

OBJECTIVE

To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions.

METHODS

This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis.

RESULTS

Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis.

CONCLUSION

Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.

Anti-Abortion Exceptionalism after Dobbs

The end of the constitutional right to abortion with Dobbs v. Jackson Women's Health stands to generate massive conflict between abortion regulation and the First Amendment. Abortion exceptionalism within constitutional doctrine -- which both treats abortion differently than other areas and favors anti-abortion over pro-choice viewpoints -- will not retreat but advance, unless confronted by the courts.

Functional considerations between flap and non-flap reconstruction in oral tongue cancer: A systematic review

This systematic review aims to provide insight into the ideal reconstructive approach of the oral tongue in oral tongue cancer (OTC) by investigating the relationship between functional outcomes and the extent of tongue resection. A structured search was performed in Ovid MEDLINE, EMBASE, and Web of Science. Studies comparing patient-reported and objective measurements of the oral tongue function between flap vs. non-flap reconstruction were included. Functional outcomes of interest were speech production, deglutition efficiency, tongue mobility, overall quality of life, and postoperative complications. A total of nine studies were retrieved and critically appraised. Patients with 20 % or less of oral tongue resected had superior swallowing efficiency and speech intelligibility with a non-flap reconstruction while patients with a tongue defect of 40-50 % self-reported or demonstrated better swallowing function with a flap repair. The data in intermediate tongue defects (20-40 % tongue resected) was inconclusive, with several studies reporting comparable functional outcomes between approaches. A longitudinal multi-institutional prospective study that rigidly controls the extent of tongue resected and subsites involved is needed to determine the percentage of tongue resected at which a flap reconstruction yields a superior functional result in OTC.

Emotion-dependent language featuring depression

BACKGROUND AND OBJECTIVES

Understanding language features of depression contributes to the detection of the disorder. Considering that depression is characterized by dysfunctions in emotion and individuals with depression often show emotion-dependent cognition, the present study investigated the speech features and word use of emotion-dependent narrations in patients with depression.

METHODS

Forty depression patients and forty controls were required to narrate self-relevant memories under five basic human emotions (i.e., sad, angry, fearful, neutral, and happy). Recorded speech and transcribed texts were analyzed.

RESULTS

Patients with depression, as compared to non-depressed individuals, talked slower and less. They also performed differently in using negative emotion, work, family, sex, biology, health, and assent words regardless of emotion manipulation. Moreover, the use of words such as first person singular pronoun, past tense, causation, achievement, family, death, psychology, impersonal pronoun, quantifier and preposition words displayed emotion-dependent differences between groups. With the involvement of emotion, linguistic indicators associated with depressive symptoms were identified and explained 71.6% variances of depression severity.

LIMITATIONS

Word use was analyzed based on the dictionary which does not cover all the words spoken in the memory task, resulting in text data loss. Besides, a relatively small number of depression patients were included in the present study and therefore the results need confirmation in future research using big emotion-dependent data of speech and texts.

CONCLUSIONS

Our findings suggest that consideration of different emotional contexts is an effective means to improve the accuracy of depression detection via the analysis of word use and speech features.

Deep brain stimulation of the subthalamic nucleus in severe Parkinson's disease: relationships between dual-contact topographic setting and 1-year worsening of speech and gait

BACKGROUND

Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs.

METHOD

An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05).

RESULTS

Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position.

CONCLUSION

Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait.

Oral Incompetence: changes in speech intelligibility following facial nerve paralysis

BACKGROUND

Speech may be compromised following facial nerve paralysis (FNP), depending on the cause of the paralysis. This can result in lower quality of life and a reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact of FNP on speech intelligibility.

METHODS

This observational study recruited patients who were diagnosed with FNP and who reported oral incompetence from the Sydney Facial Nerve Service. Their speech was analysed using patient reported outcome measures (Speech Handicap Index) and perceived intelligibility (Speech Pathologist, community member control participants, participant self-rating, and dictation software).

RESULTS

Forty participants with FNP and 40 controls were recruited. Participants with FNP rated their intelligibility to be significantly worse than other raters (p <0.001). Consonant analysis demonstrated bilabial, fricatives and labiodental phonemes to be most commonly affected following FNP.

CONCLUSION

Oral competence is compromised after FNP which can lead to a poorer perception of their intelligibility and reduced speech related quality of life.

