| 1. |
- Hägglund, Patricia, et al.
(författare)
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The Timed Water Swallow Test (TWST) : normative data on swallowing capacity for healthy people aged 60 years and older
- 2023
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Ingår i: International Journal of Speech-Language Pathology. - : Taylor & Francis. - 1754-9507 .- 1754-9515. ; 25:4, s. 479-485
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To provide normative data on swallowing capacity (mL/s) in people older than 60 years using the Timed Water Swallow Test (TWST), stratified by sex. Intra- and inter-rater reliability for swallowing time in TWST was further investigated.Method: A total of 165 participants, aged 60 years and above, were included in the study. The time taken to consume 150 mL of tap water and the swallowing capacity (mL/s) was observed in a clinical context using the TWST. Video recordings of the performances were collected for 118 of the 165 participants for inter-rater reliability testing, of which a random set of 25 performances were assessed for intra-rater reliability. Analysis of the agreement between TWST rated by an in-person clinician and rated from a video recording was further evaluated.Result: There were significant age and sex effects observed for swallowing capacity. The average reduction in swallowing capacity in the investigated age range (60-92 years) was 8.8 and 7.3 mL/s for women and men respectively. The results showed high inter-and intra-rater reliability and agreement between the clinical assessment and the video recording.Conclusion: The presented measurements indicate a clear effect of age on swallowing capacity and that women may be expected to have lower capacity scores than men when tested using TWST. The provided norms can be used as reference points in the clinical identification of people at risk of dysphagia in the older population.
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| 2. |
- Mirkoska, Vesna, et al.
(författare)
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Detection of subclinical motor speech deficits after presumed low-grade glioma surgery
- 2023
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Ingår i: Brain Sciences. - : MDPI. - 2076-3425. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- Motor speech performance was compared before and after surgical resection of presumed low-grade gliomas. This pre- and post-surgery study was conducted on 15 patients (mean age = 41) with low-grade glioma classified based on anatomic features. Repetitions of /pa/, /ta/, /ka/, and /pataka/ recorded before and 3 months after surgery were analyzed regarding rate and regularity. A significant reduction (6 to 5.6 syllables/s) pre- vs. post-surgery was found in the rate for /ka/, which is comparable to the approximate average decline over 10–15 years of natural aging reported previously. For all other syllable types, rates were within normal age-adjusted ranges in both preoperative and postoperative sessions. The decline in /ka/ rate might reflect a subtle reduction in motor speech production, but the effects were not severe. All but one patient continued to perform within normal ranges post-surgery; one performed two standard deviations below age-appropriate norms pre- and post-surgery in all syllable tasks. The patient experienced motor speech difficulties, which may be related to the tumor’s location in an area important for speech. Low-grade glioma may reduce maximum speech-motor performance in individual patients, but larger samples are needed to elucidate how often the effect occurs.
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| 3. |
- Holmberg, Jenny, et al.
(författare)
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Exploring motives and perceived barriers for voice modification : the views of transgender and gender-diverse voice clients
- 2023
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Ingår i: Journal of Speech, Language and Hearing Research. - : American Speech Language Hearing Association. - 1092-4388 .- 1558-9102. ; 66:7, s. 2246-2259
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To date, transgender and gender-diverse voice clients' perceptions and individual goals have been missing in discussions and research on gender-affirming voice therapy. Little is, therefore, known about the client's expectations of therapy outcomes and how these are met by treatments developed from views of vocal gender as perceived by cisgender persons. This study aimed to explore clients' individual motives and perceived barriers to undertaking gender-affirming voice therapy.Method: Individual, semistructured interviews with 15 transgender and gender-diverse voice clients considering voice therapy were conducted and explored using qualitative content analysis.Results: Three themes were identified during the analysis of the participants' narratives. In the first theme, “the incongruent voice setting the rules,” the contribution of the voice on the experienced gender dysphoria is put in focus. The second theme, “to reach a voice of my own choice,” centers around anticipated personal gains using a modified voice. The third theme, “a voice out of reach,” relates to worries and restricting factors for not being able to reach one's set goals for voice modification.Conclusions: The interviews clearly indicate a need for a person-centered voice therapy that starts from the individuals' expressed motives for modifying the voice yet also are affirmative of anticipated difficulties related to voice modification. We recommend that these themes should form the basis of the pretherapy joint discussion between the voice client and the speech-language pathologist to ensure therapy goals that are realistic and relevant to the client.
