Adam P. Vogel

Vocal Acoustic Biomarkers of Depression Severity and Treatment Response

BACKGROUND Valid, reliable biomarkers of depression severity and treatment response would provide new targets for clinical research. Noticeable differences in speech production between depressed and nondepressed patients have been suggested as a potential biomarker. METHODS One hundred five adults with major depression were recruited into a 4-week, randomized, double-blind, placebo-controlled research methodology study. An exploratory objective of the study was to evaluate the generalizability and repeatability of prior study results indicating vocal acoustic properties in speech may serve as biomarkers for depression severity and response to treatment. Speech samples, collected at baseline and study end point using an automated telephone system, were analyzed as a function of clinician-rated and patient-reported measures of depression severity and treatment response. RESULTS Regression models of speech pattern changes associated with clinical outcomes in a prior study were found to be reliable and significant predictors of outcome in the current study, despite differences in the methodological design and implementation of the two studies. Results of the current study replicate and support findings from the prior study. Clinical changes in depressive symptoms among patients responding to the treatments provided also reflected significant differences in speech production patterns. Depressed patients who did not improve clinically showed smaller vocal acoustic changes and/or changes that were directionally opposite to treatment responders. CONCLUSIONS This study supports the feasibility and validity of obtaining clinically important, biologically based vocal acoustic measures of depression severity and treatment response using an automated telephone system.

Dysarthria in Friedreich’s Ataxia: A Perceptual Analysis

The aims of this study were to: (1) evaluate the perceptual speech dimensions, speech intelligibility and dysarthria severity of a group of individuals diagnosed with Friedreich’s ataxia (FRDA); (2) determine the presence of subgroups within FRDA dysarthria; (3) investigate the relationship between the speech outcome and the clinical factors of disease progression. The study included 38 individuals (21 female, 17 male) with a confirmed diagnosis of FRDA. A group of 20 non-neurologically impaired individuals served as controls. Perceptual analysis, investigating 30 different dimensions of speech, was conducted on a speech sample obtained from each participant. In addition, the Assessment of Intelligibility of Dysarthria Speech was administered. All FRDA participants presented with dysarthria with severities ranging from mild to moderate. Cluster analysis revealed 3 subgroups, the first presenting with mild dysarthric symptoms, the second with increased velopharyngeal involvement and the third characterized by increased laryngeal dysfunction. Dysarthria severity showed a significant correlation to disease duration but to no other clinical measure. The findings support the notion of subgroups in FRDA dysarthria, representing distinct impairments of the speech mechanism and perhaps reflective of differing evolutions beyond the cerebellum.

Logopenic and Nonfluent Variants of Primary Progressive Aphasia Are Differentiated by Acoustic Measures of Speech Production

Differentiation of logopenic (lvPPA) and nonfluent/agrammatic (nfvPPA) variants of Primary Progressive Aphasia is important yet remains challenging since it hinges on expert based evaluation of speech and language production. In this study acoustic measures of speech in conjunction with voxel-based morphometry were used to determine the success of the measures as an adjunct to diagnosis and to explore the neural basis of apraxia of speech in nfvPPA. Forty-one patients (21 lvPPA, 20 nfvPPA) were recruited from a consecutive sample with suspected frontotemporal dementia. Patients were diagnosed using the current gold-standard of expert perceptual judgment, based on presence/absence of particular speech features during speaking tasks. Seventeen healthy age-matched adults served as controls. MRI scans were available for 11 control and 37 PPA cases; 23 of the PPA cases underwent amyloid ligand PET imaging. Measures, corresponding to perceptual features of apraxia of speech, were periods of silence during reading and relative vowel duration and intensity in polysyllable word repetition. Discriminant function analyses revealed that a measure of relative vowel duration differentiated nfvPPA cases from both control and lvPPA cases (r 2 = 0.47) with 88% agreement with expert judgment of presence of apraxia of speech in nfvPPA cases. VBM analysis showed that relative vowel duration covaried with grey matter intensity in areas critical for speech motor planning and programming: precentral gyrus, supplementary motor area and inferior frontal gyrus bilaterally, only affected in the nfvPPA group. This bilateral involvement of frontal speech networks in nfvPPA potentially affects access to compensatory mechanisms involving right hemisphere homologues. Measures of silences during reading also discriminated the PPA and control groups, but did not increase predictive accuracy. Findings suggest that a measure of relative vowel duration from of a polysyllable word repetition task may be sufficient for detecting most cases of apraxia of speech and distinguishing between nfvPPA and lvPPA.

Role of cerebellum in fine speech control in childhood: Persistent dysarthria after surgical treatment for posterior fossa tumour

Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time post-surgery=6y10m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children.

Reliability, stability, and sensitivity to change and impairment in acoustic measures of timing and frequency.

Assessment of the voice for supporting classifications of central nervous system (CNS) impairment requires a different practical, methodological, and statistical framework compared with assessment of the voice to guide decisions about change in the CNS. In experimental terms, an understanding of the stability and sensitivity to change of an assessment protocol is required to guide decisions about CNS change. Five experiments (N = 70) were conducted using a set of commonly used stimuli (eg, sustained vowel, reading, extemporaneous speech) and easily acquired measures (eg, f₀-f₄, percent pause). Stability of these measures was examined through their repeated application in healthy adults over brief and intermediate retest intervals (ie, 30 seconds, 2 hours, and 1 week). Those measures found to be stable were then challenged using an experimental model that reliably changes voice acoustic properties (ie, the Lombard effect). Finally, adults with an established CNS-related motor speech disorder (dysarthria) were compared with healthy controls. Of the 61 acoustic variables studied, 36 showed good stability over all three stability experiments (eg, number of pauses, total speech time, speech rate, f₀-f₄. Of the measures with good stability, a number of frequency measures showed a change in response to increased vocal effort resulting from the Lombard effect challenge. Furthermore, several timing measures significantly separated the control and motor speech impairment groups. Measures with high levels of stability within healthy adults, and those that show sensitivity to change and impairment may prove effective for monitoring changes in CNS functioning.

