Phonatory function of neurologically impaired patients

doi:10.1016/0021-9924(91)90004-3

Journal of Communication Disorders

Volume 24, Issue 4, August 1991, Pages 287-300

https://doi.org/10.1016/0021-9924(91)90004-3 Get rights and content

Abstract

Previous studies investigated the use of acoustic perturbation measures as a screening tool for neuropathologies with conflicting results. In the present study, five parameters of phonatory function (jitter, shimmer, signal-to-noise ratio, fundamental frequency, and standard deviation of fundamental frequency) were obtained from samples of sustained phonation in three neuropathological groups (Parkinson, Huntington, cerebellar ataxia) and a normal control group to assess the use of acoustic measures in differential diagnosis. In addition, perceptual judgements of the severity of dysphonia for each patient were obtained. The results indicated that perturbation measures of the neuropathological groups showed a higher degree of variability compared to normals. From the five parameters studied, only the standard deviation of fundamental frequency differentiated among neuropathological subgroups. The acoustic parameters studied did not clearly reflect the perceived dysphonia for all subgroups.

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Cited by (70)

Acoustic and Physiological Voice Assessment And Maximum Phonation Time In Patients With Different Types Of Dysarthria
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Citation Excerpt :
Due to the compensatory mechanisms observed in upper motor neuron lesions, spastic dysarthria is associated with vocal abnormalities consistent with laryngeal hyperfunction, except for some cases in which patients may show features of laryngeal hypofunction.64,65 Measures of F0 and amplitude are the most relevant in the vocal assessment of patients with spastic dysarthria and are preferable to measures of perturbation such as jitter and shimmer.66,67,68 In ataxic dysarthria, vocal instability as measured by auditory-perceptual and acoustic voice assessments is the main feature of speech, together with a high variability of sustained phonation as observed in the acoustic analysis.69
To compare the maximum phonation time of /a/, acoustic glottal source parameters, and physiological measures in patients with dysarthria.
Thirteen patients were classified according to dysarthria type and divided into functional profiles (hypofunctional, hyperfunctional, and mixed). Assessments of maximum phonation time of /a/, glottal source parameters, electroglottography, and nasometry were performed. Results were compared between groups using ANOVA and Tukey posthoc tests.
The highest fundamental frequency differed significantly between groups, with the hyperfunctional profile showing higher values than the other participant groups. Reductions in the maximum phonation time of /a/ and alterations in acoustic glottal source parameters and electroglottography measures were observed in all groups, with no significant differences between them. The remaining measures did not differ between groups.
The maximum phonation times for /a/ were reduced in all participant groups, suggesting air escape during phonation. The presence of alterations in several glottal source parameters in all participant groups is indicative of noise, tremor, and vocal instability. Lastly, the high fundamental frequency in patients with a hyperfunctional profile reinforces the presence of vocal instability. These findings suggest that, although the characteristics observed in the assessments were consistent with expectations of patients with dysarthria, it is difficult to perform a differential diagnosis of this condition based on acoustic and physiological parameters alone.
Voice Quality Evaluation in Patients With COVID-19: An Acoustic Analysis
2022, Journal of Voice
Citation Excerpt :
Except F0, all the other acoustic parameters were significantly different between the experimental and control groups. The results obtained in this study showed a notable difference in fundamental frequency variation (F0SD) between the healthy and infected participants, which could stem from tremor and insufficient control over laryngeal muscles in the experimental group.23,46 An increase in jitter and shimmer was also observed in both female and male patients.
With the COVID-19 outbreak around the globe and its potential effect on infected patients’ voice, this study set out to evaluate and compare the acoustic parameters of voice between healthy and infected people in an objective manner.
Voice samples of 64 COVID-19 patients and 70 healthy Persian speakers who produced a sustained vowel /a/ were evaluated. Between-group comparisons of the data were performed using the two-way ANOVA and Wilcoxon's rank-sum test.
The results revealed significant differences in CPP, HNR, H1H2, F0SD, jitter, shimmer, and MPT values between COVID-19 patients and the healthy participants. There were also significant differences between the male and female participants in all the acoustic parameters, except jitter, shimmer and MPT. No interaction was observed between gender and health status in any of the acoustic parameters.
The statistical analysis of the data revealed significant differences between the experimental and control groups in this study. Changes in the acoustic parameters of voice are caused by the insufficient airflow, and increased aperiodicity, irregularity, signal perturbation and level of noise, which are the consequences of pulmonary and laryngological involvements in patients with COVID-19.
Objective vowel sound characteristics and their relationship with motor dysfunction in Asian Parkinson's disease patients
2021, Journal of the Neurological Sciences
Citation Excerpt :
In our study, STD was significantly higher in PD patients compared to controls. Indeed, STD has been identified as the parameter that can also differentiate between PD, Huntington's disease and cerebellar ataxia [45]. In addition to STD, SPI was also an interesting parameter, found to be significantly higher in our PD patients compared to controls.
Speech impairments are very common in patients with Parkinson's disease (PD). However, knowledge of their objective characteristics and relationship to other motor symptoms amongst Asian PD patients is limited.
