RESUMO
PURPOSE: This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings. METHOD: Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar. DEPENDENT VARIABLES: In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb). RESULTS: Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants. CONCLUSIONS: The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21809544.
Assuntos
Música , Doença de Parkinson , Canto , Ataxias Espinocerebelares , Humanos , Inteligibilidade da Fala , Doença de Parkinson/complicações , Disartria/etiologia , Ataxias Espinocerebelares/complicaçõesRESUMO
INTRODUCTION: Myasthenia Gravis (MG) is an autoimmune disease. The characteristic symptoms of the disease are muscle weakness and fatigue. These symptoms affect de oral muscles causing dysarthria, affecting about 60% of patients with disease progression. PURPOSE: Describe the speech pattern of patients with MG and comparing with healthy controls (HC). MATERIAL AND METHODS: Case-control study. Participants were divided in MG group (MGG) with 38 patients MG diagnosed and HC with 18 individuals matched for age and sex. MGG was evaluated with clinical and motor scales and answered self-perceived questionnaires. Speech assessment of both groups included: recording of speech tasks, acoustic and auditory-perceptual analysis. RESULTS: In the MGG, 68.24% of the patients were female, with average age of 50.21 years old (±16.47), 14.18 years (±9.52) of disease duration and a motor scale of 11.19 points (±8.79). The auditory-perceptual analysis verified that 47.36% (n = 18) participants in MGG presented mild dysarthria, 10.52% (n = 4) moderate dysarthria, with a high percentage of alterations in phonation (95.2%) and breathing (52.63%). The acoustic analysis verified a change in phonation, with significantly higher shimmer values in the MGG compared to the HC and articulation with a significant difference between the groups for the first formant of the /iu/ (p = <.001). No correlation was found between the diagnosis of speech disorder and the dysarthria self-perception questionnaire. CONCLUSION: We found dysarthria mild in MG patients with changes in the motor bases phonation and breathing, with no correlation with severity and disease duration.
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Disartria , Miastenia Gravis , Estudos de Casos e Controles , Disartria/diagnóstico , Disartria/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Fala , Acústica da Fala , Qualidade da VozRESUMO
INTRODUCTION: Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder. CASE REPORT: We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction. CONCLUSION: To the authors' knowledge, there are two cases of individuals with artery of Percheron infarction who developed PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron's artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP.
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Encéfalo/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Disartria/etiologia , Infarto/diagnóstico por imagem , Paralisia Pseudobulbar/complicações , Tálamo/diagnóstico por imagem , Idoso , Artérias/patologia , Infarto Cerebral/complicações , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Infarto/complicações , Imageamento por Ressonância Magnética , Neuroimagem/efeitos adversos , Tálamo/irrigação sanguínea , Tálamo/fisiopatologia , Tomografia Computadorizada por Raios XAssuntos
Neoplasias Cardíacas/patologia , Mixoma/complicações , Mixoma/cirurgia , Acidente Vascular Cerebral/etiologia , Disartria/diagnóstico , Disartria/etiologia , Ecocardiografia/métodos , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mixoma/diagnóstico , Paresia/diagnóstico , Paresia/etiologia , Acidente Vascular Cerebral/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND: Dysarthric symptoms in Parkinson's disease (PD) vary greatly across cohorts. Abundant research suggests that such heterogeneity could reflect subject-level and task-related cognitive factors. However, the interplay of these variables during motor speech remains underexplored, let alone by administering validated materials to carefully matched samples with varying cognitive profiles and combining automated tools with machine learning methods. OBJECTIVE: We aimed to identify which speech dimensions best identify patients with PD in cognitively heterogeneous, cognitively preserved, and cognitively impaired groups through tasks with low (reading) and high (retelling) processing demands. METHODS: We used support vector machines to analyze prosodic, articulatory, and phonemic identifiability features. Patient groups were compared with healthy control subjects and against each other in both tasks, using each measure separately and in combination. RESULTS: Relative to control subjects, patients in cognitively heterogeneous and cognitively preserved groups were best discriminated by combined dysarthric signs during reading (accuracy = 84% and 80.2%). Conversely, patients with cognitive impairment were maximally discriminated from control subjects when considering phonemic identifiability during retelling (accuracy = 86.9%). This same pattern maximally distinguished between cognitively spared and impaired patients (accuracy = 72.1%). Also, cognitive (executive) symptom severity was predicted by prosody in cognitively preserved patients and by phonemic identifiability in cognitively heterogeneous and impaired groups. No measure predicted overall motor dysfunction in any group. CONCLUSIONS: Predominant dysarthric symptoms appear to be best captured through undemanding tasks in cognitively heterogeneous and preserved cohorts and through cognitively loaded tasks in patients with cognitive impairment. Further applications of this framework could enhance dysarthria assessments in PD. © 2021 International Parkinson and Movement Disorder Society.
