A Systematic Survey of Cognitive-Communicative Evaluations

abstract: Dementia is a syndrome resulting from an acquired brain disease that affects many domains of cognitive impairment. The progressive disorder generally affects memory, attention, executive functions, communication, and other cognitive domains that significantly alter everyday function (Quinn, 2014). The purpose of this research was to gather a systematic review of cognitive-communication assessments and screeners used in assessing dementia to assist in early prognosis. From this review, there is potential in developing a new test to address the areas that people with dementia often have deficits in 1) Memory, 2) Attention, 3) Executive Functions, 4) Language, and 5) Visuospatial Skills. In the field of speech-language pathology, or medicine in general, there is no one assessment that can diagnose dementia. Additionally, this review will explore identifying speech and language characteristics of dementia through speech analytics to theoretically help clinicians identify early signs of dementia.Dissertation/ThesisMasters Thesis Communication Disorders 201

운율 정보를 이용한 마비말장애 음성 자동 검출 및 평가

학위논문 (석사) -- 서울대학교 대학원 : 인문대학 언어학과, 2020. 8. Minhwa Chung.말장애는 신경계 또는 퇴행성 질환에서 가장 빨리 나타나는 증 상 중 하나이다. 마비말장애는 파킨슨병, 뇌성 마비, 근위축성 측삭 경화증, 다발성 경화증 환자 등 다양한 환자군에서 나타난다. 마비말장애는 조음기관 신경의 손상으로 부정확한 조음을 주요 특징으로 가지고, 운율에도 영향을 미치는 것으로 보고된다. 선행 연구에서는 운율 기반 측정치를 비장애 발화와 마비말장애 발화를 구별하는 것에 사용했다. 임상 현장에서는 마비말장애에 대한 운율 기반 분석이 마비말장애를 진단하거나 장애 양상에 따른 알맞은 치료법을 준비하는 것에 도움이 될 것이다. 따라서 마비말장애가 운율에 영향을 미치는 양상뿐만 아니라 마비말장애의 운율 특징을 긴밀하게 살펴보는 것이 필요하다. 구체 적으로, 운율이 어떤 측면에서 마비말장애에 영향을 받는지, 그리고 운율 애가 장애 정도에 따라 어떻게 다르게 나타나는지에 대한 분석이 필요하다. 본 논문은 음높이, 음질, 말속도, 리듬 등 운율을 다양한 측면에 서 살펴보고, 마비말장애 검출 및 평가에 사용하였다. 추출된 운율 특징들은 몇 가지 특징 선택 알고리즘을 통해 최적화되어 머신러닝 기반 분류기의 입력값으로 사용되었다. 분류기의 성능은 정확도, 정밀도, 재현율, F1-점수로 평가되었다. 또한, 본 논문은 장애 중증도(경도, 중등도, 심도)에 따라 운율 정보 사용의 유용성을 분석하였다. 마지막으로, 장애 발화 수집이 어려운 만큼, 본 연구는 교차 언어 분류기를 사용하였다. 한국어와 영어 장애 발화가 훈련 셋으로 사용되었으며, 테스트셋으로는 각 목표 언어만이 사용되었다. 실험 결과는 다음과 같이 세 가지를 시사한다. 첫째, 운율 정보 를 사용하는 것은 마비말장애 검출 및 평가에 도움이 된다. MFCC 만을 사용했을 때와 비교했을 때, 운율 정보를 함께 사용하는 것이 한국어와 영어 데이터셋 모두에서 도움이 되었다. 둘째, 운율 정보는 평가에 특히 유용하다. 영어의 경우 검출과 평가에서 각각 1.82%와 20.6%의 상대적 정확도 향상을 보였다. 한국어의 경우 검출에서는 향상을 보이지 않았지만, 평가에서는 13.6%의 상대적 향상이 나타났다. 셋째, 교차 언어 분류기는 단일 언어 분류기보다 향상된 결과를 보인다. 실험 결과 교차언어 분류기는 단일 언어 분류기와 비교했을 때 상대적으로 4.12% 높은 정확도를 보였다. 이것은 특정 운율 장애는 범언어적 특징을 가지며, 다른 언어 데이터를 포함시켜 데이터가 부족한 훈련 셋을 보완할 수 있 음을 시사한다.One of the earliest cues for neurological or degenerative disorders are speech impairments. Individuals with Parkinsons Disease, Cerebral Palsy, Amyotrophic lateral Sclerosis, Multiple Sclerosis among others are often diagnosed with dysarthria. Dysarthria is a group of speech disorders mainly affecting the articulatory muscles which eventually leads to severe misarticulation. However, impairments in the suprasegmental domain are also present and previous studies have shown that the prosodic patterns of speakers with dysarthria differ from the prosody of healthy speakers. In a clinical setting, a prosodic-based analysis of dysarthric speech can be helpful for diagnosing the presence of dysarthria. Therefore, there is a need to not only determine how the prosody of speech is affected by dysarthria, but also what aspects of prosody are more affected and how prosodic impairments change by the severity of dysarthria. In the current study, several prosodic features related to pitch, voice quality, rhythm and speech rate are used as features for detecting dysarthria in a given speech signal. A