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| 4. |
- Hägglund, Patricia, et al.
(författare)
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The Test of Masticating and Swallowing Solids (TOMASS) : Normative data for two crackers available in the Scandinavian and international markets
- 2021
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Ingår i: International Journal of Speech-Language Pathology. - : Taylor & Francis. - 1754-9507 .- 1754-9515. ; 23:3, s. 329-337
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To establish normative data of crackers common in the Scandinavian and international markets for use in the Test of Masticating and Swallowing Solids (TOMASS), and to investigate possible sex and age effects on masticatory performances.Method: 234 healthy participants (>20 years of age) were asked to either ingest the Göteborgskex Guld Marie™ cracker (n = 234) or to ingest both a Guld Marie cracker and a Tuc Original™ cracker (n = 115). Quantifiable measures of masticatory performance (number of bites, number of chewing cycles, number of swallows, and total time) were observed during TOMASS for each participant, directly on-site or by video recording.Result: There were no significant differences in masticatory performances between the crackers. Significant age effects were observed for all masticatory measurements, except for the number of swallows. The results showed insufficient support for an effect of sex, and that results obtained on-site and from video recordings were highly correlated.Conclusion: These findings suggest that similar masticatory performance is to be expected when performing TOMASS using the evaluated crackers. The age of the participant affects TOMASS performance, but the effect of sex is considerably smaller.
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| 5. |
- Karlsson, Fredrik, Docent, 1975-, et al.
(författare)
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A within-subject comparison of face-to-face and telemedicine screening using the timed water swallow test (TWST) and the test of mastication and swallowing of solids (TOMASS)
- 2023
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Ingår i: Dysphagia (New York. Print). - : Springer. - 0179-051X .- 1432-0460. ; 38, s. 483-490
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Tidskriftsartikel (refereegranskat)abstract
- The Timed Water Swallow Test (TWST) and the Test of Mastication of Solids (TOMASS) are dysphagia screening procedures that have been shown to be reliably assessed from video. The reliability of the procedures performed over telemedicine has not previously been assessed. TWST and TOMASS outcomes in two situations (both face-to-face and over telemedicine) were compared for 48 participants (aged 60-90; 27 with clinical conditions and 21 older persons). Both testing situation and test performed order were randomized, and all assessment procedures were performed within 3 h of each other. The results indicated a high level of agreement between face-to-face and telemedicine screening outcomes for TWST and TOMASS, respectively. The assessments indicated an 83% and 76% agreement in classifications of individual participants as within or outside normal limits for the TWST and TOMASS for the two test situations. The TWST showed a balanced distribution in differing classification in telemedicine (0.16-0.19 error rates). The TOMASS procedure classified more participants as outside normal limits over telemedicine compared to face-to-face administration. Agreement in the observed number of swallows was substantially lower than other outcome measures, which is attributed to increased difficulty in observing this property over video. Most participants (60%) reported that they would prefer telemedicine over face-to-face assessments, and 90% viewed the procedure as more accessible than expected. All participants were satisfied with the telemedicine procedures. The results suggest that clinical assessment of dysphagia over telemedicine using the TWST and TOMASS are viable alternatives to face-to-face administration of the procedures.
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| 6. |
- Karlsson, Fredrik, Docent, 1975-, et al.
(författare)
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Assessment of speech impairment in patients with Parkinson's disease from acoustic quantifications of oral diadochokinetic sequences
- 2020
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Ingår i: Journal of the Acoustical Society of America. - : Acoustical Society of America (ASA). - 0001-4966 .- 1520-8524. ; 147:2, s. 839-851
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Tidskriftsartikel (refereegranskat)abstract
- This investigation aimed at determining whether an acoustic quantification of the oral diadochokinetic (DDK) task may be used to predict the perceived level of speech impairment when speakers with Parkinson's disease (PD) are reading a standard passage. DDK sequences with repeated [pa], [ta], and [ka] syllables were collected from 108 recordings (68 unique speakers with PD), along with recordings of the speakers reading a standardized text. The passage readings were assessed in five dimensions individually by four speech-language pathologists in a blinded and randomized procedure. The 46 acoustic DDK measures were merged with the perceptual ratings of read speech in the same recording session. Ordinal regression models were trained repeatedly on 80% of ratings and acoustic DDK predictors per dimension in 10-folds, and evaluated in testing data. The models developed from [ka] sequences achieved the best performance overall in predicting the clinicians' ratings of passage readings. The developed [pa] and [ta] models showed a much lower performance across all dimensions. The addition of samples with severe impairments and further automation of the procedure is required for the models to be used for screening purposes by non-expert clinical staff.
