Torticollis spasmodicus and addiction

From a random sample of 49 patients suffering from torticollis spasmodicus and dependence on alcohol or medicaments, 6 have been selected and are discussed with i view to findings possible mutual influences between the disorders. In particular, premorbid accentuation of personality presented itself as a potential risk factor leading to both tortocollis and alcoholism. In various cases, the patient makes use of alcohol for self-treatment of extrapyramidal-motor symptoms. But such phenomenological developments are preceded by varied constellations of conditions, that have to be taken into account in the treatment.     

Psychopathologic symptoms in torticollis spasmodicus

The paper presents the results of detailed diagnosis of 51 patients with torticollis spasmodicus. A discussion of the results would seem to indicate the possibility of there being one group with prior neuroses, one group compulsive in nature, and one group whose diminished performance arises from the condition of the brain. Reliable diagnosis is only possible when both mental and physical parameters have been taken into consideration.     

Controlling for stimulus dominance effects in the Fused Dichotic Words Test when predicting speech lateralization in children

A log-linear analysis (Grimshaw et al., 1994) of Fused Dichotic Words Test data was examined in a sample of 28 children with epilepsy who had undergone the intracarotid amobarbital procedure to determine the nature of speech representation. The analysis yields a measure of ear dominance (lambda*) that controls for stimulus dominance confounds. Most patients with unilateral speech obtained statistically significant ear advantages, whereas most with bilateral speech displayed no significant ear advantage. Despite controlling for stimulus dominance confounds, some of the scores from patients with left-hemisphere speech overlapped with those from patients with bilateral speech representation.     

Stability of formal thought disorder and referential communication disturbances in schizophrenia

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.     

Why do Alzheimer patients have difficulty with pronouns? Working memory, semantics, and reference in comprehension and production in Alzheimer's disease

Three experiments investigated the extent to which semantic and working-memory deficits contribute to Alzheimer patients' impairments in producing and comprehending referring expressions. In Experiment 1, the spontaneous speech of 11 patients with Alzheimer's disease (AD) contained a greater ratio of pronouns to full noun phrases than did the spontaneous speech produced by 9 healthy controls. Experiments 2 and 3 used a cross-modal naming methodology to compare reference comprehension in another group of 10 patients and 10 age-matched controls. In Experiment 2, patients were less sensitive than healthy controls to the grammatical information necessary for processing pronouns. In Experiment 3, patients were better able to remember referent information in short paragraphs when reference was maintained with full noun phrases rather than pronouns, but healthy controls showed the reverse pattern. Performance in all three experiments was linked to working memory performance but not to word finding difficulty. We discuss these findings in terms of a theory of reference processing, the Informational Load Hypothesis, which views referential impairments in AD as the consequence of normal discourse processing in the context of a working memory impairment.     

Expressive prosodic patterns in individuals with Alzheimer's disease

This paper describes a useful technique for quantifying the degree of speech deficits in dementia of GDS 4 Alzheimer's type (DAT). Production of prosodic speech in DAT patients and healthy older controls was analysed using variation in fundamental frequency (F0) measures on a reading task. The prosogram computational model was used to analyze the prosodic contours of the speech samples, using melodic styling of F0 based on perceptual principles and prominence detection of spectral and amplitude fluctuations in the speech signal. Results revealed significant differences in most of these prosodic parameters among the DAT group. Normal pitch variation in speech and variations in syllable timing were reduced in the DAT group, these features cause "flat" speech prosody in these patients. These speech parameters may have diagnostic and prognostic value for Alzheimer's disease and therefore could be a useful aid in clinical trials.     

