Paroxysmal ataxic dysarthria.

This report reviews 13 cases in which a dysarthria appeared, remitted, and reappeared within seconds. The speech pattern of each case was characteristic of ataxic dysarthria. A cinefluorographic film for one of the subjects provided a rare opportunity to study the articulatory dynamics of this disorder. Multiple sclerosis either was given as a diagnosis or was strongly suspected in each case, and carbamazepine has been an effective treatment. Speculations concerning the origin of the paroxysmal and ataxic character of the dysarthria are presented along with a preliminary checklist for identifying the disorder.     

Acceleration and weakness in parkinsonian dysarthria.

This report presents some of the underlying neuromuscular mechanisms of dysarthric speech production as they are manifested in selected individuals with parkinsonism. Earlier explanations of parkinsonian dysarthria emphasized that the balanced hypertonus of rigidity formed the basis of reduced range of movements in speech. The present data reveal two problems in the neuromuscular control signals that can result in a reduced range of speech movements in the absence of rigidity. These neuromuscular problems are described as acceleration and weakness. The implication of these findings for the evaluation and treatment of parkinsonian dysarthria is discussed.     

Treatment of dysarthria: a case report.

There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).     

Listener agreement for auditory-perceptual ratings of dysarthria.

PURPOSE: Darley, Aronson, and Brown (1969a, 1969b) detailed methods and results of auditory-perceptual assessment for speakers with dysarthrias of varying etiology. They reported adequate listener reliability for use of the rating system as a tool for differential diagnosis, but several more recent studies have raised concerns about listener reliability using this approach. METHOD: In the present study, the authors examined intrarater and interrater agreement for perceptual ratings of 47 speakers with various dysarthria types by 2 listener groups (inexperienced and experienced). The entire set of perceptual features proposed by Darley et al. was rated based on a 40-s conversational speech sample. RESULTS: No differences in levels of agreement were found between the listener groups. Agreement was within 1 scale value or better for 67% of the pairwise comparisons. Levels of agreement were lower when the average rating fell in the mid-range of the scale compared with samples that had an average rating near either of the scale endpoints; agreement was above chance level. No significant differences in agreement were found between the perceptual features. DISCUSSION: The levels of listener agreement that were found indicate that auditory-perceptual ratings show promise during clinical assessment for identifying salient features of dysarthria for speakers with various etiologies.     

Hearing Levels In Nigerian Ataxic Neuropathy

Hearing measurements were made on both hospital samples and samples drawn from the general population in Nigeria. Poorer hearing levels were associated with Nigerian ataxic neuropathy, and a significant correlation was demonstrated between a score of overall clinical neurological deficit and the hearing levels for 250, 500 and 1 000 Hz. A variety of audiometric patterns was observed and the topodiagnostic tests indicated the occurrence of both receptor organ and neuronal lesions. Temporary threshold drift appeared to be associated with untreated cases of the condition. The study indicated that the prevalence of Nigerian Ataxic Neuropathy is probably much higher than hitherto assumed.     

Characteristics of the lax vowel space in dysarthria.

It has been hypothesized that lax vowels may be relatively unaffected by dysarthria, owing to the reduced vocal tract shapes required for these phonetic events (G. S. Turner, K. Tjaden, & G. Weismer, 1995). It also has been suggested that lax vowels may be especially susceptible to speech mode effects (M. A. Picheny, N. I. Durlach, & L. D. Braida, 1986). Studies evaluating these suggestions are lacking, however. The present study was an initial investigation of the vowel space area formed by the lax vowels /Iota/, /varepsilon/, and /upsilon/, occurring in a passage read in habitual, fast, and slow conditions by speakers with amyotrophic lateral sclerosis (ALS), speakers with Parkinson's disease (PD), and healthy controls. Vowel space areas for speakers with ALS but not speakers with PD differed from those for the appropriate control group. Thus, only the results for the PD group support the hypothesis that lax vowel space areas for speakers with dysarthria should be similar to those for neurologically normal talkers. Compared with the habitual condition, rate reduction was associated with an expanded vowel space area for all of the healthy talkers but for only about half of the speakers with dysarthria. In addition, about half of the speakers in each group demonstrated a reduced vowel space area for the fast condition relative to the habitual condition, although the statistical analyses indicated no difference in vowel space areas for the fast and habitual conditions. The current study therefore provides only limited support for the idea that lax vowels are highly susceptible to speech mode effects, at least when the speech modes under consideration include faster-than-normal and slower-than normal rates. Clinical implications are discussed.     

