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Mračková M, Mareček R, Mekyska J, Košťálová M, Rektorová I. Levodopa may modulate specific speech impairment in Parkinson's disease: an fMRI study. J Neural Transm (Vienna) 2024; 131:181-187. [PMID: 37943390 DOI: 10.1007/s00702-023-02715-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
Hypokinetic dysarthria (HD) is a difficult-to-treat symptom affecting quality of life in patients with Parkinson's disease (PD). Levodopa may partially alleviate some symptoms of HD in PD, but the neural correlates of these effects are not fully understood. The aim of our study was to identify neural mechanisms by which levodopa affects articulation and prosody in patients with PD. Altogether 20 PD patients participated in a task fMRI study (overt sentence reading). Using a single dose of levodopa after an overnight withdrawal of dopaminergic medication, levodopa-induced BOLD signal changes within the articulatory pathway (in regions of interest; ROIs) were studied. We also correlated levodopa-induced BOLD signal changes with the changes in acoustic parameters of speech. We observed no significant changes in acoustic parameters due to acute levodopa administration. After levodopa administration as compared to the OFF dopaminergic condition, patients showed task-induced BOLD signal decreases in the left ventral thalamus (p = 0.0033). The changes in thalamic activation were associated with changes in pitch variation (R = 0.67, p = 0.006), while the changes in caudate nucleus activation were related to changes in the second formant variability which evaluates precise articulation (R = 0.70, p = 0.003). The results are in line with the notion that levodopa does not have a major impact on HD in PD, but it may induce neural changes within the basal ganglia circuitries that are related to changes in speech prosody and articulation.
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Affiliation(s)
- Martina Mračková
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Radek Mareček
- Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Jiří Mekyska
- Department of Telecommunications, Brno University of Technology, Brno, Czech Republic
| | - Milena Košťálová
- Department of Neurology, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Brno, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic.
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Chivukula S, Pikul BK, Black KL, Pouratian N, Bookheimer SY. Contralateral functional reorganization of the speech supplementary motor area following neurosurgical tumor resection. Brain Lang 2018; 183:41-46. [PMID: 29783125 PMCID: PMC6499625 DOI: 10.1016/j.bandl.2018.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/24/2017] [Revised: 04/22/2018] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
We evaluated plasticity in speech supplemental motor area (SMA) tissue in two patients using functional magnetic resonance imaging (fMRI), following resection of tumors in or associated with the dominant hemisphere speech SMA. Patient A underwent resection of a anaplastic astrocytoma NOS associated with the left speech SMA, experienced SMA syndrome related mutism postoperatively, but experienced full recovery 14 months later. FMRI performed 32 months after surgery demonstrated a migration of speech SMA to homologous contralateral hemispheric regional tissue. Patient B underwent resection of a oligodendroglioma NOS in the left speech SMA, and postoperatively experienced speech hesitancy, latency and poor fluency, which gradually resolved over 18 months. FMRI performed at 64 months after surgery showed a reorganization of speech SMA to the contralateral hemisphere. These data support the hypothesis of dynamic, time based plasticity in speech SMA tissue, and may represent a noninvasive neural marker for SMA syndrome recovery.
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Affiliation(s)
- Srinivas Chivukula
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - Brian K Pikul
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, United States
| | - Keith L Black
- Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Susan Y Bookheimer
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Semel Neuropsychiatric Institute, Brain Research Institute, Center for Cognitive Neurosciences and Department of Pscychology, University of California, Los Angeles, Los Angeles, CA, United States
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Berg-Johnsen J, Høgestøl EA. Supplementary motor area syndrome after surgery for parasagittal meningiomas. Acta Neurochir (Wien) 2018; 160:583-587. [PMID: 29362933 DOI: 10.1007/s00701-018-3474-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resection within the supplementary motor area (SMA) may be accompanied by dramatic motor deficits and speech arrest when the dominant hemisphere is involved, termed the SMA syndrome. Typically, the muscle tone of the paralyzed extremities is preserved, and in most cases, a complete or near complete recovery is seen within a few months. The SMA syndrome has not been recognized for extra-axial tumor surgery in approximation of the SMA. METHODS We observed the SMA syndrome in a patient operated for a parasagittal meningioma in the posterior frontal region, and this observation intrigued us to prospectively collect similar cases. RESULTS In the period from January 2010 to December 2015, we observed five patients who developed a partial SMA syndrome after surgery for frontal parasagittal meningiomas. The muscle tone was preserved in the affected extremities. All patients experienced improvement in motor function within a few days, and on follow-up, three out of five patients had recovered completely. Three of the patients had meningioma WHO grade II. CONCLUSIONS Surgically induced SMA syndrome can easily be confused with pyramidal weakness. This series of cases demonstrate that the syndrome may also develop after removal of extra-axial tumors and is probably underdiagnosed and underreported. The good functional prognosis is helpful in the preoperative counseling and follow-up of these patients.
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Affiliation(s)
- Jon Berg-Johnsen
- Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Einar August Høgestøl
- Department of Neurology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Department of Neurology, Neuroscience Research Unit, Oslo University Hospital, Domus Medica 4, room L-268, Gaustadalleén 34, 0372, Oslo, Norway.
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Abstract
Speech-language pathologists (SLPs) are trained to correct articulation of people diagnosed with motor speech disorders by analyzing articulators' motion and assessing speech outcome while patients speak. To assist SLPs in this task, we are presenting the multimodal speech capture system (MSCS) that records and displays kinematics of key speech articulators, the tongue and lips, along with voice, using unobtrusive methods. Collected speech modalities, tongue motion, lips gestures, and voice are visualized not only in real-time to provide patients with instant feedback but also offline to allow SLPs to perform post-analysis of articulators' motion, particularly the tongue, with its prominent but hardly visible role in articulation. We describe the MSCS hardware and software components, and demonstrate its basic visualization capabilities by a healthy individual repeating the words "Hello World." A proof-of-concept prototype has been successfully developed for this purpose, and will be used in future clinical studies to evaluate its potential impact on accelerating speech rehabilitation by enabling patients to speak naturally. Pattern matching algorithms to be applied to the collected data can provide patients with quantitative and objective feedback on their speech performance, unlike current methods that are mostly subjective, and may vary from one SLP to another.