variety of feature selection methods are utilized to determine which set of features are optimal for accurate detection. After selecting an optimal set of prosodic features we use them as input to machine learning-based classifiers and assess the performance using the evaluation metrics: accuracy, precision, recall and F1-score. Furthermore, we examine the usefulness of prosodic measures for assessing different levels of severity (e.g. mild, moderate, severe). Finally, as collecting impaired speech data can be difficult, we also implement cross-language classifiers where both Korean and English data are used for training but only one language used for testing. Results suggest that in comparison to solely using Mel-frequency cepstral coefficients, including prosodic measurements can improve the accuracy of classifiers for both Korean and English datasets. In particular, large improvements were seen when assessing different severity levels. For English a relative accuracy improvement of 1.82% for detection and 20.6% for assessment was seen. The Korean dataset saw no improvements for detection but a relative improvement of 13.6% for assessment. The results from cross-language experiments showed a relative improvement of up to 4.12% in comparison to only using a single language during training. It was found that certain prosodic impairments such as pitch and duration may be language independent. Therefore, when training sets of individual languages are limited, they may be supplemented by including data from other languages.1. Introduction 1 1.1. Dysarthria 1 1.2. Impaired Speech Detection 3 1.3. Research Goals & Outline 6 2. Background Research 8 2.1. Prosodic Impairments 8 2.1.1. English 8 2.1.2. Korean 10 2.2. Machine Learning Approaches 12 3. Database 18 3.1. English-TORGO 20 3.2. Korean-QoLT 21 4. Methods 23 4.1. Prosodic Features 23 4.1.1. Pitch 23 4.1.2. Voice Quality 26 4.1.3. Speech Rate 29 4.1.3. Rhythm 30 4.2. Feature Selection 34 4.3. Classification Models 38 4.3.1. Random Forest 38 4.3.1. Support Vector Machine 40 4.3.1 Feed-Forward Neural Network 42 4.4. Mel-Frequency Cepstral Coefficients 43 5. Experiment 46 5.1. Model Parameters 47 5.2. Training Procedure 48 5.2.1. Dysarthria Detection 48 5.2.2. Severity Assessment 50 5.2.3. Cross-Language 51 6. Results 52 6.1. TORGO 52 6.1.1. Dysarthria Detection 52 6.1.2. Severity Assessment 56 6.2. QoLT 57 6.2.1. Dysarthria Detection 57 6.2.2. Severity Assessment 58 6.1. Cross-Language 59 7. Discussion 62 7.1. Linguistic Implications 62 7.2. Clinical Applications 65 8. Conclusion 67 References 69 Appendix 76 Abstract in Korean 79Maste

Exploring the Experiences of Communication Partners of People with Parkinson\u27s Disease: A Qualitative Study

The purpose of this phenomenological qualitative study was to explore interactions between persons with Parkinson\u27s disease (PD) and their communication partners. People with PD experience difficulties that can have a profound effect on their ability to communicate. This qualitative study explored the thoughts and feelings of primary communication partners of people with PD. The primary communication partners were interviewed using open-ended questions. The seven participants identified and detailed how declines in communication due to PD have resulted in changes in daily life, including; social participation, daily tasks, and psychosocial well-being. Commonalities that communication partners experienced will aid speech-language pathologists to better understand the effects that PD has on communication

