Dysarthria

Lesch-Nyhan disease (LND) is caused by deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT). Affected individuals exhibit over-production of uric acid, along with a characteristic neurobehavioural syndrome that includes mental retardation, recurrent self-injurious behaviour and motor disability. Prior studies involving relatively small numbers of patients have provided different conclusions on the nature of the motor disorder. The current study includes the results of a multi-centre international prospective study of the motor disorder in the largest cohort of patients studied to date. A total of 44 patients ranging from 2 to 38 years presented a characteristic motor syndrome that involved severe action dystonia superimposed on baseline hypotonia. Although some patients also displayed other extrapyramidal or pyramidal signs, these were always less prominent than dystonia. These results are compared with a comprehensive review of 122 prior reports that included a total of 254 patients. Explanations for the differing observations available in the literature are provided, along with a summary of how the motor disorder of LND relates to current understanding of its pathophysiology involving the basal ganglia.

Purpose: To document and describe in detail the occurrence of apraxia of speech (AOS) in a group of individuals with a diagnosis of motor neuron disease (MND).
Method: Seven individuals with MND and AOS were identified from among 80 patients with a variety of neurodegenerative diseases and AOS (J. R. Duffy, 2006). The history, presenting complaints, neurological findings, and speech language
findings were documented for each case.
Results: Spastic or mixed spastic-flaccid dysarthria was present in all 7 cases. The AOS was judged as worse than the dysarthria in 4 cases. Nonverbal oral apraxia was eventually present in all cases. Aphasia was present in 2 cases and
equivocally present in another 2. Dementia was present in 1 case and equivocally present in 2.
Conclusions: AOS can occur in MND, typically also with dysarthria, but not invariably with aphasia or other cognitive deficits. Thus, a diagnosis of MND does not preclude the presence of AOS. More importantly, MND should be a diagnostic consideration when AOS is a prominent sign of degenerative disease.

Ky studim rasti synon të vlersojë efektet e inkorperimit të terapise LSVT (Lee Silverman Voice Treatment) në terapinë tradicionale për disartinë spastike. Studimi përfshin një pacient adult 33 vjeçar me disartri spastike bilaterale të rrugëve të sipërme neurale sipasoj e një inflamacioni në moshën 2 vjecare. Pacienti nuk i është nënshtruar terapisë në femijëri. Në studim inkorperohen ushtrimet klasike për artikulimin dhe degludimin me metodat e LSVT. Synohen të maten: qartësia gjatë të folurit (ekzaminim subjektiv dhe diadokokinesik), mimika e fytyrës (niveli i hipomimisë), prosodia, rritjen e levizshmërisë së muskulatures bukofaciale dhe aspirimi. Terapia e ndjekur është intensive, katër herë në javë për nje muaj (16 orë), rreth 50 minuta për seancë. Matjet për mbledhjen e të dhënave janë kryer; para, direkt pas perfundimit të terapisë dhe mbas 3 muajsh. Rezultatet afat shkurtër treguan përmirësim të aspirimit, amplitudës së levizjes së muskulaturës orale dhe prosodisë. Përmirësimet afatgjatë, deri në 3 muaj mbas, u dalluan në volumin, cilësinë dhe tonalitetin e zerit dhe përmirësim të qartesisë dhe kuptueshmërisë gjatë të folurit. Studimi rekomandon se LSVT-ja e përshtatur me ushtrime të degludimit dhe artikulimit mund të sjell rezultate afatgjata në kuptueshmërinë e te folurit, kohezgjatjen e fonacionit dhe përmirësim të hipomimisë, por pacienti ka nevoj të ushtrohet përdite pa shkeputje të gjata për mbajten e këtyre rezultateve

This project focused on two learning disabilities. The first one is called dysgraphia; it involves written problems. Salter and Hendrickx (2009) defined dysgraphia as “a difficulty in writing which does not reflect the general intelligence and ability of the person” (p. 107).
The second disability is dysarthria. Darley, Aronson, and Brown (1975), defined this concept as “disorders that are due to disturbance in muscular control of the speech mechanism resulting from impairment of any of the basic motor processes involved in the execution of speech” (p. 2).