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Affiliation(s)
- Nordine Sebkhi
- GT-Bionics lab, School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA
| | - Dhyey Desai
- GT-Bionics lab, School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA
| | - Mohammad Islam
- GT-Bionics lab, School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA
| | - Jun Lu
- GT-Bionics lab, currently is with the School of Automation at Guangdong University of Technology, Guangzhou, GD, 510006, China
| | - Kimberly Wilson
- Department of Clinical and Professional Studies, University of West Georgia, Carrollton, GA
| | - Maysam Ghovanloo
- GT-Bionics lab, School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA
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Affiliation(s)
- J Colt Cowdell
- Mayo School of Graduate Medical Education, Jacksonville, FL
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Dana Harris
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Keri Holmes-Maybank
- Division of Hospital Medicine, General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC
| | - Brian J Harte
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH
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Fiori S, Guzzetta A, Mitra J, Pannek K, Pasquariello R, Cipriani P, Tosetti M, Cioni G, Rose SE, Chilosi A. Neuroanatomical correlates of childhood apraxia of speech: A connectomic approach. Neuroimage Clin 2016; 12:894-901. [PMID: 27882295 PMCID: PMC5114583 DOI: 10.1016/j.nicl.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
Childhood apraxia of speech (CAS) is a paediatric speech sound disorder in which precision and consistency of speech movements are impaired. Most children with idiopathic CAS have normal structural brain MRI. We hypothesize that children with CAS have altered structural connectivity in speech/language networks compared to controls and that these altered connections are related to functional speech/language measures. Whole brain probabilistic tractography, using constrained spherical deconvolution, was performed for connectome generation in 17 children with CAS and 10 age-matched controls. Fractional anisotropy (FA) was used as a measure of connectivity and the connections with altered FA between CAS and controls were identified. Further, the relationship between altered FA and speech/language scores was determined. Three intra-hemispheric/interhemispheric subnetworks showed reduction of FA in CAS compared to controls, including left inferior (opercular part) and superior (dorsolateral, medial and orbital part) frontal gyrus, left superior and middle temporal gyrus and left post-central gyrus (subnetwork 1); right supplementary motor area, left middle and inferior (orbital part) frontal gyrus, left precuneus and cuneus, right superior occipital gyrus and right cerebellum (subnetwork 2); right angular gyrus, right superior temporal gyrus and right inferior occipital gyrus (subnetwork 3). Reduced FA of some connections correlated with diadochokinesis, oromotor skills, expressive grammar and poor lexical production in CAS. These findings provide evidence of structural connectivity anomalies in children with CAS across specific brain regions involved in speech/language function. We propose altered connectivity as a possible epiphenomenon of complex pathogenic mechanisms in CAS which need further investigation. Connectivity anomalies are present in children with Childhood Apraxia of Speech. Connectivity anomalies include brain regions involved in speech/language function. Altered connectivity correlates with a measure of speech/language dysfunction.
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Affiliation(s)
- Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Corresponding author at: Department of Developmental Neuroscience, Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy.Department of Developmental NeuroscienceStella Maris FoundationViale del Tirreno 331Pisa56128Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Jhimli Mitra
- CSIRO, Commonwealth Scientific and Industrial Research Organization, Centre for Computational Informatics, Brisbane, Australia
| | - Kerstin Pannek
- Department of Computing, Imperial College London, London, United Kingdom
| | - Rosa Pasquariello
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Paola Cipriani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Michela Tosetti
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stephen E Rose
- CSIRO, Commonwealth Scientific and Industrial Research Organization, Centre for Computational Informatics, Brisbane, Australia
| | - Anna Chilosi
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
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Chouinard B, Boliek C, Cummine J. How to Interpret and Critique Neuroimaging Research: A Tutorial on Use of Functional Magnetic Resonance Imaging in Clinical Populations. Am J Speech Lang Pathol 2016; 25:269-289. [PMID: 27537490 DOI: 10.1044/2016_ajslp-15-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 12/30/2015] [Indexed: 06/06/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI), an influential experimental approach, provides valuable information about clinical disorders that can be used to select and/or refine speech and language interventions. Functional MRI (fMRI) in particular is becoming a widespread methodological tool for investigating speech and language. However, because MRI is relatively new and complex, potential consumers need to be able to critically assess the methods used in order to appraise results and conclusions. The authors offer a tutorial that (a) relays foundational knowledge related to the collection and analysis of MRI data in general and fMRI data specifically and (b) presents strategies for evaluating studies that utilize fMRI methods. METHOD This tutorial outlines methodological considerations that should be addressed by fMRI researchers and noted by consumers of the research, including clinicians and behavioral researchers who work with neurogenic communication disorders. RESULTS Readers will be able to evaluate a neuroimaging publication and identify the methodological strengths and weaknesses that potentially influence the integrity of reported findings and interpretations. CONCLUSION This tutorial provides information and strategies that can be used to critically evaluate studies that collect, analyze, and interpret fMRI data. The tutorial concludes with a summary checklist to guide critical appraisal.
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Benba A, Jilbab A, Hammouch A. Discriminating Between Patients With Parkinson's and Neurological Diseases Using Cepstral Analysis. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1100-1108. [PMID: 26929057 DOI: 10.1109/tnsre.2016.2533582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper, we wanted to discriminate between two groups of patients (patients who suffer from Parkinson's disease and patients who suffer from other neurological disorders). We collected a variety of voice samples from 50 subjects using different recording devices in different conditions. Subsequently, we analyzed and extracted features from these samples using three different Cepstral techniques; Mel frequency cepstral coefficients (MFCC), perceptual linear prediction (PLP), and ReAlitive SpecTrAl PLP (RASTA-PLP). For classification we used leave one subject out validation scheme along with five different supervised learning classifiers. The best obtained result was 90% using the first 11 coefficients of the PLP and linear SVM kernels.
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Cleland J, Scobbie J, Zharkova N. Insights from ultrasound: Enhancing our understanding of clinical phonetics. Clin Linguist Phon 2016; 30:171-3. [PMID: 26901098 DOI: 10.3109/02699206.2016.1139626] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Cardinale JP, Patel MM, Nettles KM, Caballero A, Lopez FA. CLINICAL CASE OF THE MONTH: A 31-Year-Old Man Who Presents with Speech Abnormalities. J La State Med Soc 2015; 167:35-41. [PMID: 25978756] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | - Milin M Patel
- A second-year House Officer in the Department of Internal Medicine at LSUHSC-New Orleans
| | - Karl M Nettles
- Assistant Professor in the Department of Radiology at LSUHSC-New Orleans
| | - Andrea Caballero
- A third-year House Officer in the Department of Internal Medicine at LSUHSC-New Orleans
| | - Fred A Lopez
- Dr. Lopez is the Richard Vial Professor of Medicine and Vice Chair for Education in the Department of Medicine at LSUHSC-New Orleans
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Stark C, Gupta JD, Austin T, Palacios E, Neitzschman H. Radiology case of the month. Progressive slurring of speech and difficulty reading in a 62-year-old male. Final diagnosis: Metastatic small cell cancer of the prostate gland. J La State Med Soc 2014; 166:38-40. [PMID: 25075510] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 62-year-old male with controlled hypertension, coronary artery disease, and borderline diabetes presented to the emergency room after experiencing a gradual one-month progression of slurring of speech and difficulty reading. The patient maintained his vital signs throughout his ambulance ride to the hospital and was clinically stable at time of arrival to the emergency department.
