Acoustic Analysis of Intonation in Persons With Parkinson's Disease Receiving Transcranial Magnetic Stimulation and Intensive Voice Treatment.

Intonation is one of the prosodic features manifested acoustically in the fundamental frequency (f0). Intonation abnormality is common and prominent in the speech of persons with Parkinson's disease (PD). The current research investigated acoustically five intonational features including f0 declination, f0 resetting, sentence stress, terminal fall, and syntactic prejunctural fall in 20 PD participants, receiving Lee Silverman Voice Treatment (LSVT)-LOUD alone, or combined with transcranial magnetic stimulation delivered to the left or right primary laryngeal motor cortex. The results revealed that f0 declination, sentence stress, and terminal fall changed significantly from pre- to post-treatment, and the changes of declination and terminal fall were maintained at the follow-up evaluations. The observed changes in intonation were attributed to LSVT alone, which caused large changes of f0 magnitude. f0 resetting and syntactic prejunctural fall did not change significantly following treatment, probably because these intonational features need very precise fine motor control of the intrinsic laryngeal muscles to make small-range, rapid f0 adjustments, which were not improved by LSVT in the present PD participants. Difficulties with syntactic processing previously reported in PD may have also contributed to the lack of improvement in resetting and prejunctural fall, since these f0 features are used to mark syntactic boundaries within utterances.

Mapping typical and hypokinetic dysarthric speech production network using a connected speech paradigm in functional MRI.

We developed a task paradigm whereby subjects spoke aloud while minimizing head motion during functional MRI (fMRI) in order to better understand the neural circuitry involved in motor speech disorders due to dysfunction of the central nervous system. To validate our overt continuous speech paradigm, we mapped the speech production network (SPN) in typical speakers (n = 19, 10 females) and speakers with hypokinetic dysarthria as a manifestation of Parkinson disease (HKD; n = 21, 8 females) in fMRI. We then compared it with the SPN derived during overt speech production by 15O-water PET in the same group of typical speakers and another HKD cohort (n = 10, 2 females). The fMRI overt connected speech paradigm did not result in excessive motion artifacts and successfully identified the same brain areas demonstrated in the PET studies in the two cohorts. The SPN derived in fMRI demonstrated significant spatial overlap with the corresponding PET derived maps (typical speakers: r = 0.52; speakers with HKD: r = 0.43) and identified the components of the neural circuit of speech production belonging to the feedforward and feedback subsystems. The fMRI study in speakers with HKD identified significantly decreased activity in critical feedforward (bilateral dorsal premotor and motor cortices) and feedback (auditory and somatosensory areas) subsystems replicating previous PET study findings in this cohort. These results demonstrate that the overt connected speech paradigm is feasible during fMRI and can accurately localize the neural substrates of typical and disordered speech production. Our fMRI paradigm should prove useful for study of motor speech and voice disorders, including stuttering, apraxia of speech, dysarthria, and spasmodic dysphonia.

Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study.

PURPOSE: This article examines cepstral/spectral analyses of sustained /α/ vowels produced by speakers with hypokinetic dysarthria secondary to idiopathic Parkinson's disease (PD) before and after Lee Silverman Voice Treatment (LSVT®LOUD) and the relationship of these measures with overall voice intensity. METHODOLOGY: Nine speakers with PD were examined in a pre-/post-treatment design, with multiple daily audio recordings before and after treatment. Sustained vowels were analyzed for cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low/high spectral ratio (L/H SR), and Cepstral/Spectral Index of Dysphonia (CSID) using the KAYPENTAX computer software. RESULTS: CPP and CPP SD increased significantly and CSID decreased significantly from pre- to post-treatment recordings, with strong effect sizes. Increased CPP indicates increased dominance of harmonics in the spectrum following LSVT. After restricting the frequency cutoff to the region just above the first formant and second formant and below the third formant, L/H SR was observed to decrease significantly following treatment. Correlation analyses demonstrated that CPP was more strongly associated with CSID before treatment than after. CONCLUSION: In addition to increased vocal intensity following LSVT, speakers with PD exhibited both improved harmonic structure and voice quality as reflected by cepstral/spectral analysis, indicating that there was improved harmonic structure and reduced dysphonia following treatment.

