Exploring differences between phonetic classes in Sleep Apnoea Syndrome Patients using automatic speech processing techniques

This work is part of an on-going collaborative project between the medical and signal processing communities to promote new research efforts on automatic OSA (Obstructive Apnea Syndrome) diagnosis. In this paper, we explore the differences noted in phonetic classes (interphoneme) across groups (control/apnoea) and analyze their utility for OSA detectio

Retainer-Free Optopalatographic Device Design and Evaluation as a Feedback Tool in Post-Stroke Speech and Swallowing Therapy

Stroke is one of the leading causes of long-term motor disability, including oro-facial impairments which affect speech and swallowing. Over the last decades, rehabilitation programs have evolved from utilizing mainly compensatory measures to focusing on recovering lost function. In the continuing effort to improve recovery, the concept of biofeedback has increasingly been leveraged to enhance self-efficacy, motivation and engagement during training. Although both speech and swallowing disturbances resulting from oro-facial impairments are frequent sequelae of stroke, efforts to develop sensing technologies that provide comprehensive and quantitative feedback on articulator kinematics and kinetics, especially those of the tongue, and specifically during post-stroke speech and swallowing therapy have been sparse. To that end, such a sensing device needs to accurately capture intraoral tongue motion and contact with the hard palate, which can then be translated into an appropriate form of feedback, without affecting tongue motion itself and while still being light-weight and portable. This dissertation proposes the use of an intraoral sensing principle known as optopalatography to provide such feedback while also exploring the design of optopalatographic devices itself for use in dysphagia and dysarthria therapy. Additionally, it presents an alternative means of holding the device in place inside the oral cavity with a newly developed palatal adhesive instead of relying on dental retainers, which previously limited device usage to a single person. The evaluation was performed on the task of automatically classifying different functional tongue exercises from one another with application in dysphagia therapy, whereas a phoneme recognition task was conducted with application in dysarthria therapy. Results on the palatal adhesive suggest that it is indeed a valid alternative to dental retainers when device residence time inside the oral cavity is limited to several tens of minutes per session, which is the case for dysphagia and dysarthria therapy. Functional tongue exercises were classified with approximately 61 % accuracy across subjects, whereas for the phoneme recognition task, tense vowels had the highest recognition rate, followed by lax vowels and consonants. In summary, retainer-free optopalatography has the potential to become a viable method for providing real-time feedback on tongue movements inside the oral cavity, but still requires further improvements as outlined in the remarks on future development.:1 Introduction 1.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Problem statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Goals and contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.4 Scope and limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Basics of post-stroke speech and swallowing therapy 2.1 Dysarthria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Treatment rationale and potential of biofeedback . . . . . . . . . . . . . . . . . 13 2.4 Summary and conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3 Tongue motion sensing 3.1 Contact-based methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3.1.1 Electropalatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3.1.2 Manometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3.1.3 Capacitive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3.2 Non-contact based methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.2.1 Electromagnetic articulography . . . . . . . . . . . . . . . . . . . . . . . 23 3.2.2 Permanent magnetic articulography . . . . . . . . . . . . . . . . . . . . 24 3.2.3 Optopalatography (related work) . . . . . . . . . . . . . . . . . . . . . . 25 3.3 Electro-optical stomatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.4 Extraoral sensing techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.5 Summary, comparison and conclusion . . . . . . . . . . . . . . . . . . . . . . . 29 4 Fundamentals of optopalatography 4.1 Important radiometric quantities . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.1.1 Solid angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.1.2 Radiant flux and radiant intensity . . . . . . . . . . . . . . . . . . . . . 