Perception of coarticulatory information in normal speech and dysarthria.

PURPOSE: This study addressed three research questions: (a) Can listeners use anticipatory vowel information in prevocalic consonants produced by talkers with dysarthria to identify the upcoming vowel? (b) Are listeners sensitive to interspeaker variation in anticipatory coarticulation during prevocalic consonants produced by healthy talkers and/or talkers with dysarthria, as measured by vowel identification accuracy? (c) Is interspeaker variation in anticipatory coarticulation reflected in measures of intelligibility? METHOD: Stimuli included 106 CVC words produced by 20 speakers with either Parkinson's disease or multiple sclerosis or by 16 healthy controls characterized by an operationally defined normal, under, or over level of anticipatory vowel coarticulation. Ten listeners were presented with prevocalic consonants for identification of the vowel. Ten additional listeners judged single-word intelligibility. An analysis of variance was used to determine differences in vowel identification accuracy and intelligibility as a function of speaker group, coarticulation level, and vowel type. RESULTS: Listeners accurately identified vowels produced by all speaker groups from the aperiodic portion of prevocalic consonants, but interspeaker variations in strength of coarticulation did not strongly affect vowel identification accuracy or intelligibility. CONCLUSIONS: Listeners appear to be tuned to similar types of information in the acoustic speech stream irrespective of the source or speaker, and any perceptual effects of interspeaker variation in coarticulation are subtle.     

Breath-group intelligibility in dysarthria: characteristics and underlying correlates.

PURPOSE: This study was designed to determine whether within-speaker fluctuations in speech intelligibility occurred among speakers with dysarthria who produced a reading passage, and, if they did, whether selected linguistic and acoustic variables predicted the variations in speech intelligibility. METHOD: Participants with dysarthria included a total of 10 persons with Parkinson's disease and amyotrophic lateral sclerosis; a control group of 10 neurologically normal speakers was also studied. Each participant read a passage that was subsequently separated into consecutive breath groups for estimates of individual breath group intelligibility. Sixty listeners participated in 2 perceptual experiments, generating intelligibility scores across speakers and for each breath group produced by speakers with dysarthria. RESULTS: Individual participants with dysarthria had fluctuations in intelligibility across breath groups. Breath groups of participants with dysarthria had fewer average words and reduced interquartile ranges for the 2nd formant, the latter a global measure of articulatory mobility. Regression analyses with intelligibility measures as the criterion variable and linguistic and acoustic measures as predictor variables produced significant functions both within and across speakers, but the solutions were not the same. CONCLUSIONS: Linguistic or acoustic variables that predict across-speaker variations in speech intelligibility may not function in the same way when within-speaker variations in intelligibility are considered.     

Interarticulator coordination in dysarthria: an X-ray microbeam study.

Articulatory discoordination is often said to be an important feature of the speech production disorder in dysarthria, but little experimental work has been done to identify and specify the coordination difficulties. The present study evaluated the coordination of labial and lingual gestures for /u/ production in persons with Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and in control participants. Both tongue backing/raising and reduction of the area enclosed by the lips can produce the characteristic low F2 of /u/. The timing of these articulatory gestures with respect to the acoustic target of a low F2 was inferred from X-ray microbeam data. Pellet motions of the tongue dorsum and lips revealed the timing of the lingual and labial gestures to be strongly linked together (synchronized), predictive of the temporal location of the lowest F2 within the vocalic nucleus, and scaled proportionately to the overall vowel duration in control participants. Somewhat surprisingly, essentially the same findings were obtained in the speakers with dysarthria. These relationships were noisier among the speakers with dysarthria, but the global synchronization patterns applied to all 3 groups. Further analyses revealed the synchronization to be less well defined and more variable across speakers with ALS, as compared to speakers with PD and the controls. Results are discussed relative to concepts of coordination in dysarthria.     

构音障碍的评定与康复治疗

1 构音障碍的定义和分类 1．1 构音障碍（dysarthria）是由于神经病变、与言语有关肌肉的麻痹、收缩力减弱或运动不协调所致的言语障碍。此定义强调呼吸运动、共鸣、发音和韵律方面的变化,从大脑到肌肉本身的病变都可引起言语症状。病因常见于脑血管意外、脑肿瘤、脑瘫、肌萎缩侧索硬化、重症肌无力、小脑损伤、帕金森氏病、多发性硬化等。其病理基础为运动障碍．所以又称为运动障碍性构音障碍．     

Cerebellar dysarthria (author's transl)

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.     