The Best Users of Cochlear Implants

The aim of this descriptive-analytical study was to compare the categories of auditory performance (CAP) and speech intelligibility rating (SIR) in people with cochlear implants (CI) based on the implanted ear. CAP and SIR were evaluated in 184 people with CI of right (110) and left (74) ears every 6 to 24 months (6,12,18,24). The significance level was less than 0.05. People with CI in the right-ears had better mean CAP and SIR scores than the left-ears (P values6,12,18, 24= 0.001, 0.004, 0.004, 0.002, and 0.001, 0.010, 0.010, 0.006). There were the relationship between the means of language acquisition status at the time of surgery and the means of CAP and SIR scores (P values6,12,18, 24= 0.005, 0.031, 0.006, 0.019, and 0.000, 0.000, 0.000, 0.002). The highest mean SIR scores were found in people with high school education (P values6,12,18, 24= 0.000, 0.000, 0.000, 0.008). The means of CAP scores did not show a relationship with the level of education (P values6, 12, 18, 24= 0.388, 0.217, 0.297, 0.213).  Mean SIR and CAP scores were not related to gender. People who received right ear prostheses after the language learning age and have a higher level of education are the best users of cochlear implants. Compared to others who do not have these facilities, they gain more ability in auditory-speech skills. Gender, does not affect these capabilities.

Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate

To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ±  lip (CP ± L).

3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland.

Perceptual speech analysis utilized the Cleft Audit Protocol for Speech-Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)-speech within the normal range, SS2a-no structurally related speech difficulties or history of speech surgery, and SS3-speech without significant cleft-related articulation difficulties.

Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP-aOR 0.719 [CI 0.591-0.875]; BCLP-aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete-aOR 0.701 [CI 0.540-0.909]; complete-aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent.

Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.

Evidence for a Causal Dissociation of the McGurk Effect and Congruent Audiovisual Speech Perception via TMS

Congruent visual speech improves speech perception accuracy, particularly in noisy environments. Conversely, mismatched visual speech can alter what is heard, leading to an illusory percept known as the McGurk effect. This illusion has been widely used to study audiovisual speech integration, illustrating that auditory and visual cues are combined in the brain to generate a single coherent percept. While prior transcranial magnetic stimulation (TMS) and neuroimaging studies have identified the left posterior superior temporal sulcus (pSTS) as a causal region involved in the generation of the McGurk effect, it remains unclear whether this region is critical only for this illusion or also for the more general benefits of congruent visual speech (e.g., increased accuracy and faster reaction times). Indeed, recent correlative research suggests that the benefits of congruent visual speech and the McGurk effect reflect largely independent mechanisms. To better understand how these different features of audiovisual integration are causally generated by the left pSTS, we used single-pulse TMS to temporarily impair processing while subjects were presented with either incongruent (McGurk) or congruent audiovisual combinations. Consistent with past research, we observed that TMS to the left pSTS significantly reduced the strength of the McGurk effect. Importantly, however, left pSTS stimulation did not affect the positive benefits of congruent audiovisual speech (increased accuracy and faster reaction times), demonstrating a causal dissociation between the two processes. Our results are consistent with models proposing that the pSTS is but one of multiple critical areas supporting audiovisual speech interactions. Moreover, these data add to a growing body of evidence suggesting that the McGurk effect is an imperfect surrogate measure for more general and ecologically valid audiovisual speech behaviors.

Neurophysiological explorations across the spectrum of psychosis, autism, and depression, during wakefulness and sleep: protocol of a prospective case-control transdiagnostic multimodal study (DEMETER)

BACKGROUND

Quantitative electroencephalography (EEG) analysis offers the opportunity to study high-level cognitive processes across psychiatric disorders. In particular, EEG microstates translate the temporal dynamics of neuronal networks throughout the brain. Their alteration may reflect transdiagnostic anomalies in neurophysiological functions that are impaired in mood, psychosis, and autism spectrum disorders, such as sensorimotor integration, speech, sleep, and sense of self. The main questions this study aims to answer are as follows: 1) Are EEG microstate anomalies associated with clinical and functional prognosis, both in resting conditions and during sleep, across psychiatric disorders? 2) Are EEG microstate anomalies associated with differences in sensorimotor integration, speech, sense of self, and sleep? 3) Can the dynamic of EEG microstates be modulated by a non-drug intervention such as light hypnosis?