Auditory comprehension performance of college students with and without sport concussion on Computerized-Revised Token Test Subtest VIII.

AIM: Auditory comprehension (AC) and visually assessed cognitive functions were compared in early stage postconcussed (PC) athletes and healthy controls using the Subtest VIII of the Computerized-Revised Token Test (C-RTT) and Immediate Postconcussion Assessment and Cognitive Test (ImPACT). RESULTS: As compared with healthy controls (n = 30), PC subjects (n = 30) had significantly lower C-RTT efficiency scores (p = 0.018), and lower ImPACT scores; total symptom score (p = 0.000.), verbal memory (p = 0.000), visual memory (p = 0.000), visual motor speed (p = 0.000) and reaction time (p = 0.004) in this post-test only matched subject design. Impulse Control was not significant (p = 0.613). Multiple regression and ANOVA indicated an association with reaction time only (p = 0.012) for the PC subjects. After controlling for reaction time, a significant difference in AC remained. CONCLUSION: The relationship between AC and other visually assessed cognitive functions was inconsistent suggesting that the C-RTT and ImPACT assessed different functional systems.

Referential Ambiguity in the Narrative Productions of African American Adults.

PURPOSE: The purpose of this study was to examine the production of referential ambiguities in two contrasting narrative conditions among age-defined groups of healthy African American women. METHOD: Twenty middle-aged adults (M = 51 years) and 20 older adults (M = 72 years) produced a complex story retelling and a personal narrative. All narratives were transcribed orthographically, parsed into T-units, and analyzed for surface structure markings of referents and the presence of ambiguities. RESULTS: The results demonstrated that older adults produced more ambiguities than middle-aged adults, were more compromised with task complexity, used more role or relation designations to refer to story characters while underusing proper names, and exhibited significant lexical retrieval deficits during ongoing narrative production. Middle-aged adults produced more proper names, but were also challenged by the complexity of the story-retelling task. Moreover, the results showed that older adults produced more African American English variants than middle-aged adults. CONCLUSION: This investigation revealed a pattern of age-related ambiguities during narrative production. The results demonstrated that lexical retrieval from long-term semantic memory was an important predictor of ambiguity, whereas African American English contributed negligibly. These results show that referential ambiguities may be a robust characteristic of cognitive-linguistic changes that occur with typical aging.

Distance and Interference in the Reference Management of African American Adults.

PURPOSE: The purpose of this study was to examine the effect of distance and interference on the adequacy of reference management in 2 contrasting narrative conditions among age-defined groups of healthy African American adults. METHODS: Twenty middle-aged (M = 51 years) and 20 older (M = 72 years) women produced a complex story retelling and a personal narrative of a childhood experience. All narratives were transcribed orthographically, parsed into terminal units (T-units), and analyzed for surface structure markings of referents. RESULTS: Results varied on the basis of task complexity and specific dependent variables. Older adults produced shorter T-unit distances between nouns and pronouns in story retelling compared with middle-aged adults. Middle-aged adults, but not older adults, exhibited longer T-unit distances between referents on story retelling than on personal narratives. Both groups performed similarly in the management of intervening information between referents. The presence of African American English features was related to interference but not to referential distance. CONCLUSIONS: Older adults demonstrated an effective age-related strategy for simplifying complex story retelling by producing shorter T-unit distances and, thus, less intervening information between referents. These findings suggest that referential distance may be a more important factor in mediating story recall. (For a summary and guidelines for therapy, see Bunce, 1991.).

Clinical assessment of motor speech disorders in adults with concussion.