33 4.1.3 Irradiance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.1.4 Radiance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.2 Sensing principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 4.2.1 Analytical models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 4.2.2 Monte Carlo ray tracing methods . . . . . . . . . . . . . . . . . . . . . . 37 4.2.3 Data-driven models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 4.2.4 Model comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.3 A priori device design consideration . . . . . . . . . . . . . . . . . . . . . . . . 41 4.3.1 Optoelectronic components . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.3.2 Additional electrical components and requirements . . . . . . . . . . . . 43 4.3.3 Intraoral sensor layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 5 Intraoral device anchorage 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 5.1.1 Mucoadhesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 5.1.2 Considerations for the palatal adhesive . . . . . . . . . . . . . . . . . . . 48 5.2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 5.2.1 Polymer selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 5.2.2 Fabrication method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5.2.3 Formulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5.2.4 PEO tablets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5.2.5 Connection to the intraoral sensor’s encapsulation . . . . . . . . . . . . 50 5.2.6 Formulation evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3.1 Initial formulation evaluation . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3.2 Final OPG adhesive formulation . . . . . . . . . . . . . . . . . . . . . . 56 5.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 6 Initial device design with application in dysphagia therapy 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.2 Optode and optical sensor selection . . . . . . . . . . . . . . . . . . . . . . . . . 60 6.2.1 Optode and optical sensor evaluation procedure . . . . . . . . . . . . . . 61 6.2.2 Selected optical sensor characterization . . . . . . . . . . . . . . . . . . 62 6.2.3 Mapping from counts to millimeter . . . . . . . . . . . . . . . . . . . . . 62 6.2.4 Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 6.3 Device design and hardware implementation . . . . . . . . . . . . . . . . . . . . 64 6.3.1 Block diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 6.3.2 Optode placement and circuit board dimensions . . . . . . . . . . . . . 64 6.3.3 Firmware description and measurement cycle . . . . . . . . . . . . . . . 66 6.3.4 Encapsulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6.3.5 Fully assembled OPG device . . . . . . . . . . . . . . . . . . . . . . . . 67 6.4 Evaluation on the gesture recognition task . . . . . . . . . . . . . . . . . . . . . 69 6.4.1 Exercise selection, setup and recording . . . . . . . . . . . . . . . . . . . 69 6.4.2 Data corpus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 6.4.3 Sequence pre-processing . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 6.4.4 Choice of classifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.4.5 Training and evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 6.4.6 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7 Improved device design with application in dysarthria therapy 7.1 Device design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.1.1 Design considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 7.1.2 General system overview . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1.3 Intraoral sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1.4 Receiver and controller . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 7.1.5 Multiplexer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.2 Hardware implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.2.1 Optode placement and circuit board layout . . . . . . . . . . . . . . . . 87 7.2.2 Encapsulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 7.3 Device characterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 7.3.1 Photodiode transient response . . . . . . . . . . . . . . . . . . . . . . . 91 7.3.2 Current source and rise time . . . . . . . . . . . . . . . . . . . . . . . . 91 7.3.3 Multiplexer switching speed . . . . . . . . . . . . . . . . . . . . . . . . . 92 7.3.4 Measurement cycle and firmware implementation . . . . . . . . . . . . . 93 7.3.5 In vitro measurement accuracy . . . . . . . . . . . . . . . . . . . . . . . 95 7.3.6 Optode measurement stability . . . . . . . . . . . . . . . . . . . . . . . 96 7.4 Evaluation on the phoneme recognition task . . . . . . . . . . . . . . . . . . . . 98 7.4.1 Corpus selection and recording setup . . . . . . . . . . . . . . . . . . . . 98 7.4.2 Annotation and sensor data post-processing . . . . . . . . . . . . . . . . 98 7.4.3 Mapping from counts to millimeter . . . . . . . . . . . . . . . . . . . . . 