Diagnosis and recovery patterns in patients with apraxia of speech after stroke

Background: Stroke is a leading cause of adult disability. One of its most common consequences is a communication disorder. Beside aphasia (a language disorder), a motor speech disorder may occur, manifested as dysarthria or apraxia of speech (AOS). AOS has been defined as a motor speech disorder that affects an individual's ability to transform a linguistic message into speech motor plans. The most common symptoms associated with AOS include slow rate of speech, impaired articulation with sound errors that are predominately distortions, and disturbed prosody. The effects of AOS vary, from subtle articulation deviations to a complete inability to communicate through speech. AOS is most frequently caused by infarcts in the left middle cerebral artery, which supplies areas involved in both speech, language, and hand motor function. Despite a large amount of research, our knowledge of the exact nature and neurophysiological mechanisms of AOS is limited. Few studies have investigated AOS in an early phase after stroke as well as its resolution longitudinally, and factors predicting recovery are largely unknown. While the effects of focal brain lesions induced by stroke have been frequently studied, less is known about alterations in network connectivity in patients with AOS. Despite a close relationship between speech motor, language, and hand motor function, only few studies have addressed the relation between recovery in these multiple behavioral domains. In clinical settings, there is a lack of valid and reliable assessment instruments for AOS diagnosis that are applicable at all severity levels. Aim: The overall aim of this thesis was to gain more knowledge on the diagnosis and recovery patterns of AOS in individuals in an early phase after stroke. The specific aims for the four studies were: Study I: To study the intra- and interrater reliability of the Apraxia of Speech Rating Scale (ASRS) in assessment of individuals with speech and language impairments in an early phase after stroke. The ASRS was developed for research purposes, and its reliability for clinically active SLPs is unknown. An additional aim was to investigate the applicability of the ASRS in assessment of individuals with severe speech and language impairments. Study II: To describe and evaluate preliminary measures of reliability and validity of a clinical assessment protocol for AOS diagnosis, developed as part of a clinical study with the aims to be applicable in clinical settings and to be valid in the assessment of individuals with speech and language impairments at all severity levels. Study III: To investigate the prevalence of AOS and aphasia in individuals with a hand motor impairment in a subacute phase after stroke, and to compare recovery at six months in speech, language, and hand motor domains. An additional aim was to explore factors predicting recovery from AOS. Study IV: To investigate longitudinal changes in functional connectivity (FC) in speechlanguage networks in individuals with AOS after stroke, from the subacute to the chronic phase, specifically to identify predictors of AOS recovery. Additional aims were to study the relation between FC and degree of severity in AOS and to compare FC strength in patients with AOS after a left hemisphere stroke to that in left hemisphere lesioned stroke patients without speech-language impairment. Methods: For intra- and interrater reliability of the ASRS in study I, five certified speechlanguage pathologists (SLPs) from different hospital departments participated as raters. All worked with neurogenic communication disorders in adults. The ratings were based on video recordings of ten participants in an early phase after stroke showing varying degrees of AOS symptoms, from mild to severe. For measures of intrarater reliability, a rescoring was carried out after a minimum of three weeks. The clinical assessment protocol in study II included ten items, five of which were based on operationalized measures and five were perceptual ratings of AOS characteristics. Interrater reliability for the assessment protocol was based on video recordings of five individuals with varying degrees of AOS symptoms being assessed with the assessment protocol. Eleven certified SLPs participated as raters, all of whom worked with neurogenic communication disorders in adults. For measures of validity, the total scores of the assessment protocol from 39 participants in a subacute phase after stroke were compared against the clinical judgement of an AOS diagnosis. In study III, the prevalence of AOS and aphasia in individuals with a hand motor impairment in a subacute phase after stroke was investigated in a group of 70 participants. Half of the group had a left hemispheric lesion and the other half a right hemispheric lesion. Recovery of AOS, aphasia, and hand motor impairment at six months was investigated in 15 of these participants with a left hemispheric lesion. For measures of functional connectivity in study IV, resting state functional magnetic resonance imaging was applied. Assessments of speech and language impairment and FC in speech-language networks were obtained in nine participants with AOS and concomitant aphasia after a left hemispheric stroke and compared to six left hemispheric lesioned stroke participants without speech-language impairment. Measurements were performed at four weeks and six months after stroke. Functional connectivity was investigated in a network of key regions for speech production: inferior frontal gyrus (IFG), anterior insula (aINS) and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres. Results: In study I, the intrarater reliability for the ASRS total score was moderate on average. The interrater reliability for the total score was poor. The item level values varied between moderate and poor, with lack of agreement on several items. High disagreement was especially noted in ratings of participants with severe speech-language impairments, but varying agreement were also found for participants with milder impairments. In addition, because some of the items on the ASRS require speech output consisting of multisyllabic words and phrases to target the diagnostic marker, limitations when assessing participants with signs of severe AOS with the ASRS were noted. In study II, the interrater reliability for the clinical AOS assessment protocol total score was good, but varied at an item level. The highest reliability was found for items with operationalized measures, while most items with perceptual ratings showed moderate agreement. A high index of validity was found when comparing the total score against the clinical judgement of an AOS diagnosis. In study III, 57% of the participants with a left hemispheric lesion had AOS, while 71% had aphasia. All participants with AOS also had aphasia. Recovery in AOS, aphasia and hand motor impairment at six months correlated positively across speech, language and hand motor domains. The strongest predictor for AOS recovery at six months was the initial aphasia test score. In study IV, recovery of AOS at six months correlated positively with the interhemispheric FC between left and right IFG in the subacute phase. Participants with AOS had a significantly reduced FC between bilateral vPMC in comparison to participants with a left hemispheric lesion without a language impairment, while severity of AOS at six months was related to the FC between bilateral aINS. Conclusion: The results of the two first studies add to the growing body of research that highlights the limitations of diagnosis of AOS solely based on perceptual characteristics, and call for the need to include objective measures in the diagnosis. In addition, if the same set of diagnostic AOS criteria cannot be applied during the course of the disease, it makes it difficult to study its longitudinal course and to identify predictors of recovery. In study III, a high prevalence of AOS with concomitant aphasia was noted in participants with a left hemisphere lesion and a hand motor impairment. Recovery of AOS, aphasia and hand motor followed a parallel trajectory, indicating that shared plasticity mechanisms are driving the recovery. For predictors of AOS recovery, indications that measures of aphasia at the subacute phase may be an important predictor was noticed. In study IV, the degree of AOS recovery at six months was strongly associated with the interhemispheric IFG connectivity strength at the subacute phase, indicating that increased activation in homologous speechlanguage areas in the right hemisphere in the subacute phase is positive for the recovery of AOS at six months. The reduced FC between the interhemispheric vPMC in participants with AOS is in line with earlier findings and confirms the current opinion about the left vPMC as a key region for speech motor programming