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Disfunção Cognitiva , Doença de Parkinson , Cognição , Disartria/diagnóstico , Disartria/etiologia , Humanos , Aprendizado de Máquina , FalaRESUMO
PURPOSE: To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS). METHODS: Quantitative-descriptive study approved by REC under No. CAAE 62912416.4.0000.5404, comprised of 19 individuals with sporadic or familiar ALS. Data were collected using the Dysarthria Protocol and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-Re). We used visual analogue scale (VAS) to assess speech intelligibility and summary measures; and Spearman's coefficients of correlation for the instruments with significance level of 5%. RESULTS: Speech intelligibility is compromised (41.37±39.73) in varied degrees with positive correlation with the general degree of dysarthria (p=<.0001), and with all the analyzed speech parameters, indicating impact on the speech deterioration of the studied group. There is negative correlation between speech intelligibility and the results of the bulbar sections - speech and deglutition (p=0.0166), arm - activities with the upper limb (p=0.0064) and leg - activities with the lower limb (p=0.0391). Breathing (p=0.0178), phonation (p=0.0334) and resonance (p=0.0053) parameters showed a negative correlation with the item "speech" of the ALSFRS-Re. CONCLUSION: Results show impaired speech intelligibility and dysarthria, and evidence breathing, phonation and resonance as important markers of the disease progression. A thorough and early evaluation of the oral motor production allows for a better management of alterations in ALS.
OBJETIVO: Avaliar a inteligibilidade de fala e disartria, correlacionando com a avaliação funcional da ELA. MÉTODO: Estudo quantitativo-descritivo aprovado pelo CEP, sob nº CAAE 62912416.4.0000.5404, constituído por 19 pessoas com ELA, esporádica ou familiar. Para coleta, aplicou-se o Protocolo de Disartria e Escala de Avaliação Funcional da Esclerose Lateral Amiotrófica (ALSFRS-Re). Para análise, foi utilizada escala visual analógica para inteligibilidade de fala e medidas de resumo e correlação dos instrumentos pelo Coeficiente de Spearman com nível de significância de 5%. RESULTADOS: A inteligibilidade de fala está comprometida (41,37±39,73) em graus variados com correlação positiva com o grau geral de disartria (p=<,0001) e com todos os parâmetros de fala analisados, indicando impacto na deterioração da fala do grupo estudado. Há correlação negativa entre inteligibilidade de fala e resultados das seções bulbar fala e deglutição (p=0,0166), braço atividades com membro superior (p=0,0064) e perna atividades com membro inferior (p=0,0391). Os parâmetros de respiração (p=0,0178), fonação (p=0,0334) e ressonância (p=0,0053) apresentaram correlação negativa com o item "fala" do ALSFRS-Re. CONCLUSÃO: Os achados mostram prejuízo da inteligibilidade de fala e disartria e evidenciam respiração, fonação e ressonância como importantes marcadores da progressão da doença. Uma avaliação criteriosa e precoce da produção motora oral permite melhor gerenciamento das alterações na ELA.
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Esclerose Lateral Amiotrófica , Inteligibilidade da Fala , Esclerose Lateral Amiotrófica/complicações , Disartria/diagnóstico , Disartria/etiologia , Humanos , Fala , Distúrbios da Fala , Medida da Produção da FalaAssuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Disartria/diagnóstico por imagem , Disartria/etiologia , Paralisia Facial/diagnóstico por imagem , Paralisia Facial/etiologia , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/etiologia , Transtornos Puerperais/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
ABSTRACT Purpose: to identify the knowledge produced in national and international researches on speech and language disorders in Amyotrophic Lateral Sclerosis, regarding the type of research and approach in different areas. Methods: an integrative review performed on databases, using the following descriptors: Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement and Speech Disorders. The inclusion criteria covered articles that addressed motor speech and language disorders from 2013 to 2018, excluding duplications, and categorizing valid articles for analysis. Results: 83 articles were selected, after screening the titles and abstracts. A large scientific production from different countries and areas, mainly Speech Therapy and Neurology, was found. Most of them was clinical research (65.06%), with a main focus on speech motor disorders (42.16%), speech and language motor disorders, cognition and behavior (27.71%), and language disorders (12.06%). Conclusion: researches found were mostly clinical and aimed at determining the diagnosis of disorders in different areas of knowledge. With regard to communication, few studies have been found in Brazil, and international studies addressed high technology. The results confirmed the heterogeneous nature of the disease, which shows, in addition to motor impairment of speech, cognitive, behavioral and language impairments.
RESUMO Objetivo: identificar o conhecimento produzido em pesquisas nacionais e internacionais das alterações de fala e de linguagem na Esclerose Lateral Amiotrófica, quanto tipo de pesquisa e abordagens em diferentes áreas. Métodos: revisão integrativa realizada em bases de dados, utilizando-se os descritores Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement e Speech Disorders. Os critérios de inclusão abrangeram artigos que abordassem alterações motoras de fala e de linguagem de 2013 a 2018, excluindo-se duplicações, categorizando-se os válidos para análise. Resultados: selecionou-se 83 artigos, após triagem dos títulos e resumos. Foi encontrada grande produção científica de diferentes países e áreas, principalmente Fonoaudiologia e Neurologia, na maioria pesquisas clínicas (65,06%), com foco principal em alterações motoras da fala (42,16%), alterações motoras de fala e linguagem, cognição e comportamento (27,71%) e alterações de linguagem (12,06%). Conclusão: as pesquisas encontradas foram, na maioria, clínicas e com objetivo determinar diagnóstico das alterações em diferentes áreas do conhecimento. No que se refere à comunicação, foram encontrados poucos estudos no Brasil e os internacionais voltavam-se à alta tecnologia. Os resultados confirmaram o caráter heterogêneo doença, que evidencia, além de comprometimento motor da fala, prejuízo cognitivo, comportamental e de linguagem.
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Humanos , Conhecimentos, Atitudes e Prática em Saúde , Disartria/etiologia , Esclerose Lateral Amiotrófica/complicações , Transtornos da Linguagem/diagnóstico , Transtornos da Linguagem/etiologiaRESUMO
TITLE: Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.