Lena Hartelius

Speech and Swallowing Symptoms Associated with Parkinson’s Disease and Multiple Sclerosis: A Survey

A survey of approximately 460 patients with Parkinsons disease (PD) or multiple sclerosis (MS) shows that speech and swallowing difficulties are very frequent within these groups. Seventy percent of the PD patients and 44% of the MS patients had experienced impairment of speech and voice after the onset of their disease. Forty-one percent of the PD patients and 33% of the MS patients indicated impairment of chewing and swallowing abilities. The speech disorder was regarded as one of their greatest problems by 29% of the PD patients and by 16% of the MS patients. Only a small number of patients, 3% of the PD and 2% of the MS group, had received any speech therapy.

Prevalence and Characteristics of Dysarthria in a Multiple-Sclerosis Incidence Cohort: Relation to Neurological Data

Few attempts have been made to use degree and type of multiple sclerosis (MS) dysarthria in neurological evaluation. In the present study, 77 individuals drawn from an MS population were examined both by a speech pathologist and a neurologist, and data from three sources of information were subsequently combined: (1) a clinical dysarthria test procedure, (2) a perceptual analysis of speech characteristics in continuous speech, and (3) neurological deficit scoring. The speech of 15 age- and gender-matched healthy control subjects was also investigated. It was concluded that: (1) the prevalence of mild to severe dysarthria in this cohort was 51% and occurred in all components of speech production: respiration, phonation, prosody, articulation and nasality. (2) The clinical dysarthria test was sensitive in detecting subclinical speech signs. The prevalence of pathologic speech signs found on the basis of the test was found to be 62%. The prevalence of dysarthria based on the neurological evaluation alone was 20%. (3) The dysarthria of MS was a predominantly mixed dysarthria, with both ataxic and spastic speech signs frequently present in the speech of a given individual. (4) Furthermore, when a predominant type of dysarthria existed, it was not generally associated with a characteristic profile of neurological deficits. Rather, severity of speech deviation was positively correlated to overall severity of neurological involvement, type of disease course, and number of years in progression.

Living with dysarthria: evaluation of a self-report questionnaire.

The study describes an effort to evaluate the speech difficulties as perceived by individuals with dysarthria. A self-report questionnaire, Living with Neurologically Based Speech Difficulties (Living with Dysarthria), was answered by 55 individuals with varying types and degrees of dysarthria. Results show that both type and degree of subjectively perceived communicative difficulties varied. Degree of communicative difficulties was not related to age, gender, diagnosis, disease duration or employment status in this group. Generally, the overriding problems were related to restrictions in communicative participation, possibilities to actively take part in work and studies and to express one’s personality were particularly affected. Communication was also affected by emotions and by the number and familiarity of people present in communicative encounters. The dominating speech difficulties were related to reduced speech rate and a need for repetition as a consequence of misunderstandings. A statistically nonsignificant difference was found between the higher mean of the group with moderate dysarthria compared to the groups with severe and mild dysarthria, indicating that severity of dysarthria does not necessarily predict extent of perceived communicative difficulties. It is concluded that systematic subjective reports should always be included in the assessment of individuals with acquired dysarthria.

Perceptual and acoustic analysis of speech in individuals with spinocerebellar ataxia (SCA)

With current progress in genetic research, autosomal, dominant, hereditary, neurodegenerative diseases, affecting the cerebellum and cerebellar connections, are increasingly diagnosed as spinocerebellar ataxias (SCA). In the present study speech samples from 21 subjects with spinocerebellar ataxia (SCA), and 21 matched control subjects were analyzed using perceptual and acoustic methodology. Dysarthria assessment showed that subjects had mild or mild-moderate dysarthria. Perceptual analysis indicated that equalized stress, imprecise consonants, vocal instability, monotony and reduced speech rate were the speech parameters that yielded the highest mean perceptual ratings. A factor analysis of perceptual speech parameters revealed two main factors: Factor 1 was associated with articulatory timing and Factor 2 with vocal quality. Acoustic analysis revealed significantly reduced speech rate during text reading, reduced alternating and sequential motion rates (AMR/SMR), significantly longer and more variable syllable and pause durations, and significantly higher vocal instability for subjects with SCA compared to control subjects.

