Effect of speech task on intelligibility in dysarthria: a case study of Parkinson's disease

This study assessed intelligibility in a dysarthric patient with Parkinson's disease (PD) across five speech production tasks: spontaneous speech, repetition, reading, repeated singing, and spontaneous singing, using the same phrases for all but spontaneous singing. The results show that this speaker was significantly less intelligible when speaking spontaneously than in the other tasks. Acoustic analysis suggested that relative intensity and word duration were not independently linked to intelligibility, but dysfluencies (from perceptual analysis) and articulatory/resonance patterns (from acoustic records) were related to intelligibility in predictable ways. These data indicate that speech production task may be an important variable to consider during the evaluation of dysarthria. As speech production efficiency was found to vary with task in a patient with Parkinson's disease, these results can be related to recent models of basal ganglia function in motor performance.     

Multidisciplinary assessment and diagnosis of conversion disorder in a patient with foreign accent syndrome

Multiple reports have described patients with disordered articulation and prosody, often following acute aphasia, dysarthria, or apraxia of speech, which results in the perception by listeners of a foreign-like accent. These features led to the term foreign accent syndrome (FAS), a speech disorder with perceptual features that suggest an indistinct, non-native speaking accent. Also correctly known as psuedoforeign accent, the speech does not typically match a specific foreign accent, but is rather a constellation of speech features that result in the perception of a foreign accent by listeners. The primary etiologies of FAS are cerebrovascular accidents or traumatic brain injuries which affect cortical and subcortical regions critical to expressive speech and language production. Far fewer cases of FAS associated with psychiatric conditions have been reported. We will present the clinical history, neurological examination, neuropsychological assessment, cognitive-behavioral and biofeedback assessments, and motor speech examination of a patient with FAS without a known vascular, traumatic, or infectious precipitant. Repeated multidisciplinary examinations of this patient provided convergent evidence in support of FAS secondary to conversion disorder. We discuss these findings and their implications for evaluation and treatment of rare neurological and psychiatric conditions.     

“Hearing voices”: Auditory hallucinations as failure of top‐down control of bottom‐up perceptual processes

Auditory hallucination is a key characteristic of schizophrenia that seriously debilitates the patient, with consequences for social engagement with others. Hallucinatory experiences are also observed in healthy individuals in the general population who report “hearing voices” in the absence of an external acoustic input. A view on auditory hallucinations and “hearing voices” is presented that regards such phenomena as perceptual processes, originating from speech perception areas in the left temporal lobe. Healthy individuals “hearing voices” are, however, often aware that the experience comes from inner thought processes, which is not reported by hallucinating patients. A perceptual model can therefore, not alone explain the difference in the phenomenology of how the “voices heard” are attributed to either an inner or outer cause. An expanded model is thus presented which takes into account top‐down cognitive control, localized to prefrontal cortical areas, to inhibit and re‐attribute the perceptual mis‐representations. The expanded model is suggested to be empirically validated using a dichotic listening speech perception paradigm with instructions for top‐down control of attention focus to either the right or left side in auditory space. It is furthermore suggested to use fMRI to validate the temporal and frontal lobe neuronal correlates of the cognitive processes involved in auditory hallucinations.     

Anticipatory coarticulation in a patient with apraxia of speech

Articulatory anticipation of vowel gestures was assessed in an apraxic patient, a dysarthric patient, and three normal speakers. The technique of assessment included perceptual identification of gated speech stimuli. The speech material consisted of /getVte/ utterances with the target vowels /i/, /y/, and /u/. In the case of the apraxic patient the gated vowels were identified at a later instant relative to the preceding plosion burst than in the normal speakers. This result was interpreted as reflecting a delayed onset of coarticulatory gestures, in particular lip rounding. The identification rates for the dysarthric's vowels rather reflected the general reduction of this patient's vowel space.     

Language production in Parkinson's disease: acoustic and linguistic considerations

The hypokinetic dysarthria of Parkinson's disease (PD) has been described extensively. In contrast, patterns of hesitation and the language structure in spontaneous speech of the PD patient have not been investigated, although several studies have shown language-related abnormalities in word naming, word generation, and verbal recall. In the present study, 10 male Parkinson's patients and 10 normal male speakers were compared in a reading and spontaneous speaking paradigm for acoustic and linguistic features. Among acoustic measures, fundamental frequency and relative intensity differentiated PD from control subjects, consistent with reported features of hypokinetic dysarthria. The striking observations among linguistic measures differentiating PD from control subjects were an increase in the number of (a) silent hesitations per minute, (b) abnormally long silent hesitations, (c) words per silent hesitation, (d) open class phrases, and (e) optional open phrases per speech sample, and a decrease in the number of modalizations and interjections. An increase in the number of filled hesitations occurring per minute, as well as a decrease in syntactic complexity separated moderate from mild Parkinson's patients. Our interpretation of the data favors the hypothesis that changes in the structure of spontaneous language production with increasing severity of dysarthria reflect PD patients' adaptation to their disease.     