99 7.4.4 Classifier and feature selection . . . . . . . . . . . . . . . . . . . . . . . 100 7.4.5 Evaluation paradigms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 7.5 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 7.5.1 Tongue distance curve prediction . . . . . . . . . . . . . . . . . . . . . . 105 7.5.2 Tongue contact patterns and contours . . . . . . . . . . . . . . . . . . . 105 7.5.3 Phoneme recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 7.6 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 8 Conclusion and future work 115 9 Appendix 9.1 Analytical light transport models . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.2 Meshed Monte Carlo method . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 9.3 Laser safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 9.4 Current source modulation voltage . . . . . . . . . . . . . . . . . . . . . . . . . 123 9.5 Transimpedance amplifier’s frequency responses . . . . . . . . . . . . . . . . . . 123 9.6 Initial OPG device’s PCB layout and circuit diagrams . . . . . . . . . . . . . . 127 9.7 Improved OPG device’s PCB layout and circuit diagrams . . . . . . . . . . . . 129 9.8 Test station layout drawing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Bibliography 152Der Schlaganfall ist eine der häufigsten Ursachen für motorische Langzeitbehinderungen, einschließlich solcher im Mund- und Gesichtsbereich, deren Folgen u.a. Sprech- und Schluckprobleme beinhalten, welche sich in den beiden Symptomen Dysarthrie und Dysphagie äußern. In den letzten Jahrzehnten haben sich Rehabilitationsprogramme für die Behandlung von motorisch ausgeprägten Schlaganfallsymptomatiken substantiell weiterentwickelt. So liegt nicht mehr die reine Kompensation von verlorengegangener motorischer Funktionalität im Vordergrund, sondern deren aktive Wiederherstellung. Dabei hat u.a. die Verwendung von sogenanntem Biofeedback vermehrt Einzug in die Therapie erhalten, um Motivation, Engagement und Selbstwahrnehmung von ansonsten unbewussten Bewegungsabläufen seitens der Patienten zu fördern. Obwohl jedoch Sprech- und Schluckstörungen eine der häufigsten Folgen eines Schlaganfalls darstellen, wird diese Tatsache nicht von der aktuellen Entwicklung neuer Geräte und Messmethoden für quantitatives und umfassendes Biofeedback reflektiert, insbesondere nicht für die explizite Erfassung intraoraler Zungenkinematik und -kinetik und für den Anwendungsfall in der Schlaganfalltherapie. Ein möglicher Grund dafür liegt in den sehr strikten Anforderungen an ein solche Messmethode: Sie muss neben Portabilität idealerweise sowohl den Kontakt zwischen der Zunge und dem Gaumen, als auch die dreidimensionale Bewegung der Zunge in der Mundhöhle erfassen, ohne dabei die Artikulation selbst zu beeinflussen. Um diesen Anforderungen gerecht zu werden, wird in dieser Dissertation das Messprinzip der Optopalatographie untersucht, mit dem Schwerpunkt auf der Anwendung in der Dysarthrie- und Dysphagietherapie. Dies beinhaltet auch die Entwicklung eines entsprechenden Gerätes sowie dessen Befestigungsmethode in der Mundhöhle über ein dediziertes Mundschleimhautadhäsiv. Letzteres umgeht das bisherige Problem der notwendigen Anpassung eines solchen intraoralen Gerätes an einen einzelnen Nutzer. Für die Anwendung in der Dysphagietherapie erfolgte die Evaluation anhand einer automatischen Erkennung von Mobilisationsübungen der Zunge, welche routinemäßig in der funktionalen Dysphagietherapie durchgeführt werden. Für die Anwendung in der Dysarthrietherapie wurde eine Lauterkennung durchgeführt. Die Resultate bezüglich der Verwendung des Mundschleimhautadhäsives suggerieren, dass dieses tatsächlich eine valide Alternative zu den bisher verwendeten Techniken zur Befestigung intraoraler Geräte in der Mundhöhle darstellt. Zungenmobilisationsübungen wurden über Probanden hinweg mit einer Rate von 61 % erkannt, wogegen in der Lauterkennung Langvokale die höchste Erkennungsrate erzielten, gefolgt von Kurzvokalen und Konsonanten. Zusammenfassend lässt sich konstatieren, dass das Prinzip der Optopalatographie eine ernstzunehmende Option für die intraorale Erfassung von Zungenbewegungen darstellt, wobei weitere Entwicklungsschritte notwendig sind, welche im Ausblick zusammengefasst sind.:1 Introduction 1.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Problem statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Goals and contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.4 Scope and limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Basics of post-stroke speech and swallowing therapy 2.1 Dysarthria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Treatment rationale and potential of biofeedback . . . . . . . . . . . . . . . . . 