People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options...

The article presents the results of studies conducted in a group of 36 children aged 6-15 years, diagnosed with dysarthria in the infantile cerebral palsy. The experimental group was divided into two equinumerous subgroups: 1) intellectually normal children, 2) mentally retarded children. The main diagnostic technique used in investigations was the Dysarthria Scale. Children's version. The presented experiments concern one of the problems examined as part of the project "Segmen-tal and Suprasegmental Specificity of the Phonic Sequence and the Intelligibility of Utterances in Dysarthria Cases in Infantile Cerebral Palsy". The study financed from science-targeted funds in 2010-2012 as a research project.

Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k > .58 for all comparisons). Test-retest reliability was substantial to almost perfect for all groups (k > .68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review. ß

Friedreich ataxia (FRDA) is the most frequent recessive ataxia in the Western world. Dysarthria is a cardinal feature of FRDA, often leading to severe impairments in daily functioning, but its exact characteristics are only poorly understood so far. We performed a comprehensive evaluation of dysarthria severity and the profile of speech motor deficits in 20 patients with a genetic diagnosis of FRDA based on a carefully selected battery of speaking tasks and two widely used paraspeech tasks, i.e., oral diadochokinesis and sustained vowel productions. Perceptual ratings of the speech samples identified respiration, voice quality, voice instability, articulation, and tempo as the most affected speech dimensions. Whereas vocal instability predicted ataxia severity, tempo turned out as a significant correlate of disease duration. Furthermore, articulation predicted the overall intelligibility score as determined by a systematic speech pathology assessment tool. In contrast, neurologists' ratings of intelligibility-a component of the "Scale for the Assessment and Rating of Ataxia"-were found to be related to perceived speech tempo. Obviously, clinicians are more sensitive to slowness of speech than to any other feature of spoken language during dysarthria evaluation. Our results suggest that different components of speech production and trunk/limb motor functions are differentially susceptible to FRDA pathology. Furthermore, evidence emerged that paraspeech tasks do not allow for an adequate scaling of speech deficits in FRDA.

Interpersonal communication has been described as a critical tool for life adjustment, linking people to their environment. 1 When communication disorders are present these links can be easily broken. Communication disorders form a diverse group of conditions that vary in terms of type, severity, and co-occurrence with other symptoms that limit mobility, vision, endurance, or cognition. Although communication disorders affect people of all ages, the prevalence and complexity of these conditions increase with age, and may be characterized by a stable, recovering or degenerative course. Disabilities associated with communication disorders may best be viewed as a dynamic process that varies over time instead of as a single static event that remains constant. Two broad trajectories of disability and aging have been described 2 and can be applied to those with communication disorders. The disability with aging group includes people who live most of their lives without disability and either experience the subtle communication problems associated with age or the onset of conditions such as stroke that occur most commonly in old age. The aging with disability group includes people who either have lifelong or early onset communication disorders as a result of cerebral palsy or multiple sclerosis (MS) and age in the context of the already-existing disability. Regardless of the trajectory, the burden of communication disorder is cumulative; it grows with age and has important implications for health care providers. This article describes various communication disabilities associated with aging and how these disabilities affect important functions such as access to health care and maintenance of social roles. Suggestions that preserve and enhance communication function in older adults are also provided in this article.

A taxic dysarthria is a motor speech disorder associated with cerebellar dysfunction. The dysarthria appears to be related to a disturbance in the neural mechanisms that underlie the coordination, temporal regulation, and quasi-automatic control of respiratory, phonatory, and articulatory movements for speech. The symptoms of ataxic dysarthria vary, and may include any, or a combination, of the following abnormalities: imprecise articulation, momentary irregular articulatory breakdowns, slow rate of speech, excess and equal stress, monoloudness, monopitch, prolonged syllables, irregular intrasyllabic voice fundamental frequency (F0) inflections, and breathy, weak, or unstable voice. Physiologic studies of ataxic dysarthria have documented slow movements, temporal dysregulation, errors of direction and range of movements, impaired ability to increase muscular forces in order to produce rapid movements, and reduced or exaggerated range of movements involving the respiratory, phonatory, or articulatory systems. These abnormalities may be accompanied by other signs of cerebellar dysfunction, such as hypotonia, broad-based stance and gait, truncal instability, dysmetria, tremor, and dysdiadochokinesis .