METHODS

This prospective cohort will include a population of adolescents and young adults, aged 15 to 30 years old, with ultra-high-risk of psychosis (UHR), first-episode psychosis (FEP), schizophrenia (SCZ), autism spectrum disorder (ASD), and major depressive disorder (MDD), as well as healthy controls (CTRL) (N = 21 × 6), who will be assessed at baseline and after one year of follow-up. Participants will undergo deep phenotyping based on psychopathology, neuropsychological assessments, 64-channel EEG recordings, and biological sampling at the two timepoints. At baseline, the EEG recording will also be coupled to a sensorimotor task and a recording of the characteristics of their speech (prosody and turn-taking), a one-night polysomnography, a self-reference effect task in virtual reality (only in UHR, FEP, and CTRL). An interventional ancillary study will involve only healthy controls, in order to assess whether light hypnosis can modify the EEG microstate architecture in a direction opposite to what is seen in disease.

DISCUSSION

This transdiagnostic longitudinal case-control study will provide a multimodal neurophysiological assessment of clinical dimensions (sensorimotor integration, speech, sleep, and sense of self) that are disrupted across mood, psychosis, and autism spectrum disorders. It will further test the relevance of EEG microstates as dimensional functional biomarkers.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT06045897.

Multilingual markers of depression in remotely collected speech samples: A preliminary analysis

BACKGROUND

Speech contains neuromuscular, physiological and cognitive components, and so is a potential biomarker of mental disorders. Previous studies indicate that speaking rate and pausing are associated with major depressive disorder (MDD). However, results are inconclusive as many studies are small and underpowered and do not include clinical samples. These studies have also been unilingual and use speech collected in controlled settings. If speech markers are to help understand the onset and progress of MDD, we need to uncover markers that are robust to language and establish the strength of associations in real-world data.

METHODS

We collected speech data in 585 participants with a history of MDD in the United Kingdom, Spain, and Netherlands as part of the RADAR-MDD study. Participants recorded their speech via smartphones every two weeks for 18 months. Linear mixed models were used to estimate the strength of specific markers of depression from a set of 28 speech features.

RESULTS

Increased depressive symptoms were associated with speech rate, articulation rate and intensity of speech elicited from a scripted task. These features had consistently stronger effect sizes than pauses.

LIMITATIONS

Our findings are derived at the cohort level so may have limited impact on identifying intra-individual speech changes associated with changes in symptom severity. The analysis of features averaged over the entire recording may have underestimated the importance of some features.

CONCLUSIONS

Participants with more severe depressive symptoms spoke more slowly and quietly. Our findings are from a real-world, multilingual, clinical dataset so represent a step-change in the usefulness of speech as a digital phenotype of MDD.

What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists?

OBJECTIVE

To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs).

METHODS

This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially.

RESULTS

Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention.

CONCLUSION

The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.

A Cross-sectional Study of Perceptual and Acoustic Voice Characteristics in Healthy Aging

PURPOSE

The human voice qualitatively changes across the lifespan. Although some of these vocal changes may be pathologic, other changes likely reflect natural physiological aging. Normative data for voice characteristics in healthy aging is limited and disparate studies have used a range of different acoustic features, some of which are implicated in pathologic voice changes. We examined the perceptual and acoustic features that predict healthy aging.

METHOD

Participants (N = 150) aged between 50 and 92 years performed a sustained vowel task. Acoustic features were measured using the Multi-Dimensional Voice Program and the Analysis of Dysphonia in Speech and Voice. We used forward and backward variable elimination techniques based on the Bayesian information criterion and linear regression to assess which of these acoustic features predict age and perceptual features. Hearing thresholds were determined using pure-tone audiometry tests at frequencies 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. We further explored potential relationships between these acoustic features and clinical assessments of voice quality using the Consensus Auditory-Perceptual Evaluation of Voice.

RESULTS

Chronological age was significantly predicted by greater voice turbulence, variability of cepstral fundamental frequency, low relative to high spectral energy, and cepstral intensity. When controlling for hearing loss, age was significantly predicted by amplitude perturbations and cepstral intensity. Clinical assessments of voice indicated perceptual characteristics of speech were predicted by different acoustic features. For example, breathiness was predicted by the soft phonation index, mean cepstral peak prominence, mean low-high spectral ratio, and mean cepstral intensity.

CONCLUSIONS

Findings suggest that acoustic features that predict healthy aging are different than those previously reported for the pathologic voice. We propose a model of healthy and pathologic voice development in which voice characteristics are mediated by the inability to monitor vocal productions associated with age-related hearing loss. This normative data of healthy vocal aging may assist in separating voice pathologies from healthy aging.