13 2.4 Summary and conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3 Tongue motion sensing 3.1 Contact-based methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3.1.1 Electropalatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3.1.2 Manometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3.1.3 Capacitive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3.2 Non-contact based methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.2.1 Electromagnetic articulography . . . . . . . . . . . . . . . . . . . . . . . 23 3.2.2 Permanent magnetic articulography . . . . . . . . . . . . . . . . . . . . 24 3.2.3 Optopalatography (related work) . . . . . . . . . . . . . . . . . . . . . . 25 3.3 Electro-optical stomatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.4 Extraoral sensing techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.5 Summary, comparison and conclusion . . . . . . . . . . . . . . . . . . . . . . . 29 4 Fundamentals of optopalatography 4.1 Important radiometric quantities . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.1.1 Solid angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.1.2 Radiant flux and radiant intensity . . . . . . . . . . . . . . . . . . . . . 33 4.1.3 Irradiance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.1.4 Radiance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.2 Sensing principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 4.2.1 Analytical models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 4.2.2 Monte Carlo ray tracing methods . . . . . . . . . . . . . . . . . . . . . . 37 4.2.3 Data-driven models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 4.2.4 Model comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.3 A priori device design consideration . . . . . . . . . . . . . . . . . . . . . . . . 41 4.3.1 Optoelectronic components . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.3.2 Additional electrical components and requirements . . . . . . . . . . . . 43 4.3.3 Intraoral sensor layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 5 Intraoral device anchorage 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 5.1.1 Mucoadhesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 5.1.2 Considerations for the palatal adhesive . . . . . . . . . . . . . . . . . . . 48 5.2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 5.2.1 Polymer selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 5.2.2 Fabrication method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5.2.3 Formulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5.2.4 PEO tablets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5.2.5 Connection to the intraoral sensor’s encapsulation . . . . . . . . . . . . 50 5.2.6 Formulation evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3.1 Initial formulation evaluation . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3.2 Final OPG adhesive formulation . . . . . . . . . . . . . . . . . . . . . . 56 5.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 6 Initial device design with application in dysphagia therapy 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.2 Optode and optical sensor selection . . . . . . . . . . . . . . . . . . . . . . . . . 60 6.2.1 Optode and optical sensor evaluation procedure . . . . . . . . . . . . . . 61 6.2.2 Selected optical sensor characterization . . . . . . . . . . . . . . . . . . 62 6.2.3 Mapping from counts to millimeter . . . . . . . . . . . . . . . . . . . . . 62 6.2.4 Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 6.3 Device design and hardware implementation . . . . . . . . . . . . . . . . . . . . 64 6.3.1 Block diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 6.3.2 Optode placement and circuit board dimensions . . . . . . . . . . . . . 64 6.3.3 Firmware description and measurement cycle . . . . . . . . . . . . . . . 66 6.3.4 Encapsulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6.3.5 Fully assembled OPG device . . . . . . . . . . . . . . . . . . . . . . . . 67 6.4 Evaluation on the gesture recognition task . . . . . . . . . . . . . . . . . . . . . 69 6.4.1 Exercise selection, setup and recording . . . . . . . . . . . . . . . . . . . 69 6.4.2 Data corpus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 6.4.3 Sequence pre-processing . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 6.4.4 Choice of classifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.4.5 Training and evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 6.4.6 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7 Improved device design with application in dysarthria therapy 7.1 Device design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.1.1 Design considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 7.1.2 General system overview . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1.3 Intraoral sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1.4 Receiver and controller . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 7.1.5 Multiplexer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.2 Hardware implementation . . . . . . . . . . . . . . . . . . . . .

