Exploiting Nonlinear Recurrence and Fractal Scaling Properties for Voice Disorder Detection

Background: Voice disorders affect patients profoundly, and acoustic tools can potentially measure voice function objectively. Disordered sustained vowels exhibit wide-ranging phenomena, from nearly periodic to highly complex, aperiodic vibrations, and increased "breathiness". Modelling and surrogate data studies have shown significant nonlinear and non-Gaussian random properties in these sounds. Nonetheless, existing tools are limited to analysing voices displaying near periodicity, and do not account for this inherent biophysical nonlinearity and non-Gaussian randomness, often using linear signal processing methods insensitive to these properties. They do not directly measure the two main biophysical symptoms of disorder: complex nonlinear aperiodicity, and turbulent, aeroacoustic, non-Gaussian randomness. Often these tools cannot be applied to more severe disordered voices, limiting their clinical usefulness.

Methods: This paper introduces two new tools to speech analysis: recurrence and fractal scaling, which overcome the range limitations of existing tools by addressing directly these two symptoms of disorder, together reproducing a "hoarseness" diagram. A simple bootstrapped classifier then uses these two features to distinguish normal from disordered voices.

Results: On a large database of subjects with a wide variety of voice disorders, these new techniques can distinguish normal from disordered cases, using quadratic discriminant analysis, to overall correct classification performance of 91.8% plus or minus 2.0%. The true positive classification performance is 95.4% plus or minus 3.2%, and the true negative performance is 91.5% plus or minus 2.3% (95% confidence). This is shown to outperform all combinations of the most popular classical tools.

Conclusions: Given the very large number of arbitrary parameters and computational complexity of existing techniques, these new techniques are far simpler and yet achieve clinically useful classification performance using only a basic classification technique. They do so by exploiting the inherent nonlinearity and turbulent randomness in disordered voice signals. They are widely applicable to the whole range of disordered voice phenomena by design. These new measures could therefore be used for a variety of practical clinical purposes.
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Novel speech signal processing algorithms for high-accuracy classification of Parkinson's disease

There has been considerable recent research into the connection between Parkinson's disease (PD) and speech impairment. Recently, a wide range of speech signal processing algorithms (dysphonia measures) aiming to predict PD symptom severity using speech signals have been introduced. In this paper, we test how accurately these novel algorithms can be used to discriminate PD subjects from healthy controls. In total, we compute 132 dysphonia measures from sustained vowels. Then, we select four parsimonious subsets of these dysphonia measures using four feature selection algorithms, and map these feature subsets to a binary classification response using two statistical classifiers: random forests and support vector machines. We use an existing database consisting of 263 samples from 43 subjects, and demonstrate that these new dysphonia measures can outperform state-of-the-art results, reaching almost 99% overall classification accuracy using only ten dysphonia features. We find that some of the recently proposed dysphonia measures complement existing algorithms in maximizing the ability of the classifiers to discriminate healthy controls from PD subjects. We see these results as an important step toward noninvasive diagnostic decision support in PD

Speech impairment in Parkinson’s disease: acoustic analysis of unvoiced consonants in Italian native speakers

The study of the influence of Parkinson’s Disease (PD) on vocal signals has received much attention over the last decades. Increasing interest has been devoted to articulation and acoustic characterization of different phonemes. Method: In this study we propose the analysis of the Transition Regions (TR) of specific phonetic groups to model the loss of motor control and the difficulty to start/stop movements, typical of PD patients. For this purpose, we extracted 60 features from pre-processed vocal signals and used them as input to several machine learning models. We employed two data sets, containing samples from Italian native speakers, for training and testing. The first dataset - 28 PD patients and 22 Healthy Control (HC) - included recordings in optimal conditions, while in the second one - 26 PD patients and 18 HC- signals were collected at home, using non-professional microphones. Results: We optimized two support vector machine models for the application in controlled noise conditions and home environments, achieving 98% ± 1.1 and 88% ± 2.8 accuracy in 10-fold cross-validation, respectively. Conclusion: This study confirms the high capability of the TRs to discriminate between PD patients and healthy controls, and the feasibility of automatic PD assessment using voice recordings. Moreover, the promising performance of the implemented model discloses the option of voice processing using low-cost devices and domestic recordings, possibly self-managed by the patients themselves

Automated voice pathology discrimination from audio recordings benefits from phonetic analysis of continuous speech

