Accuracy Assessment for AG500, Electromagnetic Articulograph

Purpose: The goal of this article was to evaluate the accuracy and reliability of the AG500 (Carstens Medizinelectronik, Lenglern, Germany), an electromagnetic device developed recently to register articulatory movements in three dimensions. This technology seems to have unprecedented capabilities to provide rich information about time-varying positions of articulators. However, strengths and weaknesses of the system need to be better understood before the device is used for speech research. Method: Evaluations of the sensor positions over time were obtained during (a) movements of the calibration device, (b) manual movements of sensors in a cartridge within the recording field of the cube, and (c) various speech tasks. Results: Results showed a median error to be under 0.5 mm across different types of recordings. The maximum error often ranged between 1 and 2 mm. The magnitude of error depended somewhat on the task but largely on the location of the sensors within the recording region of the cube. Conclusion: The performance of the system was judged as adequate for speech movement acquisition, provided that specific steps are taken for minimizing error during recording and for validating the quality of recorded data

Clinical Measures of Bulbar Dysfunction in ALS

Bulbar impairment represents a hallmark feature of Amyotrophic Lateral Sclerosis (ALS) that significantly impacts survival and quality of life. Speech and swallowing dysfunction are key contributors to the clinical heterogeneity of ALS and require well-timed and carefully coordinated interventions. The accurate clinical, radiological and electrophysiological assessment of bulbar dysfunction in ALS is one of the most multidisciplinary aspects of ALS care, requiring expert input from speech-language pathologists (SLPs), neurologists, otolaryngologists, augmentative alternative communication (AAC) specialists, dieticians, and electrophysiologists—each with their own evaluation strategies and assessment tools. The need to systematically evaluate the comparative advantages and drawbacks of various bulbar assessment instruments and to develop integrated assessment protocols is increasingly recognized. In this review, we provide a comprehensive appraisal of the most commonly utilized clinical tools for assessing and monitoring bulbar dysfunction in ALS based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) evaluation framework. Despite a plethora of assessment tools, considerable geographical differences exist in bulbar assessment practices and individual instruments exhibit considerable limitations. The gaps identified in the literature offer unique opportunities for the optimization of existing and development of new tools both for clinical and research applications. The multicenter validation and standardization of these instruments will be essential for guideline development and best practice recommendations

Estimation of Orofacial Kinematics in Parkinson's Disease: Comparison of 2D and 3D Markerless Systems for Motion Tracking

Orofacial deficits are common in people with Parkinson's disease (PD) and their evolution might represent an important biomarker of disease progression. We are developing an automated system for assessment of orofacial function in PD that can be used in-home or in-clinic and can provide useful and objective clinical information that informs disease management. Our current approach relies on color and depth cameras for the estimation of 3D facial movements. However, depth cameras are not commonly available, might be expensive, and require specialized software for control and data processing. The objective of this paper was to evaluate if depth cameras are needed to differentiate between healthy controls and PD patients based on features extracted from orofacial kinematics. Results indicate that 2D features, extracted from color cameras only, are as informative as 3D features, extracted from color and depth cameras, differentiating healthy controls from PD patients. These results pave the way for the development of a universal system for automatic and objective assessment of orofacial function in PD.Comment: 4 pages, 1 tabl

Assessing Oromotor Capacity in ALS: The Effect of a Fixed-Target Task on Lip Biomechanics

This work is licensed under a Creative Commons Attribution 4.0 International License.Alternating motion rate (AMR) is a standard measure often included in neurological examinations to assess orofacial neuromuscular integrity. AMR is typically derived from recordings of patients producing repetitions of a single syllable as fast and clear as possible on one breath. Because the task places high demands on oromotor performance, particularly articulatory speed, AMRs are widely considered to be tests of maximum performance and, therefore, likely to reveal underlying neurologic deficits. Despite decades of widespread use, biomechanical studies have shown that speakers often circumvent the presumed speed challenge of the standard AMR task. Specifically, speakers are likely to manipulate their displacements (movement amplitude) instead of speed because this strategy requires less motor effort. The current study examined the effectiveness of a novel fixed-target paradigm for minimizing the truncation of articulatory excursions and maximizing motor effort. We compared the standard AMR task to that of a fixed-target AMR task and focused specifically on the tasks' potential to detect decrements in lip motor performance in persons with dysarthria due to amyotrophic lateral sclerosis (ALS). Our participants were 14 healthy controls and 17 individuals with ALS. For the standard AMR task, participants were instructed to produce the syllable /bα/ as quickly and accurately as possible on one breath. For the fixed-target AMR task, participants were given the same instructions, but were also required to strike a physical target placed under the jaw during the opening phase of each syllable. Lip kinematic data were obtained using 3D electromagnetic articulography. 16 kinematic features were extracted using an algorithmic approach. Findings revealed that compared to the standard task, the fixed-target AMR task placed increased motor demands on the oromotor system by eliciting larger excursions, faster speeds, and greater spatiotemporal variability. In addition, participants with ALS exhibited limited ability to adapt to the higher articulatory demands of the fixed-target task. Between the two AMR tasks, the maximum speed during the fixed-target task showed a moderate association with the ALSFRS-R bulbar subscore. Employment of both standard and fixed-target AMR tasks is, however, needed for comprehensive assessment of oromotor function and for elucidating profiles of task adaptation