Identification of voice pathologies in an elderly population

Ageing is associated with an increased risk of developing diseases, including a greater pre- disposition to develop diseases such as Sepsis. Also, with ageing, human voices undergo a natural degradation gauged by alterations in hoarseness, breathiness, articulatory ability, and speaking rate. Nowadays, perceptual evaluation is widely used to assess speech and voice impairments despite its high subjectivity. This dissertation proposes a new method for detecting and identifying voice patholo- gies by exploring acoustic parameters of continuous speech signals in the elderly popula- tion. Additionally, a study of the influence of gender and age on voice pathology detection systems’ performance is conducted. The study included 44 subjects older than 60 years old, with the pathologies Dyspho- nia, Functional Dysphonia, and Spasmodic Dysphonia. In the dataset originated with these settings, two gender-dependent subsets were created, one with only female samples and the other with only male samples. The system developed used three feature selection methods and five Machine Learning algorithms to classify the voice signal according to the presence of pathology. The binary classification, which consisted of voice pathology detection, reached an accuracy of 85,1%±5,1% for the dataset without gender division, 83,7%±7,0% for the male dataset, and 87,4%±4,2% for the female dataset. As for the multiclass classifica- tion, which consisted of the classification of different pathologies, reached an accuracy of 69,0%±5,1% for the dataset without gender division, 63,7%± 5,4% for the male dataset, and 80,6%±8,1% for the female dataset. The obtained results revealed that features that describe fluency are important and discriminating in these types of systems. Also, Random Forest has shown to be the most effective Machine Learning algorithm for both binary and multiclass classification. The proposed model proves to be promising in detecting pathological voices and identifying the underlying pathology in an elderly population, with an increase in its performance when a gender division is performed.O envelhecimento está associado a um maior risco de desenvolvimento de doenças, nome- adamente a uma maior predisposição para a evolução de doenças como a Sepsis. Inclusiva- mente, com o envelhecimento, a voz sofre uma degradação natural aferindo-se alterações na rouquidão, respiração, capacidade articulatória e no ritmo do discurso. Atualmente, a avaliação percetual é amplamente utilizada para avaliar as perturbações da fala e da voz, possuindo elevada subjetividade. Esta dissertação propõe um novo método de deteção e identificação de patologias da voz através da exploração de parâmetros acústicos de sinais de fala contínua na população idosa. Adicionalmente, é realizado um estudo da influência do género e da idade no desempenho dos sistemas de detecção de patologias da voz. A amostra deste estudo é composta por 44 indivíduos com idades superiores a 60 anos referentes às patologias Disfonia, Disfonia Funcional e Disfonia Espasmódica. No conjunto de dados originados com esta configuração, foram criados dois subconjuntos de- pendentes do género: um com apenas amostras femininas e o outro com apenas amostras masculinas. O sistema desenvolvido utilizou três métodos de seleção de atributos e cinco algoritmos de Aprendizagem Automática de modo a classificar o sinal de voz de acordo com a presença de patologias da voz. A deteção de patologia de voz alcançou uma exatidão de 85,1%±5,1% para os da- dos sem divisão de género, 83,7%±7,0% para os dados masculinos, e 87,4%±4,2% para os dados femininos. A classificação de diferentes patologias alcançou uma exatidão de 69,0%±5,1% para os dados sem divisão de género, 63,7%±5,4% para os dados masculinos, e 80,6%±8,1% para os dados femininos. Os resultados obtidos revelaram que os atributos que caracterizam a fluência são importantes e discriminatórios nestes tipos de sistemas. Ademais, o classificador Random Forest demonstrou ser o algoritmo mais eficaz na deteção e identificação de patologias da voz. O modelo proposto revelou-se promissor na deteção de vozes patológicas e identifi- cação da patologia subjacente numa população idosa, aumentando o seu desempenho quando ocorre uma divisão de género

