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Brain Sciences
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Profiles of Dysarthria: Clinical Assessment and Treatment
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Profiles of Dysarthria: Clinical Assessment and Treatment

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurolinguistics".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 26852

Special Issue Editors

Dr. Wolfram Ziegler

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Guest Editor
Institute of Phonetics and Speech Processing, University of Munich, Munich 80539, Germany
Interests: neurophonetics; motor speech disorders; dysarthria; apraxia of speech; aphasia; childhood dysarthria; clinical assessment; phonological impairment
Dr. Anja Staiger

E-Mail Website
Guest Editor
Institute of Phonetics and Speech Processing, University of Munich, Munich 80539, Germany
Interests: neurophonetics; motor speech disorders; apraxia of speech; dysarthria; primary progressive aphasia; primary progressive apraxia of speech; clinical assessment
Dr. Theresa Schölderle

E-Mail Website
Guest Editor
Institute of Phonetics and Speech Processing, University of Munich, Munich 80539, Germany
Interests: neurophonetics; motor speech disorders; dysarthria; childhood dysarthria; cerebral palsy; clinical assessment

Special Issue Information

Dear Colleagues,

Recent decades have seen a wealth of theoretical and proof-of-principle works on dysarthria, including descriptions of dysarthric speech patterns and their classification, new assessment methods, and intervention trials.

This Special Issue looks at where we are today in terms of translating this knowledge into clinical practice. Since the 1930s, when the first oscillograms displaying “phonetic disintegration” symptoms were published, a vast number of papers presenting acoustic patterns of dysarthria appeared, but it is has not been sufficiently clear until today how their promise can be realized in daily clinical practice. Since the 1970s, increasingly sophisticated electronic devices have been introduced to study the speech movement characteristics of dysarthria, but the “physiologic approach” that has been promoted is still not firmly established in clinical care. Equally long ago, Darley’s group provided us with an inventory of auditory-perceptual descriptors of dysarthric speech, but little work has yet been done to compensate for the psychometric downsides of this approach and implement it as a reliable standard in clinical assessment.

This Issue aims to bring together the threads of these developments, with a perspective to discuss their potentials and their specific roles in the daily clinical work of speech-language pathologists or neurologists.

We invite original translational works as well as review papers on the following areas:

  • Auditory-perceptual, acoustic, or physiologic parameters in the assessment of dysarthria profiles and the measurement of severity, monitoring of change, or classification;
  • Implementation issues and the role of digital health technologies, including machine learning advancements;
  • Validity and standardization issues, with particular consideration of physiologic, communication, and participation aspects;
  • The role of cutting-edge technologies like virtual-reality-based interactive speech training systems.

Dr. Wolfram Ziegler
Dr. Anja Staiger
Dr. Theresa Schölderle
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dysarthria
  • assessment
  • therapy
  • methods
  • clinical
  • translational

Published Papers (10 papers)

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Editorial

Jump to: Research, Review, Other

5 pages, 195 KiB  
Editorial
Profiles of Dysarthria: Clinical Assessment and Treatment
by Wolfram Ziegler, Anja Staiger and Theresa Schölderle
Brain Sci. 2024, 14(1), 11; https://doi.org/10.3390/brainsci14010011 - 22 Dec 2023
Viewed by 974
Abstract
In recent decades, we have witnessed a wealth of theoretical work and proof-of-principle studies on dysarthria, including descriptions and classifications of dysarthric speech patterns, new and refined assessment methods, and innovative experimental intervention trials [...] Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)