Temporal Speech Characteristics of Individuals with Multiple Sclerosis and Ataxic Dysarthria: ‘Scanning Speech’ Revisited

‘Scanning speech’ has been used as a description of a prominent characteristic of the dysarthria of multiple sclerosis (MS) as well as of ataxic dysarthria in general. It is thought to be measurable as equalised syllable durations. There are seemingly contradictory prosodic-temporal characteristics of ataxic dysarthria: perceptually characterised as prosodic excess as well as phonatory-prosodic insufficiency and acoustic characteristics including signs of isochrony as well as variability. This study investigates the temporal characteristics at two levels, duration and variability of syllable durations and the durations of interstress intervals. A group of 14 individuals with MS and ataxic dysarthria as well as 15 control subjects were studied. It was concluded that individuals with ataxic dysarthria and MS showed (a) for syllables: significantly increased durations and decreased intrautterance variability (more isochrony or syllable equalisation) as well as significantly increased interutterance variability; (b) for interstress intervals: significantly increased durations and increased variability (less isochrony). The results point to inflexibility as well as instability of temporal control, which could contribute to the explanation of why the perceptual characteristics are contradictory.

Communication and Huntington's disease: qualitative interviews and focus groups with persons with Huntington's disease, family members, and carers

BACKGROUND As an effect of the cognitive, emotional and motor symptoms associated with Huntingtons disease, communicative interaction is often dramatically changed. No study has previously included the subjective reports on this subject from individuals with Huntingtons disease. AIMS To explore the qualitative aspects of how communication is affected by Huntingtons disease from a triangular perspective represented by individuals with Huntingtons disease, family members and professional carers. METHODS & PROCEDURES Eleven persons with Huntingtons disease, seven family members and ten carers were interviewed in focus groups or individually, using a semi-structured interview guide. The interviews were transcribed verbatim and analysed using thematic content analysis, resulting in a number of free codes concerning communication. The codes describing related phenomena were merged into categories. Categories were analysed and reanalysed resulting in three major themes, common to the three groups of participants. OUTCOMES & RESULTS The themes found were: Communication has changed; Factors that influence communication negatively; and Factors that influence communication positively. Subcategories differed between the three groups. All participants seemed to acknowledge the variability and lack of initiative in communication. The persons without Huntingtons disease focused on the changes in terms of speech, language comprehension, the lack of depth in conversation and the need to make adjustments, while the persons with Huntingtons disease focused on the effort and concentration demanded to communicate. They described the change they perceived in their communicative ability in terms of loss. All participants thought that an emotional load had a negative impact on communication. Furthermore, individuals with Huntingtons disease stressed that other peoples speed of communication had a negative impact, while family members and carers stressed that things such as personality changes in persons with Huntingtons disease and lack of eye contact with them influenced communication negatively. All participants acknowledged the need for increased participation in social life in order to enhance communication. CONCLUSIONS & IMPLICATIONS In brief, persons with Huntingtons disease expressed a need for a richer social life and more (adjusting) conversation partners, family members expressed a need for more support and professional carers wanted more information about Huntingtons disease. The triangular perspective utilized in the present study completed the picture of the communicative consequences of Huntingtons disease. In particular, it became clear, that the insights of persons with Huntingtons disease can and has to be included in communicative assessments and plans for intervention.

Assessing high-level language in individuals with multiple sclerosis : a pilot study