In this paper we evaluate the hypothesis that automated methods for diagnosis of voice disorders from speech recordings would benefit from contextual information found in continuous speech. Rather than basing a diagnosis on how disorders affect the average acoustic properties of the speech signal, the idea is to exploit the possibility that different disorders will cause different acoustic changes within different phonetic contexts. Any differences in the pattern of effects across contexts would then provide additional information for discrimination of pathologies. We evaluate this approach using two complementary studies: the first uses a short phrase which is automatically annotated using a phonetic transcription, the second uses a long reading passage which is automatically annotated from text. The first study uses a single sentence recorded from 597 speakers in the Saarbrucken Voice Database to discriminate structural from neurogenic disorders. The results show that discrimination performance for these broad pathology classes improves from 59% to 67% unweighted average recall when classifiers are trained for each phone-label and the results fused. Although the phonetic contexts improved discrimination, the overall sensitivity and specificity of the method seems insufficient for clinical application. We hypothesise that this is because of the limited contexts in the speech audio and the heterogeneous nature of the disorders. In the second study we address these issues by processing recordings of a long reading passage obtained from clinical recordings of 60 speakers with either Spasmodic Dysphonia or Vocal fold Paralysis. We show that discrimination performance increases from 80% to 87% unweighted average recall if classifiers are trained for each phone-labelled region and predictions fused. We also show that the sensitivity and specificity of a diagnostic test with this performance is similar to other diagnostic procedures in clinical use. In conclusion, the studies confirm that the exploitation of contextual differences in the way disorders affect speech improves automated diagnostic performance, and that automated methods for phonetic annotation of reading passages are robust enough to extract useful diagnostic information

Objective automatic assessment of rehabilitative speech treatment in Parkinson's disease

Vocal performance degradation is a common symptom for the vast majority of Parkinson's disease (PD) subjects, who typically follow personalized one-to-one periodic rehabilitation meetings with speech experts over a long-term period. Recently, a novel computer program called Lee Silverman voice treatment (LSVT) Companion was developed to allow PD subjects to independently progress through a rehabilitative treatment session. This study is part of the assessment of the LSVT Companion, aiming to investigate the potential of using sustained vowel phonations towards objectively and automatically replicating the speech experts' assessments of PD subjects' voices as “acceptable” (a clinician would allow persisting during in-person rehabilitation treatment) or “unacceptable” (a clinician would not allow persisting during in-person rehabilitation treatment). We characterize each of the 156 sustained vowel /a/ phonations with 309 dysphonia measures, select a parsimonious subset using a robust feature selection algorithm, and automatically distinguish the two cohorts (acceptable versus unacceptable) with about 90% overall accuracy. Moreover, we illustrate the potential of the proposed methodology as a probabilistic decision support tool to speech experts to assess a phonation as “acceptable” or “unacceptable.” We envisage the findings of this study being a first step towards improving the effectiveness of an automated rehabilitative speech assessment tool

Models and analysis of vocal emissions for biomedical applications: 5th International Workshop: December 13-15, 2007, Firenze, Italy

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies. The Workshop has the sponsorship of: Ente Cassa Risparmio di Firenze, COST Action 2103, Biomedical Signal Processing and Control Journal (Elsevier Eds.), IEEE Biomedical Engineering Soc. Special Issues of International Journals have been, and will be, published, collecting selected papers from the conference

Assessing Parkinson’s Disease at Scale Using Telephone-Recorded Speech:Insights from the Parkinson’s Voice Initiative

Numerous studies have reported on the high accuracy of using voice tasks for the remote detection and monitoring of Parkinson’s Disease (PD). Most of these studies, however, report findings on a small number of voice recordings, often collected under acoustically controlled conditions, and therefore cannot scale at large without specialized equipment. In this study, we aimed to evaluate the potential of using voice as a population-based PD screening tool in resource-constrained settings. Using the standard telephone network, we processed 11,942 sustained vowel /a/ phonations from a US-English cohort comprising 1078 PD and 5453 control participants. We characterized each phonation using 304 dysphonia measures to quantify a range of vocal impairments. Given that this is a highly unbalanced problem, we used the following strategy: we selected a balanced subset (n = 3000 samples) for training and testing using 10-fold cross-validation (CV), and the remaining (unbalanced held-out dataset, n = 8942) samples for further model validation. Using robust feature selection methods we selected 27 dysphonia measures to present into a radial-basis-function support vector machine and demonstrated differentiation of PD participants from controls with 67.43% sensitivity and 67.25% specificity. These findings could help pave the way forward toward the development of an inexpensive, remote, and reliable diagnostic support tool for PD using voice as a digital biomarker

An algorithm for Parkinson's disease speech classification based on isolated words analysis

Introduction Automatic assessment of speech impairment is a cutting edge topic in Parkinson's disease (PD). Language disorders are known to occur several years earlier than typical motor symptoms, thus speech analysis may contribute to the early diagnosis of the disease. Moreover, the remote monitoring of dysphonia could allow achieving an effective follow-up of PD clinical condition, possibly performed in the home environment. Methods In this work, we performed a multi-level analysis, progressively combining features extracted from the entire signal, the voiced segments, and the on-set/off-set regions, leading to a total number of 126 features. Furthermore, we compared the performance of early and late feature fusion schemes, aiming to identify the best model configuration and taking advantage of having 25 isolated words pronounced by each subject. We employed data from the PC-GITA database (50 healthy controls and 50 PD patients) for validation and testing. Results We implemented an optimized k-Nearest Neighbours model for the binary classification of PD patients versus healthy controls. We achieved an accuracy of 99.4% in 10-fold cross-validation and 94.3% in testing on the PC-GITA database (average value of male and female subjects). Conclusion The promising performance yielded by our model confirms the feasibility of automatic assessment of PD using voice recordings. Moreover, a post-hoc analysis of the most relevant features discloses the option of voice processing using a simple smartphone application