Evaluation of communication assessment practices during the acute stages post stroke.

RATIONALE, AIMS AND OBJECTIVES Early detection of communication impairment post stroke is an important prognostic indicator and promotes the use of individualized treatment protocols. Therefore, the methods for speech and language assessment used by communication experts in acute settings following stroke were investigated. METHODS A survey was conducted among 254 speech and language pathologists providing acute care for patients following stroke in all states and territories across Australia and New Zealand. Respondent attitudes and practices in speech and language assessment post stroke were recorded with a standardized questionnaire collected online. RESULTS A total of 174 (68.5%) speech and language pathologists responded. Over 70% of participants assessed language and 80% assessed speech using their own clinical assessments. Respondents identified limited test repeatability and poor sensitivity to change over acute periods as key areas of concern for currently available standardized assessments. CONCLUSIONS Subjective and/or un-standardized assessments were the most commonly used measures of communication during the acute phases post stroke. These results highlight a critical need for the development of population-specific communication assessments that build on existing clinician derived techniques and expertise while considering the acute time demands and transient nature of patients communicative functioning.

Speech acoustic markers of early stage and prodromal Huntington's disease: A marker of disease onset?

Speech disturbances (e.g., altered prosody) have been described in symptomatic Huntingtons Disease (HD) individuals, however, the extent to which speech changes in gene positive pre-manifest (PreHD) individuals is largely unknown. The speech of individuals carrying the mutant HTT gene is a behavioural/motor/cognitive marker demonstrating some potential as an objective indicator of early HD onset and disease progression. Speech samples were acquired from 30 individuals carrying the mutant HTT gene (13 PreHD, 17 early stage HD) and 15 matched controls. Participants read a passage, produced a monologue and said the days of the week. Data were analysed acoustically for measures of timing, frequency and intensity. There was a clear effect of group across most acoustic measures, so that speech performance differed in-line with disease progression. Comparisons across groups revealed significant differences between the control and the early stage HD group on measures of timing (e.g., speech rate). Participants carrying the mutant HTT gene presented with slower rates of speech, took longer to say words and produced greater silences between and within words compared to healthy controls. Importantly, speech rate showed a significant correlation to burden of disease scores. The speech of early stage HD differed significantly from controls. The speech of PreHD, although not reaching significance, tended to lie between the performance of controls and early stage HD. This suggests that changes in speech production appear to be developing prior to diagnosis.

Automatic method of pause measurement for normal and dysarthric speech

This study proposes an automatic method for the detection of pauses and identification of pause types in conversational speech for the purpose of measuring the effects of Friedreichs Ataxia (FRDA) on speech. Speech samples of ∼ 3 minutes were recorded from 13 speakers with FRDA and 18 healthy controls. Pauses were measured from the intensity contour and fit with bimodal lognormal distributions using the Expectation-Maximization algorithm in Matlab©. In the speakers with FRDA, both modes in the pause distributions had significantly larger means, with disproportionately fewer pauses associated with the first mode. From this preliminary study, it is concluded that distributional analysis of pause duration holds promise as a useful method of measuring the effects of FRDA on functional speech.

Acoustic analysis of the effects of sustained wakefulness on speech.

Exposing healthy adults to extended periods of wakefulness is known to induce changes in psychomotor functioning [Maruff et al. (2005). J. Sleep Res. 14, 21-27]. The effect of fatigue on speech is less well understood. To date, no studies have examined the pitch and timing of neurologically healthy individuals over 24 h of sustained wakefulness. Therefore, speech samples were systematically acquired (e.g., every 4 h) from 18 healthy adults over 24 h. Stimuli included automated and extemporaneous speech tasks, sustained vowel, and a read passage. Measures of timing, frequency and spectral energy were derived acoustically using PRAAT and significant changes were observed on all tasks. The effect of fatigue on speech was found to be strongest just before dawn (after 22 h). Specifically, total speech time, mean pause length, and total signal time all increased as a function of increasing levels of fatigue on the reading tasks; percentage pause and mean pause length decreased on the counting task; F4 variation decreased on the sustained vowel tasks /a:/; and alpha ratio increased on the extemporaneous speech tasks. These findings suggest that acoustic methodologies provide objective data on central nervous system functioning and that changes in speech production occur in healthy adults after just 24 h of sustained wakefulness.

Standardization of pitch-range settings in voice acoustic analysis.

Voice acoustic analysis is typically a labor-intensive, time-consuming process that requires the application of idiosyncratic parameters tailored to individual aspects of the speech signal. Such processes limit the efficiency and utility of voice analysis in clinical practice as well as in applied research and development. In the present study, we analyzed 1,120 voice files, using standard techniques (case-by-case hand analysis), taking roughly 10 work weeks of personnel time to complete. The results were compared with the analytic output of several automated analysis scripts that made use of preset pitch-range parameters. After pitch windows were selected to appropriately account for sex differences, the automated analysis scripts reduced processing time of the 1,120 speech samples to less than 2.5 h and produced results comparable to those obtained with hand analysis. However, caution should be exercised when applying the suggested preset values to pathological voice populations.