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| 7. |
- Karlsson, Fredrik, Docent, 1975-, et al.
(författare)
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How Well Does Diadochokinetic Task Performance Predict Articulatory Imprecision? : Differentiating Individuals with Parkinson's Disease from Control Subjects
- 2019
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Ingår i: Folia Phoniatrica et Logopaedica. - : S. Karger. - 1021-7762 .- 1421-9972. ; 71:5-6, s. 251-260
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether syllables produced in an oral diadochokinetic (DDK) task may be quantified so that persons with Parkinson's disease (PD) perceived to have reduced articulatory precision when reading may be correctly identified using that quantification.PATIENTS AND METHODS: Syllable sequences from 38 speakers with PD and 38 gender- and age-matched control speakers (normal controls [NC]) were quantified acoustically and evaluated in terms of (1) the speakers' ability to accurately predict speaker group membership (PD or NC) and (2) their ability to predict reduced/non-reduced articulatory precision.RESULTS: A balanced accuracy of 80-93% in predicting speaker group membership was achieved. The best measures were related to the proportion of a syllable made up of a vowel, amplitude slope and syllable-to-syllable variation in duration and amplitude. The best material was that based on /ka/. Reduced articulatory precision was accurately predicted from DDK measures in 89% of the samples. Release-transient prominence and voicing during the onset of plosives were particularly strong predictors.CONCLUSIONS: DDK sequences can predict articulatory imprecision as observed in another speech task. The linking of performance across speech tasks probably requires measures of stability in syllable durations and amplitudes, as well as measures of subsyllabic acoustic features.
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| 8. |
- Karlsson, Fredrik, Docent, 1975-, et al.
(författare)
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On the Primary Influences of Age on Articulation and Phonation in Maximum Performance Tasks
- 2021
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Ingår i: LANGUAGES. - : MDPI AG. - 2226-471X. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Maximum performance tasks have been identified as possible domains where incipient signs of neurological disease may be detected in simple speech and voice samples. However, it is likely that these will simultaneously be influenced by the age and sex of the speaker. In this study, a comprehensive set of acoustic quantifications were collected from the literature and applied to productions of sustained [a] productions and Alternating Motion Rate diadochokinetic (DDK) syllable sequences made by 130 (62 women, 68 men) healthy speakers, aged 20-90 years. The participants were asked to produce as stable (sustained [a] and DDK) and fast (DDK) productions as possible. The full set of features were reduced to a functional subset that most efficiently modeled sex-specific differences between younger and older speakers using a cross-validation procedure. Twelve measures of [a] and 16 measures of DDK sequences were identified across men and women and investigated in terms of how they were altered with increasing age of speakers. Increased production instability is observed in both tasks, primarily above the age of 60 years. DDK sequences were slower in older speakers, but also altered in their syllable and segment level acoustic properties. Increasing age does not appear to affect phonation or articulation uniformly, and men and women are affected differently in most quantifications investigated.
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| 9. |
- Karlsson, Fredrik, Docent, 1975-
(författare)
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'superassp' and the need for a sparse signaltrack data format
- 2021
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Ingår i: Proceedings of Fonetik 2021. - Lund : Centre for Languages and Literature. ; , s. 23-26
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The digital processing of phonetic data has long been based on the same basic data structures and consequently been stored in essentially the same manner. The transition to structured database-based workflows and the development of more complex analyses challenge the established data structures and storage models. I propose a sparsely defined data track model for structured storing of locally define signal information and suggest an implementation. The use of sparse data created by the amalgamating signal processing library ‘superassp’ is discussed within a speech database management system.