Support Vector Machine (SVM) is one of the popular Machine Learning techniques for classifying the Electroencephalography (EEG) signals based on the neuronal activity of the brain. EEG signals are represented into high dimensional feature space for analyzing the brain activity. Kernel functions are helpful for efficient implementation of non linear mapping. This paper gives an overview of classification techniques available in Support Vector Machine. This paper also focus role of SVM on EEG signal analysis.

The effect of speech rate reduction on speech and pause characteristics during a reading task was examined for speakers with Parkinson's disease (PD) and a group of control speakers. Duration of utterances and characteristics of pausing (duration, interpause phrase length, and location) were determined. At habitual reading rate, subjects with PD had shorter speech duration and greater time per pause than control subjects. At reduced reading rates, subjects with PD increased speech duration so that it was equivalent to the control speakers at habitual rate. Both groups had the majority of their pause occurring at appropriate syntactic boundaries. Subjects with PD had a greater proportion of pauses occurring at syntactically inappropriate locations than did the controls. When speech rates were reduced, both groups showed a decrease in pauses located at appropriate syntactic boundaries. The implication of these findings on speech intelligibility is discussed.

To provide preliminary evidence of the construct validity of the Communicative Effectiveness Survey (CES) for individuals with dysarthria and idiopathic Parkinson's disease (PD). In a prospective, quasi-experimental design, 25 participants each were assigned to 3 groups (N = 75): PD and dysarthria, non-PD and no dysarthria, and PD significant others (SOs). Mean CES ratings were used to test for significant differences between the PD and non-PD group, and PD and SO rating of PD's communicative effectiveness. Multiple linear regression tested for significant predictors of CES ratings for PD group only using sentence intelligibility and spontaneous speech intelligibility scores as predictor variables. The PD group rated their CES significantly lower than did the non-PD group. The PD group rated their CES significantly higher than their SOs rated them. Neither speech intelligibility score was a significant predictor of CES ratings. In follow-up analysis, the Hoehn and Yahr PD staging accounted for 47% of the variability in CES ratings for the PD group participants. This study provides preliminary evidence of the CES's construct validity. Clinicians and researchers who assess and treat individuals with PD may consider adding an additional assessment to the traditional clinical measures (i.e., speech intelligibility) by obtaining a measure of communicative effectiveness.

The measurement of intelligibility in dysarthric individuals is a major concern in clinical assessment and management and in research on dysarthria. The measurement objective is complicated by the fact that intelligibility is not an absolute quantity but rather a relative quantity that depends on variables such as test material, personnel, training, test procedures, and state of the speaker. This paper reviews scaling procedures and item identification tests as they have been applied to dysarthric speech. Based in part on previous studies of speech of the hearing impaired, a profile has been designed to direct research on the acoustic or physiologic correlates of dysarthric intelligibility impairment. In addition, a word intelligibility test is proposed for use with dysarthric speakers. This test is designed to examine 19 acoustic-phonetic contrasts that are likely to (a) be sensitive to dysarthric impairment and (b) contribute significantly to speech intelligibility. Preliminary da...

Techniki neuromuzykoterapeutyczne znajdują swoje zastosowanie w afazji, dyzartrii, chorobie Parkinsona, w porażeniu mózgowym, chorobie Alzheimera, dystorfii mięśniowej, pragnozji i wielu innych chorobach neurologicznych wpływających na funkcje poznawcze, ruch i komunikację. Wraz z rozwojem nowych technik neurobiologicznych uzyskano możliwość obserwowania mózgu człowieka podczas przetwarzania informacji muzycznej. Przyczyniło się to do lepszego zrozumienia sposobu oddziaływania muzyki w terapii.
W artykule dokonano przeglądu i charakterystyki dwudziestu wystandaryzowanych technik neuromuzykoterapeutycznych (NMT-Neurologic Music Therapy) oraz opisano ich przebieg i zastosowanie na podstawie wybranych przypadków klinicznych z własnej praktyki neurologopedycznej.