Graph-based Estimation of Information Divergence Functions

abstract: Information divergence functions, such as the Kullback-Leibler divergence or the Hellinger distance, play a critical role in statistical signal processing and information theory; however estimating them can be challenge. Most often, parametric assumptions are made about the two distributions to estimate the divergence of interest. In cases where no parametric model fits the data, non-parametric density estimation is used. In statistical signal processing applications, Gaussianity is usually assumed since closed-form expressions for common divergence measures have been derived for this family of distributions. Parametric assumptions are preferred when it is known that the data follows the model, however this is rarely the case in real-word scenarios. Non-parametric density estimators are characterized by a very large number of parameters that have to be tuned with costly cross-validation. In this dissertation we focus on a specific family of non-parametric estimators, called direct estimators, that bypass density estimation completely and directly estimate the quantity of interest from the data. We introduce a new divergence measure, the $D_p$-divergence, that can be estimated directly from samples without parametric assumptions on the distribution. We show that the $D_p$-divergence bounds the binary, cross-domain, and multi-class Bayes error rates and, in certain cases, provides provably tighter bounds than the Hellinger divergence. In addition, we also propose a new methodology that allows the experimenter to construct direct estimators for existing divergence measures or to construct new divergence measures with custom properties that are tailored to the application. To examine the practical efficacy of these new methods, we evaluate them in a statistical learning framework on a series of real-world data science problems involving speech-based monitoring of neuro-motor disorders.Dissertation/ThesisDoctoral Dissertation Electrical Engineering 201

Developing a large scale population screening tool for the assessment of Parkinson's disease using telephone-quality voice

Recent studies have demonstrated that analysis of laboratory-quality voice recordings can be used to accurately differentiate people diagnosed with Parkinson's disease (PD) from healthy controls (HC). These findings could help facilitate the development of remote screening and monitoring tools for PD. In this study, we analyzed 2759 telephone-quality voice recordings from 1483 PD and 15321 recordings from 8300 HC participants. To account for variations in phonetic backgrounds, we acquired data from seven countries. We developed a statistical framework for analyzing voice, whereby we computed 307 dysphonia measures that quantify different properties of voice impairment, such as, breathiness, roughness, monopitch, hoarse voice quality, and exaggerated vocal tremor. We used feature selection algorithms to identify robust parsimonious feature subsets, which were used in combination with a Random Forests (RF) classifier to accurately distinguish PD from HC. The best 10-fold cross-validation performance was obtained using Gram-Schmidt Orthogonalization (GSO) and RF, leading to mean sensitivity of 64.90% (standard deviation, SD 2.90%) and mean specificity of 67.96% (SD 2.90%). This large-scale study is a step forward towards assessing the development of a reliable, cost-effective and practical clinical decision support tool for screening the population at large for PD using telephone-quality voice.Comment: 43 pages, 5 figures, 6 table

Robust and language-independent acoustic features in Parkinson's disease

Introduction: The analysis of vocal samples from patients with Parkinson's disease (PDP) can be relevant in supporting early diagnosis and disease monitoring. Intriguingly, speech analysis embeds several complexities influenced by speaker characteristics (e.g., gender and language) and recording conditions (e.g., professional microphones or smartphones, supervised, or non-supervised data collection). Moreover, the set of vocal tasks performed, such as sustained phonation, reading text, or monologue, strongly affects the speech dimension investigated, the feature extracted, and, as a consequence, the performance of the overall algorithm. Methods: We employed six datasets, including a cohort of 176 Healthy Control (HC) participants and 178 PDP from different nationalities (i.e., Italian, Spanish, Czech), recorded in variable scenarios through various devices (i.e., professional microphones and smartphones), and performing several speech exercises (i.e., vowel phonation, sentence repetition). Aiming to identify the effectiveness of different vocal tasks and the trustworthiness of features independent of external co-factors such as language, gender, and data collection modality, we performed several intra- and inter-corpora statistical analyses. In addition, we compared the performance of different feature selection and classification models to evaluate the most robust and performing pipeline. Results: According to our results, the combined use of sustained phonation and sentence repetition should be preferred over a single exercise. As for the set of features, the Mel Frequency Cepstral Coefficients demonstrated to be among the most effective parameters in discriminating between HC and PDP, also in the presence of heterogeneous languages and acquisition techniques. Conclusion: Even though preliminary, the results of this work can be exploited to define a speech protocol that can effectively capture vocal alterations while minimizing the effort required to the patient. Moreover, the statistical analysis identified a set of features minimally dependent on gender, language, and recording modalities. This discloses the feasibility of extensive cross-corpora tests to develop robust and reliable tools for disease monitoring and staging and PDP follow-up

Models and Analysis of Vocal Emissions for Biomedical Applications

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

Non-invasive electrophysiological assessment of the corticospinal tract in health and disease