Impairment of temporal organization of speech in basal ganglia diseases.

Absolute and relative speech timing were examined in patients suffering from Parkinson's, Huntington's, and Wilson's disease. The task was to speak a standard sentence 10 times, first slowly, and then successively faster up to maximum rate. All patient groups had low maximal speech rates and showed decreased variability of speech rate. The duration of pauses between words was the same as in normals and the relative time structure of the test sentence was basically preserved. For comparison, two cases with nonfluent aphasia had even slower speech rates, large increases in pause duration, and major changes in relative speech timing. The results show the same type of alterations of the temporal organization of speech as those characteristic for rapid alternating limb movements in such patients. They support the view that the speech and skeletomotor systems share common neural control modes despite fundamental biomechanical differences. The common denominator between the speech and the skeletomotor disturbances in basal ganglia diseases may be the undamping and slowing of a fast central oscillator.     

The contribution of apraxic speech to working memory deficits in Parkinson's disease

This article links two formerly separate areas of research associated with Parkinson's disease (PD): speech and memory. It is proposed that speech deficits occur in PD not merely at the level of muscular control, as is commonly termed dysarthria, but also at the level of speech planning and programming, more aptly described as a form of apraxia. It is further argued that PD patient groups exhibit small deficits in verbal span, and the link between apraxic speech and verbal span is elucidated via Baddeley's (1986) model of working memory. An experiment is described in which aspects of speech of 36 PD and 43 healthy control subjects were rated and classified, and measures of span and articulation rate for words of different syllable lengths were taken. Twenty-three PD subjects had dysarthric speech, while 14 of them had apraxic speech, which was associated with lower memory span scores for longer words. It is concluded that apraxic speech can be a source of reduced memory span in PD. In addition to implications for rehabilitation and therapeutic work with PD sufferers, these findings advance our theoretical understanding of the Parkinsonian syndrome.     

Listener perceptions along a fluency--disfluency continuum: a phenomenological analysis

The purpose of this study was to conduct a phenomenological analysis (a qualitative research method) of unbiased listeners' perceptions to six speech samples across a fluency-disfluency continuum. A sample of 60 individuals heard only one sample chosen from three levels of fluent or three levels of disfluent speech. Listeners were interviewed following the presentation of the speech sample and their comments were analyzed with respect to the perception of the speaker's communicative effectiveness. Communicative effectiveness was supported by three phenomenological categories: speaker attributes, listener attributes, and story attributes. Five theme clusters further supported these categories: speech production, context, speaker identity, listener comfort, and story comprehension. The results showed that listener perceptions within theme clusters varied across the six speech samples. The results also showed that listeners differentially respond to a broad array of information in the speech signal (not simply fluency or disfluency). These findings support Traunmuller's (1994) modulation theory associated with information that can be obtained from the speech signal. Implications for the treatment of stuttering are also discussed. EDUCATIONAL OBJECTIVES: The reader will learn (1) how listeners may have multiple and varying perceptual experiences depending upon where along a fluency-disfluency continuum a speech sample is heard; (2) how perceptual experiences are influenced by speaker, listener, and story attributes; and (3) how phenomenological analysis may expand our understanding of multifactorial issues associated with stuttering.     

The influence of speaking rate on articulatory hypokinesia in parkinsonian dysarthria

This study addressed the question of whether or not speaking rate influences articulatory hypokinesia in dysarthria associated with Parkinson's disease. Analyses of parkinsonian speech samples revealed mean speaking rates consistent with normal controls. Thus, speaking rate was not abnormal overall in this group of dysarthric subjects. Kinematic analyses of labial displacement amplitude, peak instantaneous velocity, and movement time were made during repetitive syllable production spoken at two speaking rates: 3-5 syllables/sec and 5-7 syllables/sec. The results suggested that labial movements were normal at the slower of the two speaking rates. Conversely, labial movements became hypokinetic as speaking rate increased to the rate consistent with conversational speech. These findings provide a physiologic basis for the perception of hypokinetic dysarthria in Parkinson's disease and suggest that speaking rate may be an important control variable contributing to articulatory hypokinesia in Parkinson's disease. Moreover, these findings provide quantitative evidence that articulatory hypokinesia plays a dominant role in the perception of parkinsonian dysarthria.     