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Affiliation(s)
- Chris Stark
- Third-year Medical Student at Tulane School of Medicine in New Orleans
| | - Jagan D Gupta
- Second-year Radiology Resident at Tulane School of Medicine in New Orleans
| | - Tracy Austin
- Intern at Tulane School of Medicine in New Orleans
| | - Enrique Palacios
- Clinical Professor of Radiology at Tulane School of Medicine in New Orleans
| | - Harold Neitzschman
- Professor of Radiology and Chairman of the Department of Radiology at Tulane School of Medicine in New Orleans
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Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of a treatment program that includes ultrasound biofeedback for children with persisting speech sound errors associated with childhood apraxia of speech (CAS). METHOD Six children ages 9-15 years participated in a multiple baseline experiment for 18 treatment sessions during which treatment focused on producing sequences involving lingual sounds. Children were cued to modify their tongue movements using visual feedback from real-time ultrasound images. Probe data were collected before, during, and after treatment to assess word-level accuracy for treated and untreated sound sequences. As participants reached preestablished performance criteria, new sequences were introduced into treatment. RESULTS All participants met the performance criterion (80% accuracy for 2 consecutive sessions) on at least 2 treated sound sequences. Across the 6 participants, performance criterion was met for 23 of 31 treated sequences in an average of 5 sessions. Some participants showed no improvement in untreated sequences, whereas others showed generalization to untreated sequences that were phonetically similar to the treated sequences. Most gains were maintained 2 months after the end of treatment. The percentage of phonemes correct increased significantly from pretreatment to the 2-month follow-up. CONCLUSION A treatment program including ultrasound biofeedback is a viable option for improving speech sound accuracy in children with persisting speech sound errors associated with CAS.
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Bacsfalvi P, Bernhardt BM. Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: ultrasound and electropalatography. Clin Linguist Phon 2011; 25:1034-43. [PMID: 22106893 DOI: 10.3109/02699206.2011.618236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This follow-up study investigated the speech production of seven adolescents and young adults with hearing impairment 2-4 years after speech intervention with ultrasound and electropalatography. Perceptual judgments by seven expert listeners revealed that five out of seven speakers either continued to generalize post-treatment or maintained their level of performance post-treatment. Targets included fricatives, vowels and the rhotic /ɹ/. Speakers ranged in age from 14 to 19 years. Listeners were considered to be expert listeners. All listeners had extensive backgrounds in phonetics and phonology and were speech-language pathologists. This long-term investigation revealed that speech habilitation with visual feedback tools as adjuncts to therapy appeared to have lasting effects. The implications for habilitation include reduced therapy times and outcomes not previously possible.
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Affiliation(s)
- Penelope Bacsfalvi
- Department of Linguistics, University of British Columbia, Vancouver, BC, Canada.
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Adler-Bock M, Bernhardt BM, Gick B, Bacsfalvi P. The use of ultrasound in remediation of North American English /r/ in 2 adolescents. Am J Speech Lang Pathol 2007; 16:128-39. [PMID: 17456891 DOI: 10.1044/1058-0360(2007/017)] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Ultrasound can provide images of the tongue during speech production. The present study set out to examine the potential utility of ultrasound in remediation of North American English /r/. METHOD The participants were 2 Canadian English-speaking adolescents who had not yet acquired /r/. The study included an initial period without ultrasound and 13 treatment sessions, each 1 hr long, using ultrasound. Speech samples were recorded at screening and immediately before and after treatment. Samples were analyzed acoustically and with listener judgments. Ultrasound images were obtained before, during, and after the treatment period. RESULTS Three speech-language pathologists unfamiliar with the participants rated significantly more posttreatment tokens as accurate [r]s in single words and some phrases. Acoustic analyses showed an expected lowering of the third formant after treatment. A qualitative observation of posttreatment ultrasound images for accurate [r] tokens showed tongue shapes to be more similar to those of typical adults than had been observed before treatment. Participants needed continued practice of their newly acquired skills in sentences and conversation. CONCLUSION Two-dimensional dynamic ultrasound appears to have potential utility for remediation of /r/ in speakers with residual /r/ impairment. Further research is needed with larger numbers of participants to establish the relative efficacy of ultrasound in treatment.
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Affiliation(s)
- Marcy Adler-Bock
- School of Audiology and Speech Sciences, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada, V6T 1Z3.
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Soriani-Lefèvre MH, Hannequin D, Bakchine S, Ménard JF, Manrique A, Hitzel A, Kotzki PO, Boudousq V, Vera P. Evidence of bilateral temporal lobe involvement in primary progressive aphasia: a SPECT study. J Nucl Med 2003; 44:1013-22. [PMID: 12843214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
UNLABELLED Primary progressive aphasia (PPA) is rare. Only limited series have been reported with SPECT or PET. Moreover, in the majority of studies, the left-to-right asymmetry ratio was used, leading to difficulties in right hemisphere analyzes. METHODS Twenty-nine patients with clinical criteria of PPA (Mesulam and Weintraub) were included and compared with 12 control subjects. Complete language examination was performed in all patients. SPECT was performed on a double-head gamma camera after intravenous injection of hexamethylpropyleneamine oxime (22 patients and 12 control subjects) or ethylcysteinate dimer (7 patients). Nineteen regions of interest (ROIs) were drawn on each hemisphere in all patients using the Talairach atlas. The perfusion index (PI = cortex-to-cerebellum ratio) was calculated for each ROI. Atrophy was quantified on MRI by consensus of 3 observers in 16 cortical ROIs. ANOVAs were used to compare the PI between (a). patients and control subjects, (b). patients with (n = 15) or without (n = 14) lexicosemantic abnormalities (LS+ vs. LS-) and patients with (n = 19) or without (n = 10) arthric disorders (A+ vs. A-), and (c). patients with or without atrophy. RESULTS In the 29 patients, the PI was significantly lower in the left temporopolar, left lateral temporal, left Wernicke, left parietal, and right lateral temporal cortex when compared with control subjects (P < 0.001). In LS+ patients versus control subjects, the PI significantly decreased in the left temporal cortex (lateral temporal; medial temporal; temporopolar; Wernicke), left Broca, left parietal, and right lateral temporal cortex (P < 0.001). In addition, LS+ versus LS- comparison showed a significant decrease in the left lateral, left medial temporal, and left Broca cortex (P < 0.001). In comparison with control subjects, the PI was not significantly different in A+ patients, whereas in A- patients the PI was significantly decreased in the left and right lateral temporal cortex, left Wernicke, and left parietal cortex. Moreover, the PI significantly decreased in the left lateral temporal region in A+ patients compared with A- patients. Finally, in patients without atrophy, the PI significantly decreased in the right and left lateral temporal cortex and the left parietal cortex (P < 0.01). CONCLUSION Our study demonstrates that right-handed patients with PPA present a decreased perfusion in the bilateral temporal cortex. Moreover, in these regions, morphologic abnormalities are preceded by perfusion abnormalities. Finally, our results show that large left temporal dysfunction occurs in patients with LS disorders.