Toward phonetic intelligibility testing in dysarthria

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 data from a sample of subjects with amyotrophic lateral sclerosis are presented to illustrate the use of this test in the phonetic interpretation of intelligibility impairment.     

Quantitative description of the dysarthria in women with amyotrophic lateral sclerosis.

Speech intelligibility and its phonetic and acoustic correlates were studied in a group of 10 women with amyotrophic lateral sclerosis (ALS). Intelligibility assessment with a word-identification test indicated that the most disrupted phonetic features pertained to velopharyngeal valving, lingual function for consonant contrasts of place and manner, and syllable shape. An acoustic signature analysis based on trajectories of the first and second formants in selected monosyllabic test words revealed that the mean slope of the second formant (F2) was reduced compared with that of a normal geriatric control group. This F2 slope reduction is interpreted to reflect loss of lingual motoneurons. Acoustic measures of phonatory function for sustained vowel prolongation demonstrated abnormalities in fundamental frequency, perturbations of frequency (jitter) and amplitude (shimmer), and signal-to-noise ratio. The data for women with ALS are compared with data for a normal geriatric control group of women and with data for a group of 25 men with ALS (Kent et al., 1990). Although the overall ranking of errors was similar for males and females with ALS, men were more likely to have impairments of voicing in syllable-initial position.     

Rate and loudness manipulations in dysarthria: acoustic and perceptual findings.

Both rate reduction and increased loudness reportedly are associated with an increase in the size of the articulatory-acoustic working space and improved acoustic distinctiveness for speakers with dysarthria. Improved intelligibility also has been reported. Few studies have directly compared rate and loudness effects for speakers with dysarthria, however, although rate reduction and increasing vocal loudness are common treatment techniques. In the current study, 15 speakers with dysarthria secondary to multiple sclerosis, 12 speakers with dysarthria secondary to Parkinson's disease (PD), and 15 healthy controls read a passage in habitual, loud, and slow conditions. Rate and loudness variations were elicited using magnitude production. Acoustic measures included articulatory rate, sound pressure level, vowel space area, first moment difference measures, and F2 trajectory characteristics for diphthongs. Ten listeners scaled intelligibility for reading passages produced by the speakers with dysarthria. Relationships between intelligibility estimates and acoustic measures were determined by regression analysis. All speaker groups reduced articulatory rate for the slow condition and increased vocal intensity for the loud condition, relative to the habitual condition. Vowel acoustic distinctiveness, as indexed by vowel space area, was maximized in the slow condition, but stop consonant acoustic distinctiveness, as indexed by first moment difference measures, was maximized in the loud condition. F2 slope measures for diphthongs were not consistently affected by rate or loudness. Scaled intelligibility for speakers with PD also improved in the loud condition relative to both the habitual and slow conditions. Intelligibility estimates for speakers with dysarthria, however, were not strongly related to acoustic measures of supraglottal behavior. Findings are compared with previous studies, and hypotheses for future treatment studies are discussed.     

Articulatory movements during vowels in speakers with dysarthria and healthy controls.

PURPOSE: This study compared movement characteristics of markers attached to the jaw, lower lip, tongue blade, and dorsum during production of selected English vowels by normal speakers and speakers with dysarthria due to amyotrophic lateral sclerosis (ALS) or Parkinson disease (PD). The study asked the following questions: (a) Are movement measures different for healthy controls and speakers with ALS or PD, and (b) Are articulatory profiles comparable for speakers with ALS and speakers with PD? METHOD: Nineteen healthy controls and 15 speakers with dysarthria participated in this study. The severity of dysarthria varied across individuals and between the 2 disorder groups. The stimuli were 10 words (i.e., seed, feed, big, dish, too, shoo, bad, cat, box, and dog) embedded into sentences read at a comfortable reading rate. Movement data were collected using the X-ray microbeam. Movement measures included distances, durations, and average speeds of vowel-related movement strokes. RESULTS: Differences were found (a) between speakers with ALS and healthy controls and (b) between speakers with ALS and PD, particularly in movement speed. Tongue movements in PD and ALS were more consistently different from healthy controls than jaw and lower lip movements. This study showed that the effects of neurologic disease on vowel production are often articulator-, vowel-, and context-specific. CONCLUSIONS: Differences in severity between the speakers with PD and ALS may have accounted for some of the differences in movement characteristics between the groups. These factors need to be carefully considered when describing the nature of speech disorder and developing empirically based evaluation and treatment strategies for dysarthria.