Research

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30 pages, 2916 KiB  
Article
Speech and Nonspeech Parameters in the Clinical Assessment of Dysarthria: A Dimensional Analysis
by Wolfram Ziegler, Theresa Schölderle, Bettina Brendel, Verena Risch, Stefanie Felber, Katharina Ott, Georg Goldenberg, Mathias Vogel, Kai Bötzel, Lena Zettl, Stefan Lorenzl, Renée Lampe, Katrin Strecker, Matthis Synofzik, Tobias Lindig, Hermann Ackermann and Anja Staiger
Brain Sci. 2023, 13(1), 113; https://doi.org/10.3390/brainsci13010113 - 07 Jan 2023
Cited by 9 | Viewed by 3849
Abstract
Nonspeech (or paraspeech) parameters are widely used in clinical assessment of speech impairment in persons with dysarthria (PWD). Virtually every standard clinical instrument used in dysarthria diagnostics includes nonspeech parameters, often in considerable numbers. While theoretical considerations have challenged the validity of these [...] Read more.
Nonspeech (or paraspeech) parameters are widely used in clinical assessment of speech impairment in persons with dysarthria (PWD). Virtually every standard clinical instrument used in dysarthria diagnostics includes nonspeech parameters, often in considerable numbers. While theoretical considerations have challenged the validity of these measures as markers of speech impairment, only a few studies have directly examined their relationship to speech parameters on a broader scale. This study was designed to investigate how nonspeech parameters commonly used in clinical dysarthria assessment relate to speech characteristics of dysarthria in individuals with movement disorders. Maximum syllable repetition rates, accuracies, and rates of isolated and repetitive nonspeech oral–facial movements and maximum phonation times were compared with auditory–perceptual and acoustic speech parameters. Overall, 23 diagnostic parameters were assessed in a sample of 130 patients with movement disorders of six etiologies. Each variable was standardized for its distribution and for age and sex effects in 130 neurotypical speakers. Exploratory Graph Analysis (EGA) and Confirmatory Factor Analysis (CFA) were used to examine the factor structure underlying the diagnostic parameters. In the first analysis, we tested the hypothesis that nonspeech parameters combine with speech parameters within diagnostic dimensions representing domain–general motor control principles. In a second analysis, we tested the more specific hypotheses that diagnostic parameters split along effector (lip vs. tongue) or functional (speed vs. accuracy) rather than task boundaries. Our findings contradict the view that nonspeech parameters currently used in dysarthria diagnostics are congruent with diagnostic measures of speech characteristics in PWD. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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16 pages, 1112 KiB  
Article
Differentiation of Motor Speech Disorders through the Seven Deviance Scores from MonPaGe-2.0.s
by Cécile Fougeron, Ina Kodrasi and Marina Laganaro
Brain Sci. 2022, 12(11), 1471; https://doi.org/10.3390/brainsci12111471 - 29 Oct 2022
Cited by 1 | Viewed by 2088
Abstract
For the clinical assessment of motor speech disorders (MSDs) in French, the MonPaGe-2.0.s protocol has been shown to be sensitive enough to diagnose mild MSD based on a combination of acoustic and perceptive scores. Here, we go a step further by investigating whether [...] Read more.
For the clinical assessment of motor speech disorders (MSDs) in French, the MonPaGe-2.0.s protocol has been shown to be sensitive enough to diagnose mild MSD based on a combination of acoustic and perceptive scores. Here, we go a step further by investigating whether these scores—which capture deviance on intelligibility, articulation, voice, speech rate, maximum phonation time, prosody, diadochokinetic rate—contribute to the differential diagnosis of MSDs. To this aim, we trained decision trees for two-class automatic classification of different pairs of MSD subtypes based on seven deviance scores that are computed in MonPaGe-2.0.s against matched normative data. We included 60 speakers with mild to moderate MSD from six neuropathologies (amyotrophic lateral sclerosis, Wilson, Parkinson and Kennedy disease, spinocerebellar ataxia, post-stroke apraxia of speech). The two-class classifications relied mainly on deviance scores from four speech dimensions and predicted with over 85% accuracy the patient’s correct clinical category for ataxic, hypokinetic and flaccid dysarthria; classification of the other groups (apraxia of speech and mixed dysarthria) was slightly lower (79% to 82%). Although not perfect and only tested on small cohorts so far, the classification with deviance scores based on clinically informed features seems promising for MSD assessment and classification. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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19 pages, 1251 KiB  
Article
Articulatory Performance in Dysarthria: Using a Data-Driven Approach to Estimate Articulatory Demands and Deficits
by Mili Kuruvilla-Dugdale and Antje S. Mefferd
Brain Sci. 2022, 12(10), 1409; https://doi.org/10.3390/brainsci12101409 - 20 Oct 2022
Cited by 3 | Viewed by 1577
Abstract
This study pursued two goals: (1) to establish range of motion (ROM) demand tiers (i.e., low, moderate, high) specific to the jaw (J), lower lip (LL), posterior tongue (PT), and anterior tongue (AT) for multisyllabic words based on the articulatory performance of neurotypical [...] Read more.
This study pursued two goals: (1) to establish range of motion (ROM) demand tiers (i.e., low, moderate, high) specific to the jaw (J), lower lip (LL), posterior tongue (PT), and anterior tongue (AT) for multisyllabic words based on the articulatory performance of neurotypical talkers and (2) to identify demand- and disease-specific articulatory performance characteristics in talkers with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease (PD). J, LL, PT, and AT movements of 12 talkers with ALS, 12 talkers with PD, and 12 controls were recorded using electromagnetic articulography. Vertical ROM, average speed, and movement duration were measured. Results showed that in talkers with PD, J and LL ROM were already significantly reduced at the lowest tier whereas PT and AT ROM were only significantly reduced at moderate and high tiers. In talkers with ALS, J ROM was significantly reduced at the moderate tier whereas LL, PT, and AT ROM were only significantly reduced at the highest tier. In both clinical groups, significantly reduced J and LL speeds could already be observed at the lowest tier whereas significantly reduced AT speeds could only be observed at the highest tier. PT speeds were already significantly reduced at the lowest tier in the ALS group but not until the moderate tier in the PD group. Finally, movement duration, but not ROM or speed performance, differentiated between ALS and PD even at the lowest tier. Results suggest that articulatory deficits vary with stimuli-specific motor demands across articulators and clinical groups. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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17 pages, 1933 KiB  
Article
The Reliability and Validity of Speech-Language Pathologists’ Estimations of Intelligibility in Dysarthria
by Micah E. Hirsch, Austin Thompson, Yunjung Kim and Kaitlin L. Lansford
Brain Sci. 2022, 12(8), 1011; https://doi.org/10.3390/brainsci12081011 - 30 Jul 2022
Cited by 4 | Viewed by 2666
Abstract
This study examined the reliability and validity of speech-language pathologists’ (SLP) estimations of speech intelligibility in dysarthria, including a visual analog scale (VAS) method and a percent estimation method commonly used in clinical settings. Speech samples from 20 speakers with dysarthria of varying [...] Read more.