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| 10. |
- Karlsson, Fredrik, 1975-
(författare)
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The acquisition of contrast : a longitudinal investigation of initial s+plosive cluster development in Swedish children
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This Thesis explores the development of word-initial s+plosive consonant clusters in the speech of Swedish children between the ages of 1;6 and 4;6. Development in the word-initial consonant clusters is viewed as being determined by 1) the children’s ability to articulate the target sequence of consonants, 2) the level of understanding of which acoustic features in the adult model production are significant for the signalling of the intended distinction, and 3) the children’s ability to apply established production patterns only to productions where the acquired feature agrees with the adult target, to achieve a contrast between rival output forms. This Thesis employs a method where output forms are contrasted with attempted productions of potential homonym target words. Thus, development is quantified as an increase in the manifestations of phonetic features where it agrees with the adult norm, coupled by a decrease in the same feature in output forms where it is inappropriate according to the specifications of the phonological system of the ambient language. Acoustic investigations of cues of voicing, aspiration, place of articulation and syllable onset complexity, and auditory investigations of place, manner and syllable onset complexity were conducted. The Thesis has four outcomes. One, a description of the perceptual quality of the productions in terms of place, manner, voicing and syllable onset complexity is presented. Two, a developmental sequence of stable acquisition of these features is proposed; manner is shown to be acquired first, followed by syllable onset complexity and place of articulation. Evidence is provided that the voiced/aspirated distinction is still being acquired at the end of the investigated age period. Three, the developmental use of acoustic cues of place and voicing are described. Voice Onset Time and Spectral Skewness are shown to be used by children in order to increase the likeness to the adult target in terms of voicing and place of articulation. Aspiration Amplitude is shown to be used as an auxiliary cue to Voice Onset Time. The place cues Spectral Tilt Change, F2, Spectral Mean and Spectral Variance were shown to be used in order to refine already produced consonants rather than approach the adult target model. Four, the Thesis provides evidence of periods of confusions in the output of children. With the reductions of these patterns of confusion, evidence is provided of children’s re-organisation of their internal representation of the consonant to be produced.
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| 11. |
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| 12. |
- Karlsson, Fredrik, Docent, 1975-
(författare)
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Vocal activity detection and speaker diarization in speech databases : a feasibility study
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The task of creating speech corpora for phonetic research is time-consuming and could be alleviated by automatic algorithms to provide draft indexing of speech acts. The present investigation assessed the feasibility of applying speech segmentation and speaker diarization models across a collection of recordings to produce a draft indexing that could be utilised by speech management systems to help the researcher to navigate a corpus. The results show that a readily available model for speech segmentation is very likely to contribute to the effectiveness of speech annotation workflows in phonetic research. Speaker diarization models may require specific training to manage consistent speaker separation across a speech corpus, and the evaluated model currently offers no clear advantage to the effectiveness of a speech corpus creation process.
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| 13. |
- Persson, Klara Josefina, et al.
(författare)
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Do best practice recommendations align with current aphasia practices in the Swedish care context : a national survey
- 2022
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Ingår i: Aphasiology. - : Routledge. - 0268-7038 .- 1464-5041. ; 36:8, s. 903-920
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Tidskriftsartikel (refereegranskat)abstract
- Background: For healthcare professionals, decision-makers and taxpayers, clinical guidelines and recommendations are tools for implementing interventions supported by research evidence. To ensure efficient, safe, and equal care for people with aphasia (PWA) in Sweden, it is vital that speech and language pathologists (SLPs) can work in accordance with evidence-based practice.Aim: To investigate to which degree the Best practice recommendations for aphasia (BPRA) are already well aligned with current practice in the management of aphasia and to what extent they would require adjustment to fit the Swedish care contexts.Methods and procedures: The BPRA were translated from English to Swedish according to steps 1 and 2 in the translation method recommended by the World Health Organization (WHO). A web-based questionnaire was used for data collection. All healthcare regions in Sweden were represented, and the study included a total of 109 SLPs. The participants' perceived knowledge and application of the recommendations and whether the recommendations can serve as a basis for national clinical guidelines were summarized quantitatively. The participants' comments on the applicability of the BPRA were analyzed with qualitative content analysis according to an established model.Outcomes and results: Only a few participants indicated they had good knowledge of the BPRA. The responses additionally showed that the application of the BPRA varied between the participants and across clinical settings. Lacking SLP resources was stated to be the main perceived barrier for complying with the recommendations. The participants also stated that the BPRA requires adjustment to provide a partial basis for national clinical guidelines for aphasia and the need for national clinical guidelines to be adjusted to prevalent SLP resources.Conclusions: There are challenges in following up on some of the interventions that, according to both multinational recommendations and Swedish guidelines, should be given priority in the care of PWA. The barriers that are stated to complicate Swedish SLPs' compliance with some of the multinational recommendations are similar to the barriers posed by SLPs in other national studies on the uptake of aphasia rehabilitation recommendations. In Sweden, SLPs experience a lack of resources of various kinds to be able to fully comply with the BPRA.