Potential perceptual bases for successful use of a vibrotactile speech perception aid

This paper examines the possibility that perception of vibrotactile speech stimuli is enhanced in adults with early and life-long use of hearing aids. We present evidence that vibrotactile aid benefit in adults is directly related to the age at which the hearing aid was fitted and the duration of its use. The stimulus mechanism responsible for this effect is hypothesized to be long-term vibrotactile stimulation by high powered hearing aids. We speculate on possible mechanisms for enhanced vibrotactile speech perception as the result of hearing aid use: (1) long-term experience receiving degraded or impoverished speech stimuli results in a speech processing system that is more effective for novel stimuli, independent of perceptual modality; and/or (2) long-term sensory/perceptual experience causes neural changes that result in more effective delivery of speech information via somatosensory pathways.     

Relating selective brain damage to impairments with voicing contrasts

Research is reviewed concerning the performance of several neurological groups on the perception and production of voicing contrasts in speech. Patients with cerebellar damage, Parkinson's disease, specific language impairment, Broca's aphasia, apraxia, and Wernicke's aphasia have been reported to be impaired in the perception and articulation of voicing. The types of deficits manifested by these neurologically impaired groups in creating and discriminating voicing contrasts are discussed and the respective contributions of separate neural areas are identified. A model is presented specifying the level of phonemic processing thought to be impaired for each patient group and critical tests of the model's predictions are identified.     

A characterization of the prosodic loss in Parkinson's disease

Prosodic contours in the verbal output of 30 patients with Idiopathic Parkinson's disease were contrasted to those of fifteen age-, sex-, and educationally matched normal subjects. All subjects were tested for language disorder, dementia, depression, and the comprehension of linguistic prosody. The striking disorder of prosody in Parkinson's disease relates to motor control, not to a loss of the linguistic knowledge required to make prosodic distinctions. It appears that prosody, language and the motor planning of speech are integrated at a basal ganglia level.     

Non-motor aspects of Parkinson's disease

Parkinson's disease is primarily considered to be a movement disorder and is defined by its motor signs. Yet, the behavioral manifestations of the disease are often more debilitating than its motor complications. This review will focus on the non-motor aspects of Parkinson's disease, including mood, psychosis, cognitive, sleep, fatigue, apathy, delirium, and repetitive disorders, that may occur. The phenomenology, pathology, and treatment of the behavioral symptoms of Parkinson's disease will be discussed.     

Enhanced perceptual processing of speech in autism

Theories of autism have proposed that a bias towards low-level perceptual information, or a featural/surface-biased information-processing style, may compromise higher-level language processing in such individuals. Two experiments, utilizing linguistic stimuli with competing low-level/perceptual and high-level/semantic information, tested processing biases in children with autism and matched controls. Whereas children with autism exhibited superior perceptual processing of speech relative to controls, and showed no evidence of either a perceptual or semantic processing bias, controls showed a tendency to process speech semantically. The data provide partial support to the perceptual theories of autism. It is additionally proposed that the pattern of results may reflect different patterns of attentional focusing towards single or multiple stimulus cues in speech between children with autism and controls.     

Perceptual learning of noise vocoded words: effects of feedback and lexicality

Speech comprehension is resistant to acoustic distortion in the input, reflecting listeners' ability to adjust perceptual processes to match the speech input. This adjustment is reflected in improved comprehension of distorted speech with experience. For noise vocoding, a manipulation that removes spectral detail from speech, listeners' word report showed a significantly greater improvement over trials for listeners that heard clear speech presentations before rather than after hearing distorted speech (clear-then-distorted compared with distorted-then-clear feedback, in Experiment 1). This perceptual learning generalized to untrained words suggesting a sublexical locus for learning and was equivalent for word and nonword training stimuli (Experiment 2). These findings point to the crucial involvement of phonological short-term memory and top-down processes in the perceptual learning of noise-vocoded speech. Similar processes may facilitate comprehension of speech in an unfamiliar accent or following cochlear implantation.     