A journey from speech to dance through the field of oxytocin

In this article, I am going through my scientific and personal journey using my work on oxytocin as a compass. I recount how my scientific questions were shaped over the years, and how I studied them through the lens of different fields ranging from linguistics and neuroscience to comparative and population genomics in a wide range of vertebrate species. I explain how my evolutionary findings and proposal for a universal gene nomenclature in the oxytocin-vasotocin ligand and receptor families have impacted relevant fields, and how my studies in the oxytocin and vasotocin system in songbirds, humans and non-human primates have led me to now be testing intranasal oxytocin as a candidate treatment for speech deficits. I also discuss my projects on the neurobiology of dance and where oxytocin fits in the picture of studying speech and dance in parallel. Lastly, I briefly communicate the challenges I have been facing as a woman and an international scholar in science and academia, and my personal ways to overcome them.

The Relationships Among Vocal Variability, Vocal-Articulatory Coordination, and Dysphonia in Children

OBJECTIVE

The purpose of this study was to evaluate the relationship between vocal variability and variability of vocal-articulatory coordination in children. Furthermore, this study examined if this relationship was impacted by pediatric dysphonia.

STUDY DESIGN

Retrospective analysis of speech samples in the Arizona Child Acoustic Database.

METHODS

Speech samples from children 2-7 years of age were selected for analysis. Vocal variability was defined as the coefficient of variation (CoV) of fundamental frequency, taken from the center of sustained vowels. Variability of vocal-articulatory coordination was defined as the CoV of voice onset time (VOT) of voiceless stop consonants. Both objective and subjective measures of dysphonia were completed for each participant.

RESULTS

Children had a negative correlation between VOT variability and vocal variability. Further analysis indicated that this relationship was present in children with typical developmental levels of dysphonia but absent for children with moderate to severe dysphonia. Increased dysphonia severity was associated with increased vocal variability.

CONCLUSION

Increased VOT variability was associated with decreased vocal variability in children with dysphonia severities consistent with typical vocal development. However, this relationship was not present in children with moderate to severe dysphonia. This study suggests that future work is needed to examine the relationships between the vocal system and vocal-articulatory coordination in children with and without diagnosed voice disorders.

Quantitative Speech Assessment in Ataxia-Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Markers

Dysarthria is a common and debilitating symptom of many neurodegenerative diseases, including those resulting in ataxia. Changes to speech lead to significant reductions in quality of life, impacting the speaker in most daily activities. Recognition of its importance as an objective outcome measure in clinical trials for ataxia is growing. Its viability as an endpoint across the disease spectrum (i.e. pre-symptomatic onwards) means that trials can recruit ambulant individuals and later-stage individuals who are often excluded because of difficulty completing lower limb tasks. Here we discuss the key considerations for speech testing in clinical trials including hardware selection, suitability of tasks and their role in protocols for trials and propose a core set of tasks for speech testing in clinical trials. Test batteries could include forms suitable for remote short, sensitive and easy to use, with norms available in several languages. The use of artificial intelligence also could improve accuracy and automaticity of analytical pipelines in clinic and trials.

Automatic imitation of speech is enhanced for non-native sounds

Simulation accounts of speech perception posit that speech is covertly imitated to support perception in a top-down manner. Behaviourally, covert imitation is measured through the stimulus-response compatibility (SRC) task. In each trial of a speech SRC task, participants produce a target speech sound whilst perceiving a speech distractor that either matches the target (compatible condition) or does not (incompatible condition). The degree to which the distractor is covertly imitated is captured by the automatic imitation effect, computed as the difference in response times (RTs) between compatible and incompatible trials. Simulation accounts disagree on whether covert imitation is enhanced when speech perception is challenging or instead when the speech signal is most familiar to the speaker. To test these accounts, we conducted three experiments in which participants completed SRC tasks with native and non-native sounds. Experiment 1 uncovered larger automatic imitation effects in an SRC task with non-native sounds than with native sounds. Experiment 2 replicated the finding online, demonstrating its robustness and the applicability of speech SRC tasks online. Experiment 3 intermixed native and non-native sounds within a single SRC task to disentangle effects of perceiving non-native sounds from confounding effects of producing non-native speech actions. This last experiment confirmed that automatic imitation is enhanced for non-native speech distractors, supporting a compensatory function of covert imitation in speech perception. The experiment also uncovered a separate effect of producing non-native speech actions on enhancing automatic imitation effects.