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| 14. |
- Sandström, Linda, 1973-
(författare)
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Impact of deep brain stimulation in the caudal zona incerta on voice tremor and speech in persons with essential tremor
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Deep brain stimulation (DBS) is a symptomatic treatment for people with essential tremor (ET) who have unsatisfactory tremor relief with pharmacological treatment alone. A common symptom of ET is voice tremor, but only about 50% of patients with voice tremor get a satisfactory result with DBS. Moreover, stimulation-induced adverse effects on speech are often reported, especially with bilateral stimulation. In recent years, the caudal zona incerta (cZi) has been highlighted as a particularly efficient DBS-target for tremor; however, less is known about the effects of cZi-DBS on voice and speech. The aims of this thesis were to (i) describe how voice tremor and speech production are affected by habitual cZi-DBS optimized to treat the motor symptoms of ET, (ii) investigate how voice tremor and speech production are affected by unilateral cZi-stimulation at increasing amplitudes, with a particular focus on high-amplitude stimulation, and (iii) explore the extent to which patient characteristics and DBS related factors, such as electrode location and stimulation settings, influence the outcome.Methods: This thesis comprises two different study protocols. Study I was a retrospective study of 19 patients with ET and voice tremor, and DBS effects on voice tremor were evaluated from clinical assessments made at baseline and 1, 3, and 5 years after surgery, respectively. Studies II-V included 37 persons with ET, and DBS effects on voice tremor and speech production were evaluated off- and on habitual stimulation, as well as in an experimental protocol with unilateral stimulation at increasing amplitudes (up to a maximum of 4.5V). Voice tremor (study II, III) was assessed by two listeners using the Visual Sort and Rate (VISOR) method. Speech intelligibility (study IV) was estimated from orthographic transcriptions of nonsense sentences made by two speech-language pathology students. Speech function, including articulation and voice quality (study V) were analysed in 14 participants and assessed by two speech-language pathologists using VISOR. Voice and speech outcomes following the experimental stimulation condition were evaluated in relation to the location of the active electrode contacts.Results: Habitual cZi-DBS reduced voice tremor at all examinations and did not affect speech production on the group-level. By contrast, during unilateral high-amplitude stimulation, more negative effects on speech were noted, and the proportion of individuals with affected speech more than doubled at maximal amplitude stimulation compared with habitual cZi-DBS (40% compared to 17%). While most of these adverse effects were mild in general, a few participants exhibited more severe impairments of high-amplitude stimulation, especially on speech intelligibility and articulation. There were also cases in which high-amplitude stimulation worsened voice tremor or even induced the symptom. As for the contribution of electrode location, a deeper and more posterior stimulation origin were found to yield the most efficient voice tremor reduction, more medially located electrodes were associated with affected articulation, whereas deteriorated speech intelligibility was related to stimulation originating from a more superior location.Conclusions: cZi-DBS is relatively safe in the sense that adverse effects on speech production are rarely seen during stimulation with the clinical settings. Furthermore, voice tremor can be expected to improve, both short- and long- term, although not always to such an extent that the symptom is alleviated completely. However, by increasing the stimulation amplitude beyond the clinical setting, one increases the risk of inducing unwanted speech-related effects and worsen voice tremor. Thus, it appears as though the challenge in the postoperative management of the DBS treatment lies in maintaining the therapeutic effect while still keeping the stimulation amplitude at a low level. The combined results of this thesis indicate that the best outcome for voice and speech might be achieved by stimulating from the posterior-inferior-lateral part of the cZi.
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| 15. |
- Sandström, Linda, et al.