Aphasia following a right thalamic hemorrhage

A left-handed patient with a right thalamic hemorrhage and disordered speech is described. Sequential examinations and aphasia testing were done during a 1-year follow-up period and the results are reported. This case supports those authors who have described characteristics they feel are helpful in diagnosing disordered speech associated with thalamic lesions. Paucity of speech, reduced voice volume, anomia, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were relatively preserved. She showed modest improvement with time. This case also confirms that thalamic involvement in speech is a dominant, rather than a specifically left hemispheric function.     

Overcoming the other‐race effect in infancy with multisensory redundancy: 10–12‐month‐olds discriminate dynamic other‐race faces producing speech

We tested 4–6‐ and 10–12‐month‐old infants to investigate whether the often‐reported decline in infant sensitivity to other‐race faces may reflect responsiveness to static or dynamic/silent faces rather than a general process of perceptual narrowing. Across three experiments, we tested discrimination of either dynamic own‐race or other‐race faces which were either accompanied by a speech syllable, no sound, or a non‐speech sound. Results indicated that 4–6‐ and 10–12‐month‐old infants discriminated own‐race as well as other‐race faces accompanied by a speech syllable, that only the 10–12‐month‐olds discriminated silent own‐race faces, and that 4–6‐month‐old infants discriminated own‐race and other‐race faces accompanied by a non‐speech sound but that 10–12‐month‐old infants only discriminated own‐race faces accompanied by a non‐speech sound. Overall, the results suggest that the ORE reported to date reflects infant responsiveness to static or dynamic/silent faces rather than a general process of perceptual narrowing.     

Parkinsonian speech disfluencies: effects of L-dopa-related fluctuations

The excess dopamine theory of stuttering (Wu et al., 1997) contends that stuttering may be related to excess levels of the neurotransmitter dopamine in the brain. As Parkinson's disease (PD) patients commonly exhibit changes in dopamine levels accompanied by changes in motor performance, the present study examined disfluency in PD patients to gain information on the role of dopamine in speech disfluencies. Nine PD patients with no history of developmental stuttering were recorded once before and twice after taking their morning medication (on separate days). They read a passage and produced a monologue. Within-word and overall speech disfluencies were calculated at each recording. Through motor testing, it was inferred that participants had relatively low dopamine levels before taking medication, and relatively high dopamine levels after taking medication. There were no group changes in disfluency levels when the low-dopamine and high-dopamine states were compared. There were, however, significant differences in percent disfluencies between the PD participants and age-matched controls. The results of this study do not strongly support the excess dopamine theory of stuttering. Rather, the disfluency changes exhibited by individual participants support a hypothesis that speech disfluencies may be related to increases or decreases in dopamine levels in the brain. EDUCATIONAL OBJECTIVES: The reader will learn about: (1). the characteristics of disfluent speech exhibited by speakers with Parkinson's disease. (2). The effect of L-dopa based medications on disfluencies of Parkinsonian speakers. (3). The complex role brain dopamine levels may play in disfluent speaking behavior.     

Speech impairment in a large sample of patients with Parkinson's disease

This study classified speech impairment in 200 patients with Parkinson's disease (PD) into five levels of overall severity and described the corresponding type (voice, articulation, fluency) and extent (rated on a five-point scale) of impairment for each level. From two-minute conversational speech samples, parameters of voice, fluency and articulation were assessed by two trained-raters. Voice was found to be the leading deficit, most frequently affected and impaired to a greater extent than other features in the initial stages. Articulatory and fluency deficits manifested later, articulatory impairment matching voice impairment in frequency and extent at the 'Severe' stage. At the final stage of 'Profound' impairment, articulation was the most frequently impaired feature at the lowest level of performance. This study illustrates the prominence of voice and articulatory speech motor control deficits, and draws parallels with deficits of motor set and motor set instability in skeletal controls of gait and handwriting.     

Speech impairment in a large sample of patients with Parkinson's disease

This study classified speech impairment in 200 patients with Parkinson's disease (PD) into five levels of overall severity and described the corresponding type (voice, articulation, fluency) and extent (rated on a five-point scale) of impairment for each level. From two-minute conversational speech samples, parameters of voice, fluency and articulation were assessed by two trained-raters. Voice was found to be the leading deficit, most frequently affected and impaired to a greater extent than other features in the initial stages. Articulatory and fluency deficits manifested later, articulatory impairment matching voice impairment in frequency and extent at the `Severe' stage. At the final stage of `Profound' impairment, articulation was the most frequently impaired feature at the lowest level of performance. This study illustrates the prominence of voice and articulatory speech motor control deficits, and draws parallels with deficits of motor set and motor set instability in skeletal controls of gait and handwriting.