Artykuł opublikowany w tomie  poświęconym Profesorowi Stanisławowi Grabiasowi z okazji 50-lecia pracy naukowej.

The Aphasia Rapid Test (ART) is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in \3 min. We tested its inter-rater reproducibility, its sensitivity to detect changes from Day 1 to Day 8, and the predictive value of D8 ART scores on the 3-month aphasia outcome assessed with the Aphasia Handicap Score (AHS), a 0-5 ''Rankin-like'' score for aphasic disability. The reproducibility was tested in 91 aphasic patients within one week of stroke onset. The inter-rater concordance coefficient was 0.99 and the weighted Kappa value (j w ) was 0.93. The sensitivity was tested in 70 aphasic patients by measuring changes in ART values between D1 and D8. Improvement occurred in 46 patients (66 %) and aggravation in three patients (4 %). In these patients, a logistic regression analysis showed that D8 ART was the only significant predictor of good (AHS 0-2) or poor (AHS 4-5) outcome. The ROC curves analyzes showed areas under the curve above 0.9 for good and poor outcome and revealed D8 ART best cut-off values of\12 for good and[21 for poor outcome, with more than 90 % sensitivity and 80 % specificity. The ART is a simple, rapid and reproducible language task, useful in monitoring early aphasic changes in acute stroke patients and highly predictive of the 3-month verbal communication outcome. It should be easy to adapt to other languages.

The Four-Level Framework of speech sensorimotor control (Van der Merwe, 1997) complicates the traditional view of dysarthria as a purely motor execution disorder. According to this framework, hypokinetic, hyperkinetic and ataxic dysarthria are programming-execution dysarthrias, while flaccid dysarthria is the only execution dysarthria. This preliminary study aimed to differentiate programming-execution dysarthria from execution dysarthria by examining variability of the temporal control of speech. Six participants and five control participants repeated 15 stimulus words ten times. Voice onset time, vowel duration, vowel steady state duration and vowel formant transition duration were measured acoustically. The coefficient of variation of the temporal parameters, and the correlation coefficient between the durational parameters, were calculated and analysed using descriptive statistics. The coefficient of variation revealed that the speakers with dysarthria were more variable than th...

Spoken language comprehension, including comprehension for inferential material in narrative discourse, is diminished in dementia of the Alzheimer type (DAT). There are, however, no empirical data concerning comprehension by adults with DAT of main ideas versus details in narratives. Evidence from other groups with and without brain damage has shown that comprehension for main ideas is relatively better than for details and that comprehension for stated material is relatively better than comprehension for inferential material. Participants in the present investigation were 24 older adults, 8 with early-stage DAT (EDAT), 8 with middle-stage DAT (MDAT), and 8 with no brain damage (NBD). Selected narratives and associated sets of yes-no questions from the Discourse Comprehension Test (DCT) (Brookshire and Nicholas, 1993) were presented on videotape. Participants with EDAT and MDAT had significantly poorer overall comprehension of DCT narratives than did those in the NBD group (p < .0001), but they did not differ significantly from each other. Responses to DCT narratives by participants in the NBD, EDAT, and MDAT groups followed the same pattern of relatively better comprehension for main ideas than for details and relatively better comprehension for stated than for implied information. Working memory and episodic memory were shown to be significantly associated with DCT overall scores. Together, these findings suggest that although overall narrative comprehension is diminished in those with DAT, individuals appear to retain a mental representation for narratives that facilitates better comprehension of main ideas than of details as well as better comprehension of stated information than of implied information. This interpretation is consistent with schema-based accounts of narrative comprehension.

Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in older people that has only been recognized in the past decade and that remains widely underdiagnosed. At postmortem examination, affected patients show numerous ␣-synuclein-positive Lewy bodies (LB) in many parts of the cerebral cortex, particularly neocortical and limbic areas in addition to the nigral LB degeneration characteristic of Parkinson's disease (PD). Clinical presentation, unlike PD, is with progressive cognitive decline with particular deficits of visuospatial ability as well as frontal executive function accompanied by usually only mildly to moderately severe parkinsonism, which is often akineto-rigid without the classical parkinsonian rest-tremor. Further accompanying features include spontaneous recurrent visual hallucinations and conspicuous fluctuations in alertness and cognitive performance. The two main differential diagnoses are Alzheimer's disease (AD) and Parkinson's disease dementia (PDD).

Differentiation of the symptoms of dissociation and neurodegeneration in adolescent patients causes many problems. Diagnostic criteria unequivocally show that dissociative disorders should be diagnosed only after excluding general-medical and neurological causes and the results of the effect of psychoactive substances. The diagnosis of dissociation is indicated by the occurrence of conversion symptoms or recurrent somatic complaints temporally connected with a stressogenic factor in the dynamism of their clinical picture. The aim of the paper is to determine the psycho-pathological picture of neurodegeneration in an 18-year-old female student who was erroneously diagnosed as having dissociative disorders. The results of extended genetic tests conducted after eight years of ineffective treatment and therapy showed a hereditary form of neurodegeneration. The disease , although with different intensity, also manifested itself in the patient's grandmother, mother and in sister at different periods of their lives.

Purpose: This article was written as an editorial to a collection of original articles on apraxia of speech (AOS) in which some of the more recent advancements in the understanding of this syndrome are discussed. It covers controversial issues concerning the theoretical foundations of AOS. Our approach was motivated by a change of perspective on motor speech that has taken place in neurobiology, neurolinguistics, phonology, and phonetics during the past few decades. Method: The literature on AOS is reviewed from 3 different but overlapping perspectives-that is, a disconnection, a motor memory, and a fine motor skill perspective. Separate sections are devoted to the delimitations of AOS from oral facial apraxia, dysarthria, and phonological impairment. Conclusions: We conclude that many of the still unresolved conceptual issues about AOS arise from an underspecification of existing models of spoken language production. We suggest that phonological and motor impairments of sound production should be studied by an integrated approach.

Background: Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. Aims: The investigation sought to collect development-phase data, in accordance with the Medical Research Council (MRC) evaluation of complex interventions. The aims were to establish the extent of use of NSOMExs in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. Methods & Procedures: Speech and language therapists throughout Scotland, Wales, and Northern Ireland, working with adult-acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. Outcome & Results: One hundred and ninety-one (56% response) completed questionnaires were returned. Eightyone per cent of respondents used NSOMExs in dysarthria. There was no association with years of speech and language therapy experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute teaching. More experienced speech and language therapists were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended Higher Education Institute was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but also included improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were four to six repetitions of each exercise, during three practice periods daily, each of 6-10 min.

Despite the importance of speech naturalness to treatment outcomes, little research has been done on what constitutes speech naturalness and how to best maximize naturalness in relationship to other treatment goals like intelligibility. This study investigated the speech naturalness ratings of individuals with dysarthria and the associated perceptual correlates of highly natural and unnatural speech. Four speakers with hypokinetic dysarthria secondary to Parkinson's disease were recorded and rated for naturalness by 69 students in Communication Disorders. Students were presented with 436 speech samples and asked to provide speech naturalness ratings on a 1–9 Likert scale. After rating speech samples, subjects listed perceptual cues associated with samples rated most and least natural and weighted each cue on a visual analog scale. The data on naturalness ratings showed that spontaneous speech was rated the least natural on average, while sentences from a short story were rated slightly more natural and individually read sentences were rated the most natural of all of the utterance types. Thirteen themes emerged from the perceptual cues collected. Of the 13 themes, intelligibility was rated significantly more important than other cues in highly natural speech and intelligibility and articulation were rated significantly more important than other cues in highly unnatural speech.

Velopharyngeal function is often compromised by the resection and reconstruction of oropharyngeal and palatal tumours. While free tissue transfer has improved the outcomes of head and neck reconstruction. In general, palatal reconstruction remains a challenge.