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Affiliation(s)
- Marie-Hélène Soriani-Lefèvre
- Department of Nuclear Medicine, Rouen University Hospital, Henri Becquerel Center, Laboratoire Universitaire Quantification en Imagerie Fonctionnelle, Rouen, France
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Abstract
Disturbance of neurologic function in disorders of the central nervous system is expressed as altered activation pattern in functional networks after specific tasks, and can be studied by functional imaging modalities, e.g. positron emission tomography (PET). Language, a complex brain function is based on the interplay of a distributed network in which partial functions are executed in various centers and tasks are hierarchically organized according to their complexity. The specialization of different centers and the lateralization of integrative functions into the dominant (usually left) hemisphere is achieved by collateral and transcallosal inhibition of structures of lower order in the network. Patients with ischemic stroke often suffer from aphasia; the features and the prognosis of this disturbance is determined by the localization and the extent of the infarct in the dominant hemisphere. The preservation of the left superior temporal gyrus or its functional reintegration, respectively, is of utmost importance for the recovery of the deficits and for a satisfactory outcome. Reactivation of this region in repeated PET-activation studies were related to a favorable outcome, activation of other eloquent regions or of contralateral areas were accompanied by some improvements, but never indicated recovery of sufficient speech production. Symptoms develop slowly in patients with tumors in the left hemisphere, and the functional network can adapt to the lesion. In these patients a dislocation of areas activated during language tasks was observed, either to ipsilateral regions usually not involved or to contralateral homotopic areas. Aphasia was frequent in cases with activation shift to the subdominant hemisphere, and the right over left asymmetry in activation of the cerebellum was correlated to the severity of language impairment. The shift of dominance in activation could be reversed after surgical resection of the tumor leading to improved speech performance. The patterns of intrahemispheric as well as interhemispheric compensation may be explained by reduction of collateral inhibition of specific centers on other structures within the network (disinhibition): circumscript and/or slowly developing lesions disinhibit surrounding areas leading to increases and to displacements of activated centers; large morphological defects reduce the transcallosal inhibition leading to the activation of contralateral regions.
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Affiliation(s)
- W-D Heiss
- Max-Planck-Institut für neurologische Forschung, Klinik für Neurologie, Universität zu Köln.
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Audenaert K, Goethals I, Van Laere K, Lahorte P, Brans B, Versijpt J, Vervaet M, Beelaert L, Van Heeringen K, Dierckx R. SPECT neuropsychological activation procedure with the Verbal Fluency Test in attempted suicide patients. Nucl Med Commun 2002; 23:907-16. [PMID: 12195096 DOI: 10.1097/00006231-200209000-00015] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Performance on the Verbal Fluency Test, as a measure of the ability of initiating processes, is reduced in depressed suicidal patients. The hampered results in this prefrontal executive task parallel the reduction in prefrontal blood perfusion and metabolism in depressed subjects. A neuropsychological activation study with the verbal fluency paradigm could evaluate a possible blunted increase in perfusion in the prefrontal cortex in depressed suicidal patients. Twenty clinically depressed patients who had recently attempted suicide and 20 healthy volunteers were included in a single photon emission computed tomography (SPECT) split-dose activation study following a verbal fluency paradigm. Statistical parametric mapping was used to determine voxelwise significant changes. Differences in regional cortical activation between the letter fluency and category fluency tasks in attempted suicide patients were found. These patients showed a blunted increase in perfusion in the prefrontal cortex. Methodological restrictions concerning group uniformity, medication bias and subjective effort of the participants are discussed. Our findings indicate a blunted increase in prefrontal blood perfusion as a possible biological reason for reduced drive and loss of initiative in attempted suicide patients.
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Affiliation(s)
- Kurt Audenaert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent University, 185 De Pintelaan, B-9000 Ghent, Belgium.
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Halász P, Neuwirth M, Mikecz P, Szakáll S, Emri M, Zelei Z, Trón L. [The role of PET scan in the investigation of epileptic functional disorders]. Orv Hetil 2002; 143:1298-301. [PMID: 12077921] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Systematic research is needed to evaluate the exact role of pathological factors in the determination of the extension of the hypometabolic area in partial epileptic patients. Together with structural damage, previous seizures, deafferentation and inhibitory mechanisms may contribute to the functional disorders. Benzodiazepine receptor studies showed that the density and binding ability of these receptors decreased in the area of epileptic functional disorder. Circumscribed hypermetabolism may appear during epileptic seizures or even more electrical discharges. The authors' PET studies aimed at presurgical evaluation showed that bilateral temporal hypometabolism occurred more frequently with right-sided seizure start. FDG-PET supported the localization of the pacemaker area both in temporal lobe epilepsies and in extratemporal epilepsies. This method proved instrumental in delineating the extension of the background pathology, too. The authors also demonstrated the strength of PET brain activation in mapping the hemispheric distribution of speech functions required in the planning of surgical interventions. The role of hippocampal sclerosis in temporal lobe hypometabolism was investigated and a short account is given of the observations relating to the relationship of hypermetabolism due to subclinical epileptic discharges and cognitive deficit symptoms.