This article reviews the occurrence of motor speech disorders of dysarthria and apraxia of speech following closed head injury and other traumatic brain injuries in adults as they apply to sport concussion and related trauma. Athletic sideline and speech-language pathology screenings are considered. Procedures for clinical assessment and diagnosis of motor speech disorder, most particularly dysarthria, are discussed with special reference to closed head injury. Included are the evaluation components of cranial nerve and speech mechanism examination, nonspeech musculature examination, perceptual and instrumental assessment procedures, quasi-standardized testing for dysarthria, and the determination of restrictions of participation in everyday life activities. The resultant output of such an evaluation is described in depth. Future directions for clinical research on motor speech disorders following sports concussion are also briefly considered.

Influence of consonant voicing characteristics on sentence production in abductor versus adductor spasmodic dysphonia.

OBJECTIVES/HYPOTHESIS: This study evaluated the hypotheses that sentence production by speakers with adductor (AD) and abductor (AB) spasmodic dysphonia (SD) may be differentially influenced by consonant voicing and manner features, in comparison with healthy, matched, nondysphonic controls. STUDY DESIGN: This was a prospective, single blind study, using a between-groups, repeated measures design for the independent variables of perceived voice quality and sentence duration. METHODS: Sixteen subjects with ADSD and 10 subjects with ABSD, as well as 26 matched healthy controls produced four short, simple sentences that were systematically loaded with voiced or voiceless consonants of either obstruant or continuant manner categories. Experienced voice clinicians, who were "blind" as to speakers' group affixations, used visual analog scaling to judge the overall voice quality of each sentence. Acoustic sentence durations were also measured. RESULTS: Speakers with ABSD or ADSD demonstrated significantly poorer than normal voice quality on all sentences. Speakers with ABSD exhibited longer than normal duration for voiceless consonant sentences. Speakers with ADSD had poorer voice quality for voiced than for voiceless consonant sentences. Speakers with ABSD had longer durations for voiceless than for voiced consonant sentences. CONCLUSIONS: The two subtypes of SD exhibit differential performance on the basis of consonant voicing in short, simple sentences; however, each subgroup manifested voicing-related differences on a different variable (voice quality vs sentence duration). Findings suggest different underlying pathophysiological mechanisms for ABSD and ADSD. Findings also support inclusion of short, simple sentences containing voiced or voiceless consonants as part of the diagnostic protocol for SD, with measurement of sentence duration in addition to judments of voice quality severity.

Perceptual structure of adductor spasmodic dysphonia and its acoustic correlates.

OBJECTIVES: To examine the perceptual structure of voice attributes in adductor spasmodic dysphonia (ADSD) before and after botulinum toxin treatment and identify acoustic correlates of underlying perceptual factors. Reliability of perceptual judgments is considered in detail. STUDY DESIGN: Pre- and posttreatment trial with comparison to healthy controls, using single-blind randomized listener judgments of voice qualities, as well as retrospective comparison with acoustic measurements. METHODS: Oral readings were recorded from 42 ADSD speakers before and after treatment as well as from their age- and sex-matched controls. Experienced judges listened to speech samples and rated attributes of overall voice quality, breathiness, roughness, and brokenness, using computer-implemented visual analog scaling. Data were adjusted for regression to the mean and submitted to principal components factor analysis. Acoustic waveforms, extracted from the reading samples, were analyzed and measurements correlated with perceptual factor scores. RESULTS: Four reliable perceptual variables of ADSD voice were effectively reduced to two underlying factors that corresponded to hyperadduction, most strongly associated with roughness, and hypoadduction, most strongly associated with breathiness. After treatment, the hyperadduction factor improved, whereas the hypoadduction factor worsened. Statistically significant (P<0.01) correlations were observed between perceived roughness and four acoustic measures, whereas breathiness correlated with aperiodicity and cepstral peak prominence (CPPs). CONCLUSIONS: This study supported a two-factor model of ADSD, suggesting perceptual characterization by both hyperadduction and hypoadduction before and after treatment. Responses of the factors to treatment were consistent with previous research. Correlations among perceptual and acoustic variables suggested that multiple acoustic features contributed to the overall impression of roughness. Although CPPs appears to be a partial correlate of perceived breathiness, a physical basis of this percept remained less clear.