The Campbell Collaboration (C2) was founded on the principle that systematic reviews on the effects of interventions will inform and help improve policy and services. C2 offers editorial and methodological support to review authors throughout the process of producing a systematic review. A number of C2's editors, librarians, methodologists and external peerreviewers contribute.

Acquired cerebellar lesions are associated with motor speech deficits. Spina bifida with hydrocephalus (SBH) is a neurodevelopmental disorder that involves significant dysmorphology of the cerebellum. Videotaped narratives produced by 40 children and adults with SBH and their 40 age-matched controls were coded for three motor speech deficits: dysfluency, ataxic dysarthria (articulatory inaccuracy, prosodic excess, and phonatory-prosodic insufficiency) , and speech rate. Individuals with SBH had more motor speech deficits than controls. Dysfluency was related to an interaction between chronological age and SBH. Speech rate was related independently to chronological age and SBH. Ataxic dysarthria was related to the biology of SBH, and was associated with both physical phenotype (level of spinal cord lesion) and medical history (number of shunt revisions). The data show that developmental as well as acquired lesions of the cerebellum disrupt motor speech, and add to the developmental role of the cerebellum in the automatization of motor skills, including speech. © 2002 Elsevier Science (USA)

A taxic dysarthria is a motor speech disorder associated with cerebellar dysfunction. The dysarthria appears to be related to a disturbance in the neural mechanisms that underlie the coordination, temporal regulation, and quasi-automatic control of respiratory, phonatory, and articulatory movements for speech. The symptoms of ataxic dysarthria vary, and may include any, or a combination, of the following abnormalities: imprecise articulation, momentary irregular articulatory breakdowns, slow rate of speech, excess and equal stress, monoloudness, monopitch, prolonged syllables, irregular intrasyllabic voice fundamental frequency (F0) inflections, and breathy, weak, or unstable voice. Physiologic studies of ataxic dysarthria have documented slow movements, temporal dysregulation, errors of direction and range of movements, impaired ability to increase muscular forces in order to produce rapid movements, and reduced or exaggerated range of movements involving the respiratory, phonatory, or articulatory systems. These abnormalities may be accompanied by other signs of cerebellar dysfunction, such as hypotonia, broad-based stance and gait, truncal instability, dysmetria, tremor, and dysdiadochokinesis .

Starting from the general concept of Dysarthria, the present work focuses on the clinical, neurobiological, and functional aspects of the morbid condition, suggesting a multidimensional treatment between physiotherapy, psychotherapy, and rehabilitation exercises for lost skills.

Background: Hypernasality is a common feature of non-progressive dysarthria. However, limited research has investigated the effectiveness of treatments for this impairment. Preliminary research has revealed positive effects on nasalance when using increased loudness in certain non-progressive dysarthric speakers. However, the long-term effects of loud speech on nasalance as part of a structured intervention such as Lee Silverman Voice Treatment (LSVT) w are yet to be investigated in this population. Aims: The study aimed to investigate the short-and long-term effects of LSVT w on hypernasality (perceptual ratings and degree of nasalance) in non-progressive dysarthria; and secondly, to evaluate the effects of traditional dysarthria therapy on these same measures, in comparison with the effects of LSVT w. Methods & Procedures: Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT w (n ¼ 5) or individually tailored traditional dysarthria therapy (n ¼ 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 £ 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at followup 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively. Outcomes & Results: Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT w , but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up. Conclusions & Implications: Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT w on nasality with a larger population with different dysarthria types is essential.

The reported study investigated the effect of 7 rate control methods (RCM) on running speech intelligibility, speaking rate (SR), articulation rate (AR) and pause characteristics in 27 individuals with dysarthria. The data reveal that with the exception of slower on demand, each RCM resulted in lower mean SRs and ARs (p ! 0.05). Clinically significant improvements in intelligibility were found in half of the participants with different types of dysarthria. The majority of them had normal or decreased ARs and SRs. The most effective methods were: alphabet board, hand tapping and pacing board. For the majority of speakers, the maximal decrease in speech rate was not associated with the maximal increase in intelligibility.

Dysarthria is a motor speech disorder that impairs the physical production of speech. Modern automatic speech recognition for normal speech is ineffective for dysarthric speech due to the large mismatch of acoustic characteristics. In this paper, a new speaker adaptation scheme is proposed to reduce the mismatch. First, a speaker with dysarthria is classified into one of the pre-defined severity-levels, and then an initial model to be adapted is selected depending on their severity-level. The candidates of an initial model are generated using dysarthric speech associated with their labeled severity-level in the training phase. Finally, speaker adaptation is applied to the selected initial model. Evaluation of the proposed method on a database of several hundred words for 31 speakers with moderate to mild dysarthria showed that the proposed approach provides substantial improvement over the conventional speaker-adaptive system when a small amount of adaptation data is available.

OBJETIVO: La CPAP en ventilación no invasiva es utilizada ampliamente en el paciente pediátrico con insuficiencia respiratoria aguda. Sin embargo la escasez de interfases específicas, respiradores adecuados y la escasa tolerancia de la técnica en estos pacientes pueden hacer fracasar su aplicación. El objetivo de este estudio fue analizar la eficacia de un sistema de CPAP formado por un circuito respiratorio de Mapleson modificado, durante la IRA en pediatría. MATERIAL Y MÉTODOS: Estudio prospectivo observacional realizado en niños con insuficiencia respiratoria aguda con indicación de ventilación no invasiva. La CPAP se aplicó mediante un circuito respiratorio Mapleson D provisto de un manómetro y un tubo nasofaríngeo como interfase. Se recogieron previo al tratamiento y 2 horas después, frecuencia cardiaca, frecuencia respiratoria, fracción inspirada de oxígeno, presión arterial de oxígeno, de dióxido de carbono y pulsioximetría. RESULTADOS: Se incluyeron 16 pacientes de edad media 3,8 años durante un periodo de 18 meses. Observamos una disminución PaCO 2 desde 66,8±18,08 mmHg a 46,48±5,9 mmHg tras CPAP (p=0,16) y un aumento en la relación PaO 2 /FiO 2 de 201±111 a 262±115 mm Hg tras CPAP (p=0,30). La FC descendió de 156±22 a 127±18 l/min (p=0,05) y la FR de 53±15 a 33±13 resp/min (p<0,05). No se registraron complicaciones graves y la tolerancia fue adecuada. La técnica se consideró exitosa en 12 pacientes (75%). CONCLUSIONES: La aplicación de CPAP sin respirador mediante circuito Mapleson D puede ser utilizado como ventilación no invasiva en pacientes pediátricos con insuficiencia respiratoria aguda con elevada tasa de éxito. Palabras clave: Insuficiencia Respiratoria aguda. Ventilación no invasiva. Circuito Mapleson. Circuito Mapleson tipo D. CPAP. Aceptado para su publicación en diciembre de 2008.

This study investigated the acoustic basis of across-utterance, within-speaker variation in speech naturalness for four speakers with dysarthria secondary to Parkinson’s disease (PD). Speakers read sentences and produced spontaneous speech. Acoustic measures of fundamental frequency, phrase-final syllable lengthening, intensity and speech rate were obtained. A group of listeners judged speech naturalness using a nine-point Likert scale. Relationships between judgements of speech naturalness and acoustic measures were determined for individual speakers with PD. Relationships among acoustic measures also were quantified. Despite variability between speakers, measures of mean F0, intensity range, articulation rate, average syllable duration, duration of final syllables, vocalic nucleus length of final unstressed syllables and pitch accent of final syllables emerged as possible acoustic variables contributing to within-speaker variations in speech naturalness. Results suggest that acoustic measures correlate with speech naturalness, but in dysarthric speech they depend on the speaker due to the within-speaker variation in speech impairment.

neurological lesions such as jejunal atresia, possibly proceeding from localized vascular compromise, were also encountered. In one sibship, one sister was found to have a severe developmental anomaly of one foot, suggesting that genetic factors may be involved.

This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment--the Sentence Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-trea...