Transcranial Direct Current Stimulation (tDCS) to Improve Lower Limb Motor Recovery Following Stroke: A Review and Study Proposal

Strokes are the result of restricted blood flow to particular areas of the brain classified by their cause. The neural damage they cause are of growing concern as the number of young adults experiencing strokes has increased by 11% in the last decade. Following stroke, there is an imbalance of inhibitory and excitatory neuronal activity, and disruption of neural networks. These changes lead to neuronal death and loss of synaptic connections that, depending on which part of the brain is affected, result in behavioral deficits such as weakness, limb hemiparesis, and loss of coordination, as well as speech and cognitive impairments. However, this loss of function can be partly recovered due to neuroplastic processes. Non-invasive brain stimulation (NIBS) is an approach that involves implanting electrodes into targeted areas of the brain which are connected to an implantable pulse generator on the skin that delivers chronic electric pulse. There are different forms of stimulation, but one with some established success in improving upper and lower limb mobility, as well as some cognitive symptoms, is transcranial direct current stimulation (tDCS). For the treatment of stroke, tDCS aims to increase excitability of the lesioned areas to improve contralesional mobility. While past research has focused on stimulating well established motor regions, such as the cerebellum, motor cortex, and basal ganglia, sensory systems also play a key role in sending information through the ascending dorsal column medial lemniscal pathway, posterior and anterior spinocerebellar tracts, and spinoreticular tracts. Here is a review of the current research on the integration of sensory and motor information in order to carry out desired movement, a discussion about how these networks are being targeted by tDCS after stroke to help patients regain lower limb movement, and finally, a proposed study in which improvements in balance, gait, and postural stability after anodal tDCS continue up to a year post-treatment in chronic ischemic stroke patients