Sentence intelligibility before and after voice treatment in speakers with idiopathic Parkinson's disease.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine whether sentence intelligibility improves in speakers with idiopathic Parkinson's disease (PD) as a result of Lee Silverman Voice Treatment (LSVT). It was hypothesized that all the speakers would improve following treatment, in association with increased vocal loudness, which was the primary target of the treatment. STUDY DESIGN: Prospective study of eight Speakers with PD using a single-blinded, randomized pre-post treatment design, with multiple daily assessments before and after treatment was carried out. Resultant data were corrected for regression to the mean. METHODS: Randomized digital recordings of sentences produced by speakers with idiopathic PD before and after the treatment were presented to normal-hearing listeners with equalized intensity at conversational loudness in the presence of pink noise. Percentage of words understood was calculated before and after the treatment. Changes in overall vocal intensity were also analyzed. RESULTS: There was a statistically significant group effect from pre-to-post voice treatment; however, there was also significant interaction of treatment with speakers. Six of the speakers with PD improved significantly following voice treatment, one exhibited no change, and one exhibited a decline in sentence intelligibility post-treatment. CONCLUSIONS: LSVT yielded significant improvement in sentence intelligibility for most speakers in the study but was not beneficial for two of the speakers despite the fact that they increased their overall vocal loudness.

Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection.

Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.

Spectral amplitude measures of adductor spasmodic dysphonic speech.

Spectral amplitude measures are sensitive to varying degrees of vocal fold adduction in normal speakers. This study examined the applicability of harmonic amplitude differences to adductor spasmodic dysphonia (ADSD) in comparison with normal controls. Amplitudes of the first and second harmonics (H1, H2) and of harmonics affiliated with the first, second, and third formants (A1, A2, A3) were obtained from spectra of vowels and /i/ excerpted from connected speech. Results indicated that these measures could be made reliably in ADSD. With the exception of H1(*)-H2(*), harmonic amplitude differences (H1(*)-A1, H1(*)-A2, and H1(*)-A3(*)) exhibited significant negative linear relationships (P < 0.05) with clinical judgments of overall severity. The four harmonic amplitude differences significantly differentiated between pre-BT and post-BT productions (P < 0.05). After treatment, measurements from detected significant differences between ADSD and normal controls (P < 0.05), but measurements from /i/ did not. LTAS analysis of ADSD patients' speech samples proved a good fit with harmonic amplitude difference measures. Harmonic amplitude differences also significantly correlated with perceptual judgments of breathiness and roughness (P < 0.05). These findings demonstrate high clinical applicability for harmonic amplitude differences for characterizing phonation in the speech of persons with ADSD, as well as normal speakers, and they suggest promise for future application to other voice pathologies.

Perceptual analyses of spasmodic dysphonia before and after treatment.

OBJECTIVE: To evaluate expert listeners' perceptions of voice and fluency in persons with adductor spasmodic dysphonia (ADSD) before and after treatment with botulinum toxin type A (Botox), as a function of initial severity of the disorder (while controlling for patients' age at injection). DESIGN: Simple before-and-after trial with blinded randomized listener judgments. SETTING: Ambulatory care clinic at a single medical center. PARTICIPANTS: Forty-two consecutive patients with ADSD who underwent examination, with a 3- to 6-week follow-up, after initial botulinum toxin type A injection. There were also 42 age- and sex-matched healthy control subjects. INTERVENTIONS: Injections of botulinum toxin type A into the thyroarytenoid muscle(s). MAIN OUTCOME MEASURES: Computer-implemented visual analog scaling judgments of voice quality and speech fluency made by expert listeners under psychoacoustically controlled conditions. RESULTS: Response to botulinum toxin type A varied markedly as a function of pretreatment severity of ADSD. More severe initial symptoms exhibited greater magnitudes of improvement. Patients with mild dysphonia did not exhibit pretreatment to posttreatment change. Following treatment, voice and fluency remained significantly (P<.05) poorer in ADSD than in healthy speakers. Older patients exhibited less improvement than younger patients when the effect of initial severity was statistically controlled. CONCLUSIONS: Voice quality and fluency improved for most patients following treatment, but older patients and those with milder dysphonia exhibited the least optimal responses to the procedure. Patients who were profoundly impaired demonstrated the greatest amount of improvement. Computer-implemented visual analog scaling provided a reliable clinical tool for determining treatment-related changes in those with ADSD.

Speech intelligibility in severe adductor spasmodic dysphonia.

This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched healthy adults. This yielded 3 speaking conditions: pre-Botox injection, post-Botox injection, and normal control. Thirty phrases were extracted from the speech samples and arranged in a counterbalanced listening experiment. Thirty students, reporting little experience with distorted speech, served as listeners. Each listener's response was scored for words correctly identified using a liberal scoring criterion yielding a percentage of words correctly identified for each speaker. The results indicated that the speakers with ADSD were significantly more intelligible in the post-Botox condition than in the pre-Botox condition. The results also indicated that healthy speakers were significantly more intelligible than the speakers in both the pre- and post-Botox conditions. In general, these results indicated that intelligibility is affected in severe ADSD and that the use of Botox injection in ADSD improves intelligibility scores. However, the results also indicated that the use of Botox injection does not result in speech intelligibility similar to that of normal, non-ADSD speakers.

Cortical control mechanisms in volitional swallowing: the Bereitschaftspotential.

OBJECTIVE: This research sought to identify a well-defined pre-motor potential, the Bereitschaftspotential (BP), as a manifestation of cortical contribution to the pre-motor planning of volitional swallowing. METHODS: EEG data were collected from 20 research participants during volitional execution of swallowing and finger movement tasks. A5 second pre-movement epoch for each task was triggered on EMG identification of movement onset. A grand average for each task representing approximately 2400 trials across all research participants was derived to compare and contrast morphological features of the derived waveform. RESULTS: Volitional pharyngeal swallowing and finger movement generated similar waveform characteristics of duration and slope; however, statistically significant differences were identified in polarity and in amplitude at four points both early and late in the epoch. Additionally, swallowing produced a pre-motor waveform with a rapid declination of EEG activity in the final 500 msec prior to movement onset. CONCLUSIONS: This study demonstrates activation of the supplementary motor cortex preceding the onset of volitional swallowing. However, unlike purely voluntary movements, the volitional pharyngeal swallowing task, as assessed with this methodology, does not appear to recruit the primary motor cortex. Thus engagement of the swallowing response appears to rely on indirect parallel pathways between extrapyramidal cortical motor planning regions and lower motor neurons.

Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection.

Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre- and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex- and age-matched control group (+/-2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity.

Botox treatment in adductor spasmodic dysphonia: a meta-analysis.

Over the years many studies have been conducted to document the treatment effects of Botulinum toxin type A in adductor spasmodic dysphonia. The results of these studies have led to the view that overall Botulinum toxin treatment is moderately effective. This study reviews efficacy research qualitatively and quantitatively to determine the extent to which this conclusion is fully supported by the data. Although the data indicate moderate overall improvement as a result of Botulinum toxin treatment, they also suggest significant variation across patients, measurements, and treatment conditions. This result, together with methodological limitations and lack of standardization in BT efficacy research, justifies caution when making inferences regarding BT treatment benefit in adductor spasmodic dysphonia.

Modes of vocal variation in Sykes's monkey (Cercopithecus albogularis) squeals.

Acoustic and laryngographic measurements of Sykes's monkey (Cercopithecus albogularis) squeals showed that acoustic variation between exemplars was principally due to 4 underlying modes of modification: (Class I) variation in the transfer function produced by articulation, (Class II) variation in F0 produced by inflection, (Class III) variation in turbulence, and (Class IV) variation in the pattern of vibration of laryngeal tissue with large or small surface areas (polyphonic variation). These findings suggest that some modes of variation (Class I, II, and III calls) were due to phonatory and articulatory acts resembling, at a very general level, sound production mechanics used in speech. Acoustic variation in the polyphonic group (Class IV calls) is not evident in speech and was attributed to the possibility of independent and simultaneous vibrations of the vocal lip and the principal component of the vocal folds.