Memory and encoding of spoken discourse following right hemisphere damage: evidence from the Auditory Moving Window (AMW) technique

We investigated the hypotheses that impaired discourse processing following right hemisphere damage is mediated by task difficulty and is associated with deficits in discourse encoding. Spoken discourse passages differing in contextual predictability were presented to right hemisphere-damaged (RHD) patients and to non-brain-damaged (NBD) controls for subsequent recall using the Auditory Moving Window paradigm. To manipulate processing difficulty, speech segments were of normal or accelerated speech rates. The recall results showed that RHD adults recalled less than NBD controls overall and failed to recall major idea units better than minor idea units for high predictability passages presented at accelerated speech rates. Both RHD patients and NBD controls failed to recall major idea units better than minor idea units for low predictability passages, regardless of speech rate. The encoding results showed that RHD adults were both slower overall and differentially slower than NBD controls when listening to accelerated passage segments. Taken together, the encoding and recall results are consistent with the view that extracting passage gist under difficult listening conditions is especially vulnerable for patients with right hemisphere strokes.     

Auditory perception of speech and speech sounds in recent and recovered cases of aphasia

Auditory perception of speech and speech sounds was examined in three groups of patients with cerebral damage in the dominant hemisphere. Two groups consisted of brain-injured war veterans, one group of patients with high-frequency hearing loss and the other, a group of patients with a flat hearing loss. The third group consisted of patients with recent cerebral infarcts due to vascular occlusion of the middle cerebral and internal carotid artery. Word and phoneme discrimination as well as phoneme confusions in incorrect responses were analyzed from conventional speech audiometry tests with bisyllabic Finnish words fed close to the speech reception threshold of the patient. The results were compared with those of a control group with no cerebral disorders and normal hearing. The speech discrimination scores of veterans with high-frequency hearing loss and patients with recent cerebral infarcts were some 15–20% lower than those of controls or veterans with flat hearing loss. Speech sound feature discrimination, analyzed in terms of place of articulation and distinctive features, was distorted especially in cases of recent cerebral infarcts, whereas general information transmission of phonemes was more impaired in patients with high-frequency hearing loss.     

Auditory processing of brain-damaged adults under competitive listening conditions

Right CVAs, mild left CVAs, and non-brain-damaged adults received the Token Test under three conditions: quiet, white noise, and speech babble. Left CVAs performed most poorly of all groups in all conditions experiencing difficulty with subtests III, IV, and V. Right CVAs were inferior to controls on each of these three subtests in the speech babble condition only. Thus, right CVA difficulty with both memory and syntactic tasks was demonstrated in speech babble. These results are explained by the hypothesis that both hemispheres are necessary to process auditory information under complex listening conditions. Total brain capacity of right CVA patients may be overloaded if either memory load or linguistic complexity is increased in the presence of certain types of listening competition.     

Missing referents, psychotic symptoms, and discriminating the internal from the externalized

The communicative efficacy of the speech of schizophrenia patients is compromised by the presence of references for which there are no referents. There is evidence that this kind of error is positively associated with the genetic substrate of schizophrenia. The present study was an effort to identify a cognitive process source of these errors by looking at their association with performance on an internal source memory task assessing the ability to remember what one has said out loud versus only thought. Their relationship to psychotic symptoms also was examined. A sample of 110 schizophrenic/schizoaffective outpatients, and 23 nonpsychiatric controls provided 10-min speech samples and completed a battery of memory tests. Patients' symptoms also were rated for severity. Patients performed more poorly than controls on the memory tests, and their speech contained much more frequent references without referents. Frequency of missing referents was associated with scores on the test of internal source memory, even after scores on tests of immediate memory, working memory, and external source memory were regressed out. Missing referents were also related to severity of hallucinations and delusions, and internal source memory performance was related to hallucinations. The findings of this study support the idea that missing referents, hallucinations, and delusions have some common process underpinnings. Impairment in internal source memory appears to be one such process.     

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.     

Neuromotor speech deficits in children and adults with spina bifida and hydrocephalus

Acquired cerebellar lesions are associated with motor speech deficits. Spina bifida with hydrocephalus (SBH) is a neurodevelopmental disorder that involves significant dysmorphology of the cerebellum. Videotaped narratives produced by 40 children and adults with SBH and their 40 age-matched controls were coded for three motor speech deficits: dysfluency, ataxic dysarthria (articulatory inaccuracy, prosodic excess, and phonatory-prosodic insufficiency) (Brown, Darley, & Aronson, 1970; Darley, Aronson, & Brown, 1969a), and speech rate. Individuals with SBH had more motor speech deficits than controls. Dysfluency was related to an interaction between chronological age and SBH. Speech rate was related independently to chronological age and SBH. Ataxic dysarthria was related to the biology of SBH, and was associated with both physical phenotype (level of spinal cord lesion) and medical history (number of shunt revisions). The data show that developmental as well as acquired lesions of the cerebellum disrupt motor speech, and add to the developmental role of the cerebellum in the automatization of motor skills, including speech.     

Educational consequences of developmental speech disorder: Key Stage 1 National Curriculum assessment results in English and mathematics

Background: Children with speech difficulties may have associated educational problems. This paper reports a study examining the educational attainment of children at Key Stage 1 of the National Curriculum who had previously been identified with a speech difficulty. Aims: (1) To examine the educational attainment at Key Stage 1 of children diagnosed with speech difficulties two/three years prior to the present study. (2) To compare the Key Stage 1 assessment results of children whose speech problems had resolved at the time of assessment with those whose problems persisted. Sample(s): Data were available from 39 children who had an earlier diagnosis of speech difficulties at age 4/5 (from an original cohort of 47) at the age of 7. A control group of 35 children identified and matched at preschool on age, nonverbal ability and gender provided comparative data. Methods: Results of Statutory Assessment Tests (SATs) in reading, reading comprehension, spelling, writing and maths, administered to children at the end of Year 2 of school were analysed. Performance across the two groups was compared. Performance was also compared to published statistics on national levels of attainment. Results: Children with a history of speech difficulties performed less well than controls on reading, spelling and maths. However, children whose speech problems had resolved by the time of assessment performed no differently to controls. Children with persisting speech problems performed less well than controls on tests of literacy and maths. Spelling performance was a particular area of difficulty for children with persisting speech problems.     

Acoustic analysis in the differentiation of Parkinson's disease and major depression

In its early stages, Parkinson's disease (P.D.) may be difficult to distinguish from major depression (M.D.) leading to inappropriate management. Both illnesses are characterized by psychomotor retardation. The neurovegetative symptoms used to diagnose M.D. are not specific and in P.D. may be due to the physical illness itself. Currently, differentiation of the two disorders relies on subjective clinical observation. Improved diagnostic accuracy based on more objective data is needed. To this end, this study used computerized acoustic analysis to contrast speech patterns in P.D. and M.D. The sample consisted of 30 P.D. patients without depression or dementia, 30 patients with uncomplicated M.D., and 31 normal controls, each 60 years of age or over. Of the acoustic variables studied, M.D. patients had significantly reduced rates of speech compared with P.D. patients. The data suggest that this temporal measure of speech may be useful in the differentiation of P.D. and M.D.     

Impaired perception of vocal emotions in Parkinson's disease: influence of speech time processing and executive functioning

Little is known about the underlying dimensions of impaired recognition of emotional prosody that is frequently observed in patients with Parkinson's disease (PD). Because patients with PD also suffer from working memory deficits and impaired time perception, the present study examined the contribution of (a) working memory (frontal executive functioning) and (b) processing of the acoustic parameter speech rate to the perception of emotional prosody in PD. Two acoustic parameters known to be important for emotional classifications (speech duration and pitch variability) were systematically varied in prosodic utterances. Twenty patients with PD and 16 healthy controls (matched for age, sex, and IQ) participated in the study. The findings imply that (1) working memory dysfunctions and perception of emotional prosody are not independent in PD, (2) PD and healthy control subjects perceived vocal emotions categorically along two acoustic manipulation continua, and (3) patients with PD show impairments in processing of speech rate information.     

Speech discrimination and lip reading in patients with word deafness or auditory agnosia

The purpose of this study was to assess the ability of four patients with word deafness or auditory agnosia to discriminate speech by reading lips. The patients were studied using nonsense monosyllables to test for speech discrimination, a lip reading test, the Token Test for auditory comprehension, and the Aphasia test. Our results show that patients with word deafness or auditory agnosia without aphasia can improve speech comprehension by reading lips in combination with listening, as compared with lip reading or listening alone. In conclusion, lip reading was shown to be useful for speech comprehension among these patients.