(författare)
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Long-term effects of unilateral deep brain stimulation on voice tremor in patients with essential tremor
- 2019
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Ingår i: Parkinsonism & Related Disorders. - : Elsevier. - 1353-8020 .- 1873-5126. ; 60, s. 70-75
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Voice tremor (VT) is a common symptom of Essential tremor (ET). Deep brain stimulation (DBS) is an established treatment for ET overall, however, its effect on VT is less clear. The aim of this study was to evaluate long-term effects of DBS on VT and to investigate how VT symptoms develop over time in patients with ET.METHODS: VT scores for the cohort of 81 ET patients that had undergone DBS surgery in the caudal zona incerta (cZi) were analyzed retrospectively. Thirty-four patients had preoperative VT and long-term evaluations were available for 19 patients. Longitudinal effects of cZi-DBS were investigated 1, 3 and 5 years postoperatively. VT progression was evaluated based on preoperative-, and off stimulation postoperative assessments.RESULTS: Unilateral cZi-DBS reduced average voice tremor by 58% at the 3-year follow-up and by 67% 5 years after surgery. Four patterns of VT development were identified among patients, and the effectiveness of cZi-DBS in alleviating voice tremor symptoms showed differing patterns for these subgroups.CONCLUSIONS: This retrospective analysis of a small cohort of patients suggests that cZi-DBS may reduce VT in the long-term for patients with ET overall, but the pattern of VT progression likely influences the effectiveness of the treatment. These results also suggest that unilateral cZi-DBS may be more efficacious when treating patients with mild to moderate VT. A prospective, blinded, controlled clinical trial in patients with ET is needed to determine developmental patterns of VT, and the safety and efficacy of cZi-DBS for the treatment of VT.
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| 16. |
- Sandström, Linda, et al.
(författare)
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Speech following DBS for essential tremor : Effects of chronic and high-amplitude stimulation in the posterior subthalamic area
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Deep brain stimulation (DBS) can be very effective in alleviating tremor, but adverse effects on speech are frequently reported, especially following bilateral DBS. Most of the existing literature on DBS and speech deals with the effects of DBS targeting the subthalamic nucleus or the ventral intermediate nucleus of the thalamus, which are the traditional targets for Parkinson’s disease and essential tremor, respectively. More recently, the posterior subthalamic area (PSA) has been highlighted as a particularly effective target for tremor; however, there are limited studies of PSA-DBS effects on speech.We report speech outcomes for 14 persons with essential tremor during chronic PSA-DBS and at unilateral high-amplitude PSA-stimulation.The objectives were to answer the following questions:To what extent is speech function, and in particular articulation and voice, affected by chronic PSA-DBS?How is speech affected by unilateral high-amplitude stimulationIs bilateral chronic PSA-DBS worse for speech than unilateral PSA-stimulation?
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| 17. |
- Sandström, Linda, et al.
(författare)
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Speech function following deep brain stimulation of the caudal zona incerta : effects of habitual and high-amplitude stimulation
- 2021
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Ingår i: Journal of Speech, Language and Hearing Research. - : American Speech-Language-Hearing Association. - 1092-4388 .- 1558-9102. ; 64:6, s. 2121-2133
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET.Method: Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audio-perceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS (n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms.Results: Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision (n = 9) had more medially placed electrodes than the nonaffected group (n = 5). Bilateral and unilateral left stimulation had comparable effects on speech.Conclusions: Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement.
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| 18. |
- Sandström, Linda, et al.
(författare)
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The effects of deep brain stimulation on speech intelligibility in persons with essential tremor
- 2020
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Ingår i: Journal of Speech, Language and Hearing Research. - : American Speech-Language-Hearing Association. - 1092-4388 .- 1558-9102. ; 63:2, s. 456-471
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate how deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech intelligibility in persons with essential tremor (ET).Method: Thirty-five participants were evaluated: off stimulation, on chronic stimulation optimized to alleviate tremor, and during unilateral stimulation at increasing amplitude levels. At each stimulation condition, the participants read 10 unique nonsense sentences from the Swedish Test of Intelligibility. Two listeners, blinded to stimulation condition, transcribed all recorded sentences orthographically in a randomised procedure. A mean speech intelligibility score for each patient and stimulation condition was computed, and comparisons were made between scores off- and on stimulation.Results: Chronic cZi-DBS had no significant effect on speech intelligibility, and there was no difference in outcome between bilateral and unilateral treatments. During unilateral stimulation at increasing amplitudes, nine participants demonstrated deteriorating speech intelligibility. These nine participants were on average older and had more superior contacts activated during the evaluation compared with the participants without deterioration.Conclusions: Chronic cZi-DBS, optimized for tremor suppression, does not generally affect speech intelligibility in persons with ET. Furthermore, speech intelligibility may be preserved in many individuals, even when stimulated at high amplitudes. Adverse effects of high-amplitude unilateral stimulation observed in this study were associated with stimulation originating from a more superior location, as well as with the participants’ age. These results, highlighting age and stimulation location as contributing to speech intelligibility outcomes were, however, based on a limited number of individuals experiencing adverse effects with high-amplitude stimulation and should, therefore, be interpreted with caution.
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