To identify objective vowel sound characteristics in Thai PD patients and correlate with disease severity, as determined by UPDRS and various sub-scores.
We evaluated 100 Thai PD patients, with a mean age of 66.56 years (±7.52) and HY of 2.7 (±1.08), and 101 age-matched controls. Phonatory evaluation, comprising of 15 objective parameters, was conducted using the Multi-Dimensional Voice Programme with a sustained /a/ phonation.
PD patients exhibited significantly higher values of all dimensions of the phonatory parameters evaluated compared to controls (All, p < 0.001) except for duration of sustained phonation, which was significantly shorter in PD patients. When early- and advanced-stage patients were compared, significantly different parameters were limited to frequency perturbation parameters (Jitt, p = 0.01; RAP, p = 0.013; PPQ, p = 0.01; sPPQ, p = 0.001; vF0, p = 0.011), and NHR (p = 0.028). Several significant and moderate correlations were observed between both STD and frequency perturbation parameters and UPDRS-III, bradykinesia sub-score, and gait and postural instability sub-score. Both vF0, and STD significantly correlated with UPDRS-III and sub-scores in advanced stage patients.
Our study provides objective evidence of phonatory dysfunction in Asian PD patients with certain characteristics correlated with advanced stage or different motor dysfunction. Sustained vowel phonation is a promising digital outcome for global phenotyping a large number of PD patients.
Speech in prodromal and symptomatic Huntington's disease as a model of measuring onset and progression in dominantly inherited neurodegenerative diseases
2019, Neuroscience and Biobehavioral Reviews
Subtle motor and cognitive changes can manifest prior to diagnosis in many progressive neurological disorders. Most people with Huntington’s disease (HD) develop dysarthria. Yet, how speech evolves, how the brain regulates speech in HD, and the clinical implications of these changes remain unclear. We reviewed existing literature on speech production in premanifest (PreHD) to symptomatic HD. A search of databases yielded 12 eligible studies. Nine of the twelve studies were included in the meta-analysis. Data suggest that speech in PreHD is characterized by impaired speech agility, phonatory function and speech rate. Over the disease course, speech gradually deteriorates across all subsystems of speech. Our findings indicate subtle changes in speech appear prior to a clinical diagnosis of HD. However, distinct patterns of decline and the magnitude of these deficits require further investigation. Our current understanding of speech impairment in HD relies on small cohort studies. Natural history studies documenting changes from premanifest to end stage may facilitate the development of speech as a marker of disease onset and treatment response.
Expiratory and phonation times as measures of disease severity in patients with Multiple Sclerosis. A case-control study
2018, Multiple Sclerosis and Related Disorders
Speech disorders are common in patients with Multiple Sclerosis (MS). They can be assessed with several methods, which are however expensive, complex, and not easily accessible to physicians during routine clinic visits. This study aimed at measuring maximum phonation times, maximum expiratory times, and articulation abilities scores in patients with MS compared to healthy subjects and at investigating if any of these parameters could be used as a measure of MS progression.
50 MS patients and 50 gender- and age-matched healthy controls were enrolled in the study. Maximum expiratory times and maximum phonation times were collected from both groups. Articulation abilities were evaluated using the articulation subtest from the Fussi assessment (dysarthria scores). MS patients were evaluated with the Expanded Disability Status Scale (EDSS). Correlations between EDSS scores and maximum expiratory times, maximum phonation times, and dysarthria scores were calculated.
EDSS scores of MS patients ranged from 4.5 to 7.5. In MS patients, maximum expiratory times, maximum phonation times, and dysarthria scores were significantly altered compared to healthy controls. Moreover, the EDSS scores were correlated with the maximum expiratory times; the maximum expiratory times were correlated with the maximum phonation times, and the maximum phonation times were correlated with the dysarthria scores.
As the expiratory times were significantly correlated with the EDSS scores, they could be used to measure the severity of MS and to monitor its progression.
On the harmonic-to-noise ratio as an acoustic cue of vocal timbre of Parkinson speakers
2017, Biomedical Signal Processing and Control
The relevance of the harmonic-to-noise ratio (HNR) and glottal cycle length jitter as cues of the vocal timbre of Parkinson speakers is investigated. HNR and vocal cycle length jitter are known to be suitable cues for the evaluation of the vocal timbre of dysphonic speakers. However, the question whether they are relevant descriptors of the voice quality of Parkinson speakers is still unanswered. Empirical mode decomposition (EMD) has been used to estimate the HNR by decomposing the log-magnitude spectrum of the speech signal into its harmonic, contour and noise components. Cycle length jitter has been estimated via the break-up by empirical mode decomposition of the cycle length time series into the intonation contour as well as the perturbations owing to tremor and jitter. HNR and cycle length jitter values of vowels [a] sustained by 205 Parkinson and 74 control speakers are in the same interval respectively and the differences are not statistically significant. Also, the standard deviations of the per-frame HNR values of an utterance do not differ statistically significantly between control and Parkinson speakers.

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Phonatory function of neurologically impaired patients

Abstract

J. Phonet.

J. Common. Disord.

Clinical Voice Disorders

Motor Speech Disorders

Cinegraphic observations of laryngeal function in Parkinson's Disease

Laryngoscope

Parkinsonism: Onset, progression and mortality

Neurology

Frequency and occurence of vocal tract dysfunction in the speech of a large sample of Parkinson patients

J. Speech Hear. Disord.

The results of acoustic and perceptual assesment of two types dysarthria