This study examined the reliability and validity of speech-language pathologists’ (SLP) estimations of speech intelligibility in dysarthria, including a visual analog scale (VAS) method and a percent estimation method commonly used in clinical settings. Speech samples from 20 speakers with dysarthria of varying etiologies were used to collect orthographic transcriptions from naïve listeners n=70 and VAS ratings and percent estimations of intelligibility from SLPs n=21. Intra- and interrater reliability for the two SLP intelligibility measures were evaluated, and the relationship between these measures was assessed. Finally, linear regression was used to evaluate the relationship between the naïve listeners’ orthographic transcription scores and the two SLP intelligibility measures. The results indicated that the intrarater reliability for both SLP intelligibility measures was strong, and the interrater reliability between the SLP ratings was moderate to excellent. A moderate positive relationship between SLPs’ VAS ratings and percent estimations was also observed. Finally, both SLPs’ percent estimations and VAS ratings were predictive of naïve listeners’ orthographic transcription scores, with SLPs’ percent estimations being the strongest predictor. In conclusion, the average SLP percent estimations and VAS ratings are valid and reliable intelligibility measures. However, the validity and reliability of these measures vary between SLPs. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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19 pages, 2522 KiB  
Article
Dysarthria Subgroups in Talkers with Huntington’s Disease: Comparison of Two Data-Driven Classification Approaches
by Daniel Kim, Sarah Diehl, Michael de Riesthal, Kris Tjaden, Stephen M. Wilson, Daniel O. Claassen and Antje S. Mefferd
Brain Sci. 2022, 12(4), 492; https://doi.org/10.3390/brainsci12040492 - 13 Apr 2022
Cited by 2 | Viewed by 2133
Abstract
Although researchers have recognized the need to better account for the heterogeneous perceptual speech characteristics among talkers with the same disease, guidance on how to best establish such dysarthria subgroups is currently lacking. Therefore, we compared subgroup decisions of two data-driven approaches based [...] Read more.
Although researchers have recognized the need to better account for the heterogeneous perceptual speech characteristics among talkers with the same disease, guidance on how to best establish such dysarthria subgroups is currently lacking. Therefore, we compared subgroup decisions of two data-driven approaches based on a cohort of talkers with Huntington’s disease (HD): (1) a statistical clustering approach (STATCLUSTER) based on perceptual speech characteristic profiles and (2) an auditory free classification approach (FREECLASS) based on listeners’ similarity judgments. We determined the amount of overlap across the two subgrouping decisions and the perceptual speech characteristics driving the subgrouping decisions of each approach. The same speech samples produced by 48 talkers with HD were used for both grouping approaches. The STATCLUSTER approach had been conducted previously. The FREECLASS approach was conducted in the present study. Both approaches yielded four dysarthria subgroups, which overlapped between 50% to 78%. In both grouping approaches, overall bizarreness and speech rate characteristics accounted for the grouping decisions. In addition, voice abnormalities contributed to the grouping decisions in the FREECLASS approach. These findings suggest that apart from overall bizarreness ratings, indexing dysarthria severity, speech rate and voice characteristics may be important features to establish dysarthria subgroups in HD. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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16 pages, 1578 KiB  
Article
Orofacial Muscle Strength across the Dysarthrias
by Heather M. Clark, Joseph R. Duffy, Edythe A. Strand, Holly Hanley and Nancy Pearl Solomon
Brain Sci. 2022, 12(3), 365; https://doi.org/10.3390/brainsci12030365 - 10 Mar 2022
Cited by 6 | Viewed by 3215
Abstract
This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure [...] Read more.
This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure generation (Pmax) by the tongue, lips, and cheeks represented strength. Pmax was lower for speakers with mixed spastic–flaccid dysarthria for all tongue and lip measures, as well as for speakers with flaccid or spastic dysarthria for anterior tongue elevation and lip compression. Anterior tongue elevation and cheek compression tended to be lower than normal for the hypokinetic group. Pmax did not differ significantly between controls and speakers with ataxic dysarthria on any measure. Correlations were generally weak between dysarthria severity and orofacial weakness but were stronger in the dysarthria groups with more prominent orofacial weakness. The results generally support predictions that orofacial weakness accompanies flaccid and/or spastic dysarthria but not ataxic dysarthria. The findings support including type of dysarthria as a variable of interest when examining orofacial weakness in motor speech disorders. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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14 pages, 955 KiB  
Article
Utility of the Intelligibility in Context Scale for Predicting Speech Intelligibility of Children with Cerebral Palsy
by Jennifer U. Soriano, Abby Olivieri and Katherine C. Hustad
Brain Sci. 2021, 11(11), 1540; https://doi.org/10.3390/brainsci11111540 - 20 Nov 2021
Cited by 4 | Viewed by 2387
Abstract
The Intelligibility in Context Scale (ICS) is a widely used, efficient tool for describing a child’s speech intelligibility. Few studies have explored the relationship between ICS scores and transcription intelligibility scores, which are the gold standard for clinical measurement. This study examined how [...] Read more.
The Intelligibility in Context Scale (ICS) is a widely used, efficient tool for describing a child’s speech intelligibility. Few studies have explored the relationship between ICS scores and transcription intelligibility scores, which are the gold standard for clinical measurement. This study examined how well ICS composite scores predicted transcription intelligibility scores among children with cerebral palsy (CP), how well individual questions from the ICS differentially predicted transcription intelligibility scores, and how well the ICS composite scores differentiated between children with and without speech motor impairment. Parents of 48 children with CP, who were approximately 13 years of age, completed the ICS. Ninety-six adult naïve listeners provided orthographic transcriptions of children’s speech. Transcription intelligibility scores were regressed on ICS composite scores and individual item scores. Dysarthria status was regressed on ICS composite scores. Results indicated that ICS composite scores were moderately strong predictors of transcription intelligibility scores. One individual ICS item differentially predicted transcription intelligibility scores, and dysarthria severity influenced how well ICS composite scores differentiated between children with and without speech motor impairment. Findings suggest that the ICS has potential clinical utility for children with CP, especially when used with other objective measures of speech intelligibility. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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Review

Jump to: Editorial, Research, Other

34 pages, 792 KiB  
Review
Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence
by Gary Weismer
Brain Sci. 2023, 13(5), 768; https://doi.org/10.3390/brainsci13050768 - 06 May 2023
Cited by 2 | Viewed by 1761
Abstract
This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent [...] Read more.
This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent rationale for their use is needed. The use of oromotor nonverbal performance to diagnose disease or dysarthria type, versus specific aspects of speech production deficits that contribute to loss of speech intelligibility, is argued to be an important part of the debate. Framing these issues are two models of speech motor control, the Integrative Model (IM) and Task-Dependent Model (TDM), which yield contrasting predictions of the relationship between oromotor nonverbal performance and speech motor control. Theoretical and empirical literature on task specificity in limb, hand, and eye motor control is reviewed to demonstrate its relevance to speech motor control. The IM rejects task specificity in speech motor control, whereas the TDM is defined by it. The theoretical claim of the IM proponents that the TDM requires a special, dedicated neural mechanism for speech production is rejected. Based on theoretical and empirical information, the utility of oromotor nonverbal tasks as a window into speech motor control is questionable. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)

Other

12 pages, 253 KiB  
Perspective
Communicative Participation in Dysarthria: Perspectives for Management
by Allyson D. Page and Kathryn M. Yorkston
Brain Sci. 2022, 12(4), 420; https://doi.org/10.3390/brainsci12040420 - 22 Mar 2022
Cited by 5 | Viewed by 3613
Abstract
Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative participation. In it, the emergence of this construct is reviewed, along with the predictors of and variables associated with communicative participation in the [...] Read more.
Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative participation. In it, the emergence of this construct is reviewed, along with the predictors of and variables associated with communicative participation in the dysarthrias. In doing so, the features that make communicative participation unique and distinct from other measures of dysarthria are highlighted, through emphasizing how communicative participation cannot be predicted solely from other components of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), including levels of impairment or activity limitations. Next, the empirical literature related to the measurement of communicative participation and how this research relates to dysarthria management is presented. Finally, the development of robust clinical measures of communicative participation and approaches to management is described from the point of view of the clinician. We argue that communicative participation should be a primary focus of treatment planning and intervention to provide patient-centered, holistic, and value-based clinical interventions which are responsive to the needs of individuals living with dysarthria. Full article
(This article belongs to the Special Issue Profiles of Dysarthria: Clinical Assessment and Treatment)
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