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Affiliation(s)
- Péter Halász
- Bethesda Református Gyermekkórház, Neurológiai Osztály, Budapest.
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Tebartz van Elst LH, Juengling FD, Kassubek J, Schmidtke K, Thiel T, Ebert D, Dykierek P, Hüll M. On the role of quantitative brain imaging in the differential diagnosis of speech disorders. Psychiatry Clin Neurosci 2002; 56:111-5. [PMID: 11929580 DOI: 10.1046/j.1440-1819.2002.00938.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We present the case of a 71-year-old woman with an 11-year history of slowly progressive decline of motor speech. Normal clinical investigations including routine magnetic resonance imaging (MRI) at 7, 8 and 10 years after the onset of speech dysfunction led to the suggestion of a psychogenic disorder. Extensive clinical, neuropsychological and neuroimaging investigations including 18F-desoxyglucose-positron emission tomography (PET), quantitative MRI and MR spectroscopy were performed to look for subtle brain pathology. Quantitative assessment of 3D-MRI, F-desoxyglucose-PET and magnetic resonance spectroscopy all demonstrated clear evidence of multifocal frontotemporal brain pathology that had not been picked up on routine MRI investigations on previous admissions. This is the longest benign history of slowly progressive anarthria reported so far. It demonstrates a possible role of quantitative neuroimaging techniques in the diagnosis of complex neuropsychiatric disorders.
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Ueki Y, Kohara N, Oga T, Fukuyama H, Akiguchi I, Kimura J, Shibasaki H. Membranous lipodystrophy presenting with palilalia: a PET study of cerebral glucose metabolism. Acta Neurol Scand 2000; 102:60-4. [PMID: 10893065 DOI: 10.1034/j.1600-0404.2000.102001060.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A case of membranous lipodystrophy (Nasu-Hakola disease; NHD) associated with palilalia was reported. A 38-year-old Japanese woman developed walking difficulty in her twenties. At age 35 she manifested neuropsychiatric symptoms characterized by euphoria, palilalia and dementia. A bone marrow biopsy showed periodic acid Schiff-positive membranous cystic lesions in the adipose tissue. Positron emission tomography with (18F)-2-fluoro-2-deoxy-D-glucose disclosed that regional cerebral glucose metabolism was decreased in the bilateral frontal white matter with mild hypometabolism in the thalamus and basal ganglia; all predominantly on the right. Taken together with the previous postmortem findings, it is postulated that frontal lobe hypofunction, predominantly in the right hemisphere, produced the unique neuropsychiatric symptoms in this patient.
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Affiliation(s)
- Y Ueki
- Department of Neurology, Faculty of Medicine, Kyoto University, Japan
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21
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Spence SA, Liddle PF, Stefan MD, Hellewell JS, Sharma T, Friston KJ, Hirsch SR, Frith CD, Murray RM, Deakin JF, Grasby PM. Functional anatomy of verbal fluency in people with schizophrenia and those at genetic risk. Focal dysfunction and distributed disconnectivity reappraised. Br J Psychiatry 2000; 176:52-60. [PMID: 10789327 DOI: 10.1192/bjp.176.1.52] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND PET studies of verbal fluency in schizophrenia report a failure of 'deactivation' of left superior temporal gyrus (STG) in the presence of activation of left dorsolateral prefrontal cortex (DLPFC), which deficit has been attributed to underlying 'functional disconnectivity'. AIM To test whether these findings provide trait-markers for schizophrenia. METHOD We used H2(15)O PET to examine verbal fluency in 10 obligate carriers of the predisposition to schizophrenia, 10 stable patients and 10 normal controls. RESULTS We found no evidence of a failure of left STG deactivation in carriers or patients. Instead, patients failed to deactivate the precuneus relative to other groups. We found no differences in functional connectivity between left DLPFC and left STG but patients exhibited significant disconnectivity between left DLPFC and anterior cingulate cortex. CONCLUSIONS Failure of left STG 'deactivation' and left fronto-temporal disconnectivity are not consistent findings in schizophrenia; neither are they trait-markers for genetic risk. Prefrontal functional disconnectivity here may characterise the schizophrenic phenotype.
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Affiliation(s)
- S A Spence
- Division of Neuroscience, Imperial College School of Medicine, Hammersmith Hospital, London.
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22
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Watkins KE, Gadian DG, Vargha-Khadem F. Functional and structural brain abnormalities associated with a genetic disorder of speech and language. Am J Hum Genet 1999; 65:1215-21. [PMID: 10521285 PMCID: PMC1288272 DOI: 10.1086/302631] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- K E Watkins
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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Vargha-Khadem F, Watkins KE, Price CJ, Ashburner J, Alcock KJ, Connelly A, Frackowiak RS, Friston KJ, Pembrey ME, Mishkin M, Gadian DG, Passingham RE. Neural basis of an inherited speech and language disorder. Proc Natl Acad Sci U S A 1998; 95:12695-700. [PMID: 9770548 PMCID: PMC22893 DOI: 10.1073/pnas.95.21.12695] [Citation(s) in RCA: 282] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/1998] [Indexed: 11/18/2022] Open
Abstract
Investigation of the three-generation KE family, half of whose members are affected by a pronounced verbal dyspraxia, has led to identification of their core deficit as one involving sequential articulation and orofacial praxis. A positron emission tomography activation study revealed functional abnormalities in both cortical and subcortical motor-related areas of the frontal lobe, while quantitative analyses of magnetic resonance imaging scans revealed structural abnormalities in several of these same areas, particularly the caudate nucleus, which was found to be abnormally small bilaterally. A recent linkage study [Fisher, S., Vargha-Khadem, F., Watkins, K. E., Monaco, A. P. & Pembry, M. E. (1998) Nat. Genet. 18, 168-170] localized the abnormal gene (SPCH1) to a 5. 6-centiMorgan interval in the chromosomal band 7q31. The genetic mutation or deletion in this region has resulted in the abnormal development of several brain areas that appear to be critical for both orofacial movements and sequential articulation, leading to marked disruption of speech and expressive language.
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Affiliation(s)
- F Vargha-Khadem
- Cognitive Neuroscience Unit, Institute of Child Health, University College London Medical School, Wolfson Centre, Mecklenbourgh Square, London WC1N 2AP, United Kingdom.
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Abstract
BACKGROUND The association between temporal lobe epilepsy and schizophrenia suggests that the critical abnormality may be pathology within the temporal lobes. People with schizophrenia-like psychosis of epilepsy (SLPE) provide a useful group in which to examine the importance of temporal and frontal lobe dysfunction in schizophrenia. METHOD A verbal fluency activation paradigm and a 99mTc HMPAO SPET were used to study frontotemporal function in people with SLPE (n = 12), schizophrenia (n = 11) and epilepsy (n = 16). RESULTS People with SLPE differed from both other groups by showing lower blood flow in the left superior temporal gyrus during performance of a verbal fluency task compared with a word repetition task (F = 5.4, P = 0.01). During the verbal fluency task people with primary schizophrenia showed a greater increase in blood flow in anterior cingulate (F = 4.5, P = 0.02) than the other two groups. There were no between-group differences in frontal brain regions. CONCLUSION Our findings support an association between left temporal lobe abnormality and SLPE. The different patterns of activation observed in people with primary schizophrenia and SLPE suggests that different pathophysiological mechanisms may operate in these two groups. In SLPE the pathophysiology may be relatively confined to the dominant temporal lobe.
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Affiliation(s)
- J D Mellers
- Department of Neuropsychiatry, Maudsley Hospital, London
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25
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Wener DL. Imaging assists appraisal of speech pathology. Diagn Imaging (San Franc) 1997; 19:213-4. [PMID: 10176116] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- D L Wener
- Florida Atlantic University, Boca Raton, USA
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26
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Abstract
OBJECTIVE To evaluate a technique to reduce dysfunctional spasm in the pharyngoesophageal segment (PES) in patients after laryngectomy. DESIGN Pharyngoesophageal segment function related to voice and/or swallowing in patients who had undergone a laryngectomy was evaluated before and after the injection of botulinum toxin A. SETTING Academic referral medical center. PATIENTS Eight outpatients with voice and/or swallowing complaints after undergoing a total laryngectomy. INTERVENTIONS Videofluoroscopic contrast examination was completed to identify stricture vs spasm in the PES in patients with voice and/or swallowing complaints after undergoing a laryngectomy. Lidocaine hydrochloride injection under fluoroscopic guidance was completed to facilitate immediate relaxation of spasm. After positive results with lidocaine, botulinum toxin was injected into the same area to facilitate longer-lasting benefit. MAIN OUTCOME MEASURE Patient report of benefit and videofluoroscopic evaluation of PES function. RESULTS Six of 8 patients demonstrated improved function within the PES after lidocaine injection. Five of these 6 received transcutaneous injection of botulinum toxin. Four of the 5 patients demonstrated improved swallowing and/or voice function, and 3 of these 4 received subsequent injections of botulinum. No serious complications were encountered. CONCLUSIONS Transcutaneous injection of botulinum toxin in the PES under videofluoroscopic guidance provides improvement in voice and/or swallowing function without significant complications. Additional clinical study will be required to evaluate dose and technique influences on degree and duration of benefit and complications.
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Affiliation(s)
- M A Crary
- Department of Communicative Disorders, College of Health Professions, University of Florida Health Science Center, Gainesville, USA
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27
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Tanimoto K, Henningsson G, Isberg A, Ren YF. Comparison of tongue position during speech before and after pharyngeal flap surgery in hypernasal speakers. Cleft Palate Craniofac J 1994; 31:280-6. [PMID: 7918523 DOI: 10.1597/1545-1569_1994_031_0280_cotpds_2.3.co_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Tongue position was cineradiographically analyzed during speech, before and after pharyngeal flap surgery, in 19 hypernasal cleft palate speakers with acceptable articulation and in 10 noncleft reference individuals. The results showed that the position of the tongue was significantly retracted during production of the consonants (/ti/, /ki/, and /ka/) in the cleft palate speakers with VPI compared to the reference individuals. Following pharyngeal flap surgery, the position of the tongue remained different in cleft palate speakers compared to reference individuals, although the articulation quality and resonance were evaluated to have normalized in almost all the speech samples produced by cleft palate speakers. It was suggested that the cleft palate speakers with VPI may exploit the plasticity of the speech system in order to achieve perceptually good speech, even though their tongue movements might be different from tongue movement in noncleft speakers.
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Affiliation(s)
- K Tanimoto
- Department of Oral Radiology, Karolinska Institutet, Stockholm, Sweden
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28
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Coffey JP, Hamilton D, Fitzsimons M, Freyne PJ. Image processing of videofluoroscopy of patients with velopharyngeal insufficiency and hypernasal speech. Clin Radiol 1993; 48:260-3. [PMID: 8243004 DOI: 10.1016/s0009-9260(05)81014-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eleven patients with hypernasal speech and velopharyngeal insufficiency (VPI), together with five normals, were evaluated by videofluoroscopy to assess velopharyngeal movement, velar lift and lateral pharyngeal wall movement. Computer processing of the images obtained was used to compensate for initial poor quality images by contrast and edge enhancement techniques and to provide objective measurement of the movements involved. It was demonstrated that objective computer aided analysis of videofluoroscopic images is feasible and may provide additional subtle diagnostic information when nasendoscopy is unavailable. In addition, results obtained showed an increased degree of velar lift and lateral pharyngeal wall movement for the more severely affected patients. These suggest a compensatory mechanism in operation for the more severe cases of VPI.
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Affiliation(s)
- J P Coffey
- Department of Diagnostic Imaging, St James's Hospital, Dublin
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29
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Abstract
We report the pattern of metabolic activation of the brain associated with speech, using 15O positron emission tomography (PET) in normal volunteers, as well as patients with or without language deficit. 15 trials were performed on 13 subjects. Regional oxygen metabolism with the subjects at rest was compared to that during a speech-from-memory task. As expected, there was strong activation of Broca's area and the medial left temporal lobe, corresponding to the motor speech and memory aspects of the task. In addition, both cerebellar hemispheres and pre-motor areas, as well as the right frontal operculum, supplementary motor area and right parietal lobe were active. This technique provided insight into the mechanism of aphasia in two subjects, even in one whose traditional language areas were structurally and metabolically intact at rest. We conclude that this practical activation technique may be useful not only in studying the physiology of normal brain, but also in understanding functional responses to disease.
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Affiliation(s)
- L B Tamas
- Department of Neurological Surgery, Gunma University School of Medicine, Japan
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30
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Abstract
A right-handed man suffered aneurysmal haemorrhage with lesions of the genu and body of the corpus callosum and the inferomedial frontal lobes bilaterally (right more than left). He exhibited remarkable breakdown in behavioural unity characterized by conflict between the two sides of the body, actions inconsistent with verbalizations, and internal conflict over control of the left hand. A major feature of the deficit was its temporal variability. This is interpreted as reflecting intermittent failure of metacontrol processes, which are neural mechanisms for maintaining behavioural unity. Medial frontal structures and their interconnections through the corpus callosum appear particularly important in the maintenance of metacontrol.