PhD ThesisTo date, no candidate markers of upper motor neuron (UMN) function have performed sufficiently well to enter widespread clinical use, and the lack of such markers impedes both the diagnostic process and clinical trials in motor neuron disease (MND). We studied 15-30Hz intermuscular coherence (IMC), a novel marker of UMN function, and central motor conduction time (CMCT), an established marker of UMN function based on transcranial magnetic stimulation (TMS), in healthy volunteers and patients newly diagnosed with MND. To clarify the relative contributions of different parts of the motor system to IMC generation, we examined IMC in patients with longstanding diagnoses of hereditary spastic paraparesis (HSP), multifocal motor neuropathy (MMN) and inclusion body myositis (IBM). Previous studies reported conflicting results for the relationship between CMCT and predictors such as age and height. We only found a significant correlation between lower limb CMCT and height. IMC did not vary significantly with age, allowing data from healthy subjects across all ages to be pooled into a single normative dataset. The variability of IMC between subjects was considerable, and within a given subject variability was greater between than within recording sessions; potential contributors are discussed. Anodal transcranial direct current stimulation (tDCS) caused a significant increase in IMC, but interindividual variability was substantial, which might hinder its future use as an adjunct to IMC. To compare individual disease groups to the normal cohort, we evaluated the area under the receiver-operating characteristic curve (AUC). IMC generally matched or exceeded the performance of CMCT in discriminating patients with MND from normal, achieving AUCs of 0.83 in the upper and 0.79 in the lower limb. Previous evidence suggests that IMC abnormalities are primarily attributable to corticospinal tract (CST) dysfunction. In line with this, most patients with HSP exhibited diminished IMC. However, patients with MMN also showed decreased IMC, suggesting either that subclinical CST involvement was present or that dysfunction of lower motor neurons (LMNs) may affect IMC; clarification through computational modelling is suggested. In iii IBM, IMC was generally increased, which might reflect that the altered motor unit discharge pattern makes synchronisation more readily detectable. IMC appears to be a promising marker of CST function. It remains to be clarified how strongly it is influenced by LMN lesions, and optimisation of methods should help to minimise the variability of results. Since IMC is non-invasive and can be measured using commonly available EMG equipment, wider dissemination should prove straightforward.Wellcome Trus

Robust and language-independent acoustic features in Parkinson's disease

IntroductionThe analysis of vocal samples from patients with Parkinson's disease (PDP) can be relevant in supporting early diagnosis and disease monitoring. Intriguingly, speech analysis embeds several complexities influenced by speaker characteristics (e.g., gender and language) and recording conditions (e.g., professional microphones or smartphones, supervised, or non-supervised data collection). Moreover, the set of vocal tasks performed, such as sustained phonation, reading text, or monologue, strongly affects the speech dimension investigated, the feature extracted, and, as a consequence, the performance of the overall algorithm.MethodsWe employed six datasets, including a cohort of 176 Healthy Control (HC) participants and 178 PDP from different nationalities (i.e., Italian, Spanish, Czech), recorded in variable scenarios through various devices (i.e., professional microphones and smartphones), and performing several speech exercises (i.e., vowel phonation, sentence repetition). Aiming to identify the effectiveness of different vocal tasks and the trustworthiness of features independent of external co-factors such as language, gender, and data collection modality, we performed several intra- and inter-corpora statistical analyses. In addition, we compared the performance of different feature selection and classification models to evaluate the most robust and performing pipeline.ResultsAccording to our results, the combined use of sustained phonation and sentence repetition should be preferred over a single exercise. As for the set of features, the Mel Frequency Cepstral Coefficients demonstrated to be among the most effective parameters in discriminating between HC and PDP, also in the presence of heterogeneous languages and acquisition techniques.ConclusionEven though preliminary, the results of this work can be exploited to define a speech protocol that can effectively capture vocal alterations while minimizing the effort required to the patient. Moreover, the statistical analysis identified a set of features minimally dependent on gender, language, and recording modalities. This discloses the feasibility of extensive cross-corpora tests to develop robust and reliable tools for disease monitoring and staging and PDP follow-up

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy