Functional Speech and Voice Disorders: Approaches to Diagnosis and Treatment.

Historically, formal training for speech-language therapists (SLTs) in the area of functional speech and voice disorders (FSVD) has been limited, as has the body of empirical research in this content area. Recent efforts in the field have codified expert opinions on best practices for diagnosing and treating FSVD and have begun to demonstrate positive treatment outcomes. To provide comprehensive interventions for these complex conditions at the intersection of neurology, psychiatry, and other medical specialties, the SLT must not only build knowledge of diagnostic strategies and components of symptomatic treatment in FSVD but also embrace behavior change techniques and counseling strategies.

Speech and language therapy: A treatment case series of 20 patients with functional speech disorder.

BACKGROUND: While expert consensus recommendations support the use of speech and language therapy (SLT) for patients with functional speech disorder (FND-speech), there are limited published data on clinical outcomes. OBJECTIVE: To retrospectively report the treatment outcomes and clinical characteristics of patients with FND-speech that attended outpatient SLT as part of a multidisciplinary program for functional neurological disorder (FND). METHODS: In this case series, we included adult patients with FND-speech that consecutively participated in outpatient SLT at our institution between October 2014 and September 2021. Baseline demographic and neuropsychiatric characteristics were extracted from the medical records, along with data on FND-speech phenotypes, number of treatment sessions received, and clinician-determined outcomes. Only descriptive statistics were used to report findings. RESULTS: Twenty patients met inclusion criteria; ages ranged from 21-77, with a mean of 51.6±16.2 years. 85% of the cohort presented with mixed FND-speech symptoms. Patients attended a range of 2-37 visits, with an average of 9.2±8.0 visits over 4.4±3.5 months. At the last treatment session, 3 patients were asymptomatic, 15 had improved, and 2 had not improved; 8 individuals that improved received video telehealth interventions. CONCLUSION: This case series lends additional support for outpatient SLT in the assessment and management of individuals with FND-speech, and may help clarify patient and provider treatment expectations. Additional prospective research is needed to investigate baseline predictors of treatment response and further define the optimal frequency, intensity, duration, and clinical setting for SLT delivery in this population.

[Functional neurological disorders: A clinical anthology]. / Troubles neurologiques fonctionnels : une anthologie clinique.

Functional neurological disorders have a broad phenotypic spectrum and include different clinical syndromes, which are sometimes associated to each other or appear consecutively over the course of the disease. This clinical anthology provides details on the specific and sensitive positive signs that are to be sought in the context of a suspected functional neurological disorder. Beside these positive elements leading to the diagnosis of functional neurological disorder, we should keep in mind the possibility of an associated organic disorder as the combination of both organic and functional disorders is a relatively frequent situation in clinical practice. Here we describe the clinical characteristics of different functional neurological syndromes: motor deficits, abnormal hyperkinetic and hypokinetic movements, voice or speech disorders, sensory disorders, and functional dissociative seizures. The clinical examination and the identification of positive signs play a critical role in the diagnosis of functional neurological disorder. Knowledge of the specific signs associated with each phenotype render possible to make an early diagnosis. For that matter, it contributes to the improvement of patient care management. It allows to a better engagement in an appropriate care pathway, which influence their prognosis. Highlighting and discussing positive signs with patients can also be an interesting step in the process of explaining the disease and its management.

Construct validity of the focus on the outcomes of communication under six (FOCUS) total and profile scores for multilingual preschoolers: Considering functional speech skills.

PURPOSE: To conduct an exploratory study to establish construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS) in the Jamaican context for FOCUS Total and Profile scores. METHOD: Parents of a representative sample of 3-to-6-year-old Jamaican Creole (JC)-English-speaking simultaneous bilingual children completed the FOCUS in English, and the Intelligibility in Context Scale (ICS) in JC and in English. Children completed the Diagnostic Evaluation of Articulation and Phonology (DEAP) in both languages. Percent phonemes, consonants, and vowels correct were calculated using single word responses to DEAP items. Pearson correlations were completed to describe relationships between measurement scores. RESULT: Convergent validity was found for FOCUS Total and ICS/JC scores. Convergent and divergent validity were found for specific FOCUS Profile scores and ICS/JC scores. Minimal evidence of convergent validity was found with FOCUS Total scores and transcription-based measures of speech production in JC and in English. Convergent and divergent validity were found between specific FOCUS Profile scores and some transcription-based measures of speech production in JC and in English. CONCLUSION: This study provides evidence of construct validity for FOCUS Total and Profile scores. It also provides validity evidence for FOCUS scores in a multilingual context using a representative sample of children that serves to broaden the range of applicability of the FOCUS.

Functional Speech and Voice Disorders: Case Series and Literature Review.

BACKGROUND: Functional disorders of speech and voice, subtypes of functional movement disorders, represent abnormalities in speech and voice that are thought to have an underlying psychological cause. These disorders exhibit several positive and negative features that distinguish them from organic disorders. METHODS AND RESULTS: We describe the clinical manifestations of functional disorders of speech and voice, and illustrate these features using six clinical cases. CONCLUSIONS: Functional disorders of speech and voice may manifest in a variety of ways, including dysphonia, stuttering, or prosodic abnormalities. Given that these disorders have been understudied and may resemble organic disorders, diagnosis may be challenging. Appropriate treatment may be quite effective, highlighting the importance of prompt and accurate diagnosis.

Functional speech disorders: clinical manifestations, diagnosis, and management.

Acquired psychogenic or functional speech disorders are a subtype of functional neurologic disorders. They can mimic organic speech disorders and, although any aspect of speech production can be affected, they manifest most often as dysphonia, stuttering, or prosodic abnormalities. This chapter reviews the prevalence of functional speech disorders, the spectrum of their primary clinical characteristics, and the clues that help distinguish them from organic neurologic diseases affecting the sensorimotor networks involved in speech production. Diagnosis of a speech disorder as functional can be supported by sometimes rapidly achieved positive outcomes of symptomatic speech therapy. The general principles of such therapy are reviewed.

Eye gaze technology: a South African perspective.

PURPOSE: Based on the bioecological model by Bronfenbrenner, this paper will provide a broad perspective on factors that need to be taken into account in order to facilitate communication and participation in preliterate children making use of electronic Augmentative and Alternative Communication (AAC) systems accessed through eye gaze. METHOD: Two case studies of children who have been provided with the technology described are presented. The case studies were analysed using the four nested systems of the ecology as a framework to describe not only the environment, but also the processes and interactions between the persons and their context. RESULTS: Risk and opportunity factors are evident at all levels of the ecology. CONCLUSIONS: While a good fit between the person and the technology is an essential starting point, additional factors pertaining to the partner, the immediate environment as well as meso-, exo- and macrosystemic issues (such as societal attitudes and funding sources) have a significant influence on benefits derived. In resource-limited environments, the lack of support at more distal levels of the ecology (meso-, exo- and marosystemic levels) seems to be a factor that differentiates these environments from more resourced ones. Implications for Rehabilitation Within resource-limited environments lack of support from wider ecological systems pose a risk to the implementation of eye gaze technology. Attempts to improve collaboration between all role players could provide the opportunity for the establishment of an integrated plan for intervention and set the stage for information sharing and multiskilling between role players. Intervention should not only be aimed at addressing the needs of the individual client and their family, but also focus on building community capacity that could provide support to others.

functional MRI of Language Area

PURPOSE: To evaluate the usefulness of functional MR imaging(fMRI) for language mapping and determination of language lateralization. MATERIALS AND METHODS: Functional maps of the language area were obtained during word generation tasks and decision task in ten volunteers(7 right handed, 3 left-handed). MR examination were performed at 1.5T scanner with EPI BOLD technique. Each task consisted of three resting periods and two activation periods with each period of 30 seconds. Total acquisition time was 162sec. SPM program was used for the postprocessing of images. Statistical comparisons were performed by using t-statistics on a pixel-by-pixel basis after global normalization by ANCOVA. Activation areas were topographically analyzed(p<0.001) and activated pixels in each hemisphere were compared quantitatively by lateralization index. RESULTS: Significant activation signals were demonstrated in 9 of 10 volunteers. Activation signals were found in the premotor and motor cortices, the inferior frontal, inferior parietal, and mid-temporal lobes during stimulation tasks. In the right handed seven volunteers, activation of language areas was lateralized to the left side. Verb generation task produced stronger activation in the language areas and higher value of lateralization index than noun generation task or decision task. CONCLUSION: fMRI could be a useful non-invasive method for language mapping and determination of language dominance.