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Affiliation(s)
- G W Jason
- Division of Psychology, Foothills Hospital
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31
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Abstract
Two strongly right-handed patients with aprosodia following left hemisphere strokes are described. These patients appear to represent the aprosodia analogue of crossed aphasia--crossed aprosodia--and provide further evidence that the organization of the effective components of language is functionally and anatomically similar to the organization of the propositional components of language in the brain. In addition, both patients evidenced "double-crossed" agraphia involving the left hand.
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Affiliation(s)
- E D Ross
- Department of Neurology, University of Texas Southwestern Medical School, Dallas
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32
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Kluin KJ, Gilman S, Markel DS, Koeppe RA, Rosenthal G, Junck L. Speech disorders in olivopontocerebellar atrophy correlate with positron emission tomography findings. Ann Neurol 1988; 23:547-54. [PMID: 3261572 DOI: 10.1002/ana.410230604] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We compared the severity of ataxic and spastic dysarthria with local cerebral metabolic rates for glucose (lCMRGlc) in 30 patients with olivopontocerebellar atrophy (OPCA). Perceptual analysis was used to examine the speech disorders, and rating scales were devised to quantitate the degree of ataxia and spasticity in the speech of each patient. lCMRGlc was measured with 18F-2-fluoro-2-deoxy-D-glucose and positron emission tomography (PET). PET studies revealed marked hypometabolism in the cerebellar hemispheres, cerebellar vermis, and brainstem of OPCA patients compared with 30 control subjects. With data normalized to the cerebral cortex, a significant inverse correlation was found between the severity of ataxia in speech and the lCMRGlc within the cerebellar vermis, cerebellar hemispheres, and brainstem, but not within the thalamus. No significant correlation was found between the severity of spasticity in speech and lCMRGlc in any of these structures. The findings support the view that the severity of ataxia in speech in OPCA is related to the functional activity of the cerebellum and its connections in the brainstem.
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Affiliation(s)
- K J Kluin
- Department of Physical Medicine, University of Michigan, Ann Arbor 48109-0316
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33
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Wolfe GI, Ross ED. Sensory aprosodia with left hemiparesis from subcortical infarction. Right hemisphere analogue of sensory-type aphasia with right hemiparesis? Arch Neurol 1987; 44:668-71. [PMID: 3579688 DOI: 10.1001/archneur.1987.00520180082024] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We report a case of sensory aprosodia with left hemiparesis following an ischemic infarction of the right thalamus and posterior limb of the internal capsule. Bedside evaluation, confirmed by special quantitative tests, demonstrated normal spontaneous affective prosody and gesturing with marked impairment of affective repetition and comprehension of affective prosody and gestures. A left hemiparesis with sensory loss was also present. This combination of deficits appears to represent the right-side analog to the unusual syndrome of Wernicke-type aphasia with right hemiparesis occasionally observed following left subcortical injury, thus providing further support for the hypothesis that the functional-anatomic organization of affective language in the right hemisphere mirrors that of propositional language in the left.
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34
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Zhu YL. [Role of subcortical structures in speech activity--analysis of speech disorders caused by subcortical lesions in cerebrovascular disease]. Zhonghua Shen Jing Jing Shen Ke Za Zhi 1987; 20:14-8. [PMID: 3622092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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35
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Timmons JH, Howard WH, Wright HR. Esophageal speech: double-contrast evaluation of the pharyngo-esophageal segment. Radiology 1986; 160:852. [PMID: 3737930 DOI: 10.1148/radiology.160.3.3737930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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36
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Abstract
Twenty five patients with manifestations of cerebrovascular ischemic disease were evaluated with high resolution computed tomography of the neck, following intravenous infusion of a contrast agent. Computed tomography images of extracranial carotid arteries revealed atherosclerotic plaque formations and their complications: stenosis, occlusion, ulceration, calcification and mural lucent defects. Histologic analysis of 15 endarterectomy specimens obtained from symptomatic patients who had computed tomography images of discrete lucent defects in carotid plaques demonstrated subintimal hemorrhage of varying age in 13, focal necrosis in 1 and excessive subintimal thickening in 1. It is concluded that lucent images observed in computed tomography of extracranial carotid arteries represent vascular wall lesions within carotid plaques suggestive of subintimal hemorrhage, focal necrosis and/or excessive subintimal thickening. Computed tomography of the extracranial carotid arteries is a relatively non-invasive method that permits the diagnosis of plaque hemorrhages in symptomatic and asymptomatic carotid arteries.
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Abstract
A patient with atrial fibrillation and internal carotid artery occlusion developed mixed transcortical aphasia. The CT scan showed two recent distinct infarcts in the dominant hemisphere, one in the precentral artery area (pial artery infarct) and one in the borderzone area between the posterior and middle cerebral arteries territories (watershed infarct). The perisylvian speech areas were spared, but probably disconnected from other areas by the infarcts. The syndrome of isolation of speech area may be caused by vascular conditions which are able to produce simultaneous pial artery and watershed infarcts, and is not necessarily related to more extensive processes of the brain.
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38
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Ugawa Y, Ihara Y. [Bilateral symmetrical low density areas in the basal ganglia--a case with dysarthria and gait disturbance]. Rinsho Shinkeigaku 1984; 24:354-7. [PMID: 6744757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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39
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Knopman DS, Selnes OA, Niccum N, Rubens AB, Yock D, Larson D. A longitudinal study of speech fluency in aphasia: CT correlates of recovery and persistent nonfluency. Neurology 1983; 33:1170-8. [PMID: 6684253 DOI: 10.1212/wnl.33.9.1170] [Citation(s) in RCA: 78] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The anatomic correlates of speech fluency were studied in 54 right-handed patients with aphasia due to stroke. Speech fluency was assessed at 1 month postonset and then monthly for 5 months. CTs obtained at 5 months postonset were used for lesion localization and volume determination. Persistent nonfluency was associated with lesions in the rolandic cortical region and underlying white matter. Recovery from nonfluency occurred in 6 of 27 patients. Lesions in these six patients were less extensive than lesions in patients with persistent nonfluency. Patients who were fluent by 1 month lacked extensive rolandic lesions.
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41
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Naeser MA, Alexander MP, Helm-Estabrooks N, Levine HL, Laughlin SA, Geschwind N. Aphasia with predominantly subcortical lesion sites: description of three capsular/putaminal aphasia syndromes. Arch Neurol 1982; 39:2-14. [PMID: 6976780 DOI: 10.1001/archneur.1982.00510130004002] [Citation(s) in RCA: 306] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nine cases of subcortical aphasia with capsular/putaminal (C/P) lesion sites demonstrated on computed tomographic (CT) scans were studied. Eight cases were occlusive-vascular in etiology and one was hemorrhagic. Three subcortical aphasia syndromes and three C/P lesion site patterns were observed. Patients with C/P lesion sites with anterior-superior white-matter lesion extension had good comprehension, grammatical, but slow, dysarthric speech, and lasting right hemiplegia. Patients with C/P lesion sites with posterior white-matter lesion extension across the auditory radiations in the temporal isthmus had poor comprehension, fluent Wernicke-type speech, and lasting right hemiplegia. Patients with C/P lesion sites with both anterior-superior and posterior extension were globally aphasic and had lasting right hemiplegia. Although these cases of C/P subcortical aphasia shared certain well-known features of Broca's and Wernicke's cortical aphasia syndromes, they did not completely resemble cases of either Broca's, Wernicke's, global, or thalamic aphasia in neurologic findings, CT scan lesion sites, or language behavior. Further study of the subcortical aphasias associated with these C/P lesion sites seems to be warranted.
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Abstract
It was recently proposed that the affective components of language, encompassing prosody and emotional gesturing, are a dominant function of the right hemisphere, and that their functional-anatomic organization in the right hemisphere mirrors that of propositional language in the left hemisphere. Ten right-handed patients with focal lesions of the right hemisphere and disorders of affective language are described. Observations were made about each patient's spontaneous prosody, prosodic repetition, prosodic comprehension, and comprehension of emotional gesturing. Using this particular examination strategy, which is derived from the usual bedside approach to aphasic disorders, the organization of affective language in the right hemisphere does mirror the organization of propositional language in the left hemisphere. Furthermore, the disorders of affective language seem to be classifiable in the same manner as the aphasias. Thus, the term "aprosodia," preceded by specific modifiers such as motor, global, transcortical sensory, etc, seems appropriate when classifying the various disorders of affective language that occur following-right-hemisphere damage. The relationships between affect, mood, pathologic laughing and crying, and depression are also discussed.
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43
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Abstract
Language was studied in four patients with bilateral cerebral infarctions. Bilateral destruction of the third frontal gyri did not necessarily produce the severely limited language output characteristic of global or severe Broca aphasia; for Broca aphasia to occur, there must be extensive frontoparietal damage in the dominant cerebral hemisphere. Thus, the marked recovery of language after lesions limited to the dominant third frontal gyrus is mediated by adjacent areas of the dominant hemisphere, and not by the nondominant third frontal gyrus. The nondominant hemisphere nevertheless has a limited capacity to produce oral speech after extensive damage to the dominant hemisphere and may play an appreciable, although still subsidiary, role in normal articulation. The central gyri and rolandic operculum may be more essential than the third frontal gyri for well-articulated speech.
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Böhme G. [Cerebellar dysarthria (author's transl)]. HNO 1977; 25:436-8. [PMID: 563858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dysarthria due to involvement of the cerebellum represents a facultative symptom of cerebellar disease. The mechanisms by which such dysarthrias are produced are unknown but may result from pathologic involvement of the entire cerebellum. The symptoms of cerebellar dysarthria in children and in adults are described in two case histories. Characteristic speech defects or dysarthrophony occur. In addition to speech pathology, computer tomography of the skull is useful in obtaining both differential diagnosis and an estimate of prognosis. The goal of treatment should be the improvement of muscle defects of tonus and coordination needed for speech, and can employ both physio- and ergotherapy.
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Abstract
Articulatory positioning and movement characteristics were compared between /w/ and intended /r/ productions in three children exhibiting w/r substitutions and one normal control subject. High-speed lateral-view cineradiography was utilized. It was found that only the control subject demonstrated significant differences in lip, jaw, and tongue positioning for /w/ compared to /r/. However, systematic patterns of articulatory variability within and between subjects suggested that the experimental subjects were possibly differentiating between /w/ and intended /r/ even though the articulatory target configuration appeared to be nondiscriminatory. Perceptual judgmnets of the tape-recorded utterances mirrored the physiological data in that only those intended /r/ productions involving articulatory positioning clearly different from that of /w/ were perceived as /r/.
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Abstract
This paper describes cineradiographic techniques for the assessment of articulatory mobility in dysarthric subjects. Sample data for the mobility ranges of articulatory points on the tongue, lower lip, and jaw are presented for four normal speakers and four dysarthric speakers. In addition, fleshpoint displacements during the articulatory movements of the dysarthric subjects are used to illustrate abnormalities in the range, rate, and direction of speech movements. Discussion of the point-parameterized cineradiographic data emphasizes possibilities for the clinical evaluation of dysarthric impairments.
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Neiman GS, Peterson SJ, Pruzansky S. Delayed pharyngeal flap success: report of a case. Cleft Palate J 1975; 12:244-6. [PMID: 1054631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pitt M, Ingram TT. The radiology of speech disorders in childhood. Part 2: radiology in the diagnosis of speech disorders. Radiography (Lond) 1975; 41:90-104. [PMID: 1162045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pitt M, Ingram TT. The radiology of speech disorders in childhood. Part1: disorders and their study. Radiography (Lond) 1975; 41:53-60. [PMID: 1162041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Cineradiographic and spectrographic analyses were performed to study the speech production of a subject who presented the classical neurologic signs of cerebellar lesion and who had speech characteristics like those that have been reported for ataxic dysarthria. These analyses were conducted with special attention to the deviant perceptual dimensions that have been described for ataxic speech. Examination of the cineradiographic and spectrographic records revealed conspicuous abnormalities in speaking rate, stress patterns, articulatory placements for both vowels and consonants, velocities of articulator movements, and fundamental frequency contours. In general, our physiological and acoustic observations of ataxic dysarthria were compatible with existing perceptual descriptions of this condition. The data for the subject are discussed in the light of current hypotheses concerning cerebellar participation in the regulation of skilled movement. Particular suggestions are made concerning the nature of the neuromuscular abnormalities that may underlie the aberrant motorics of ataxic dysarthria.
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