This study describes the development of a test battery to assess high-level language function in Swedish and a description of the test performances of a group of 9 individuals with multiple sclerosis (MS). The test battery included tasks such as repetition of long sentences, understanding of complicated logicogrammatical sentences, naming famous people, resolving ambiguities, recreating sentences, understanding metaphors, making inferences, defining words. The MS group included individuals with self-reported language problems as well as individuals without any such problems. Their performances were compared to a group of 7 control subjects with a KruskalWallis one-way ANOVA which indicated significantly different total mean scores. Post hoc analysis with Mann-Whitney Utests revealed that the group with self-reported language problems had significantly lower mean scores when compared to control subjects and to MS subjects without self-reported language problems. None of the language difficulties were detected by a standard aphasia test.This study describes the development of a test battery to assess high-level language functions in Swedish and also the test performances of a group of nine individuals with multiple sclerosis. The test battery included tasks such as repetition of long sentences, understanding of complicated logico-grammatical sentences, naming famous people, resolving ambiguities, recreating sentences, understanding metaphors, making inferences, and defining words. The multiple sclerosis group included individuals with self-reported language problems as well as individuals without any such problems. The performances of these two subgroups were compared to that of a group of seven control subjects using a Kruskal-Wallis one-way ANOVA. Post hoc analysis with Mann-Whitney U-tests revealed that the group with self-reported language problems had significantly lower mean scores when compared to control subjects and to multiple sclerosis subjects without self-reported language problems. None of the language difficulties were detected by a standard aphasia test.

Clinical assessment of dysarthria: Performance on a dysarthria test by normal adult subjects, and by individuals with Parkinson's disease or with multiple sclerosis

The study reports the results of a clinical dysarthria test procedure applied to a group of 59 normal subjects, and two patient groups: 30 individuals with Parkinsons disease (PD) and 30 with multiple sclerosis (MS). The assessment protocol consists of 54 test items divided into 6 subtests—Respiration, Phonation, Oral motor performance, Articulation, Prosody and Intelligibility. The test procedure generated statistically significant differences between a) normal adult subjects and each of the two neurological subject groups; b) normal adult subjects and individuals with dysarthria; and c) normal adult subjects and individuals with MS who did not show any audible signs of abnormality in continuous speech.

Comprehension of complex discourse in different stages of Huntington's disease

BACKGROUND Huntingtons disease not only affects motor speech control, but also may have an impact on the ability to produce and understand language in communication. AIMS The ability to comprehend basic and complex discourse was investigated in three different stages of Huntingtons disease. METHODS & PROCEDURES In this experimental group study, 18 patients with Huntingtons disease completed a test that assessed basic language abilities as well as tests from a battery of tasks that explored the ability to comprehend more complex information. The test battery assessed the ability to comprehend logico-grammatical sentences, ambiguous information and inferred meaning on sentence and discourse levels. OUTCOMES & RESULTS In comparison with results from pair-matched participants in a control group, matched for gender, age and education, the group of individuals with Huntingtons disease had significantly more problems with all tasks requiring more complex cognitive processing. There was a correlation, as well as tendencies towards correlations, between results in the group of individuals with Huntingtons disease and stage of the disease. However, results within the stage groups were heterogeneous, and some individuals in an early stage of the disease sometimes performed as well as others in a late stage. CONCLUSIONS & IMPLICATIONS It is likely that, in complex discourse tasks, individual differences in cognitive capacity may contribute and override other differences related to stage of disease. These results indicate that it is important to assess comprehension even in early stages of Huntingtons disease, with tests that are sensitive to subtle language disorders, to reduce communication problems for the individuals concerned and their conversational partners.

Using Talking Mats to support communication in persons with Huntington's Disease

BACKGROUND Many individuals with Huntingtons disease experience reduced functioning in cognition, language and communication. Talking Mats is a visually based low technological augmentative communication framework that supports communication in people with different cognitive and communicative disabilities. AIMS To evaluate Talking Mats as a communication tool for people in the later stages of Huntingtons disease. METHODS & PROCEDURES Five individuals with Huntingtons disease participated in the study. Three conditions were compared: unstructured communication, verbally structured communication, and communication using Talking Mats. The conversations were videotaped and analysed quantitatively and qualitatively. OUTCOMES & RESULTS Talking Mats increased communicative effectiveness for all participants. Verbally structured conversation resulted in higher effectiveness than the unstructured counterpart and effectiveness differed depending on the type of conversational topic. CONCLUSIONS & IMPLICATIONS Talking Mats could be a valuable resource for people with Huntingtons disease and their conversation partners. It could be used for social purposes, for understanding a persons opinions and for making decisions. Additional research is necessary in order to generalize the results to the population of individuals with Huntingtons disease and to understand better the mechanisms behind the positive effects observed.