Predicting Speech Intelligibility Decline in Amyotrophic Lateral Sclerosis Based on the Deterioration of Individual Speech Subsystems

This research was supported by the following grants: National Institute of Health— National Institute of Deafness and Other Communication Disorders (http://www.nidcd.nih.gov/Pages/default.aspx) Grants R01 DC009890 & R01 DC0135470 (PI: JG); ALS Society of Canada (https://www.als.ca/en) Denise Ramsay Discovery Grant (PI:YY); Canadian Institute of Health Research (http:// www.cihr-irsc.gc.ca/e/47631.html) CIHR Planning Grant FRN126682 (PI: YY). The funders had no role n study design, data collection and analysis, decision to publish, or preparation of the manuscript.Purpose: To determine the mechanisms of speech intelligibility impairment due to neurologic impairments, intelligibility decline was modeled as a function of co-occurring changes in the articulatory, resonatory, phonatory, and respiratory subsystems. Method: Sixty-six individuals diagnosed with amyotrophic lateral sclerosis (ALS) were studied longitudinally. The disease-related changes in articulatory, resonatory, phonatory, and respiratory subsystems were quantified using multiple instrumental measures, which were subjected to a principal component analysis and mixed effects models to derive a set of speech subsystem predictors. A stepwise approach was used to select the best set of subsystem predictors to model the overall decline in intelligibility. Results: Intelligibility was modeled as a function of five predictors that corresponded to velocities of lip and jaw movements (articulatory), number of syllable repetitions in the alternating motion rate task (articulatory), nasal airflow (resonatory), maximum fundamental frequency (phonatory), and speech pauses (respiratory). The model accounted for 95.6% of the variance in intelligibility, among which the articulatory predictors showed the most substantial independent contribution (57.7%). Conclusion: Articulatory impairments characterized by reduced velocities of lip and jaw movements and resonatory impairments characterized by increased nasal airflow served as the subsystem predictors of the longitudinal decline of speech intelligibility in ALS. Declines in maximum performance tasks such as the alternating motion rate preceded declines in intelligibility, thus serving as early predictors of bulbar dysfunction. Following the rapid decline in speech intelligibility, a precipitous decline in maximum performance tasks subsequently occurred

Bulbar and speech motor assessment in ALS: Challenges and future directions

Bulbar motor deterioration due to amyotrophic lateral sclerosis (ALS) leads to the eventual impairment of speech and swallowing functions. Despite these devastating consequences, no standardized diagnostic procedure for assessing bulbar dysfunction in ALS exists and adequate objective markers of bulbar deterioration have not been identifi ed. In this paper, we consider objective measures of speech motor function, which show promise for forming the basis of a comprehensive, quantitative bulbar motor assessment in ALS. These measures are based on the assessment of four speech subsystems: respiratory, phonatory, articulatory, and resonatory. The goal of this research is to design a non-invasive, comprehensive bulbar motor assessment instrument intended for early detection, monitoring of disease progression, and clinical trial application. Preliminary data from an ongoing study of bulbar motor decline are presented, which demonstrate the potential clinical effi cacy of the speech subsystem approach

Face and content validation of the amyotrophic lateral sclerosis—Bulbar dysfunction index (ALS-BDI)

PurposeEarly detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Existing physiological assessments of bulbar dysfunction are often inaccessible and cost-prohibitive for clinical application. Existing clinical assessments are limited. The overall goal of our research is to develop a brief and reliable, clinician-administered assessment tool, the ALS Bulbar Dysfunction Index (ALS-BDI) to evaluate bulbar dysfunction. The aim of this study was to establish content and face validity of the ALS-BDI through item generation and reduction, including item scoring.MethodsThe design of the ALS-BDI followed guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The design stage of the ALS-BDI involved two steps: (Step 1) the generation of candidate items from a literature review of commonly used clinical tools, and selection of items following a review of item reliability and item relevance and expert consensus; (Step 2) the assessment of their content and face validity via online survey feedback from experts (n = 35). The initial design was followed by a semi-structured cognitive interview with Speech-Language Pathologists (n = 5) to finalize a testable draft of the instrument.ResultsTwo drafts of the ALS-BDI were developed. The first draft contained 48 items, after a review of existing clinical tools for their relevance to bulbar dysfunction in ALS. Of the 48 items, 35 items were retained after surveying experts and clinician users for their relevance, feasibility, interpretability, and appropriateness. The second draft of the ALS-BDI contained 37 items, due to one item splitting, based on users cognitive interviews.ConclusionsThe ALS-BDI described in this study aims to provide a brief and reliable, clinician-administered assessment tool to evaluate bulbar dysfunction in patients with ALS. Future research will evaluate the psychometric properties of this tool including its reliability, validity, and responsiveness to change over time

Bulbar and speech motor assessment in ALS: Challenges and future directions

Bulbar motor deterioration due to amyotrophic lateral sclerosis (ALS) leads to the eventual impairment of speech and swallowing functions. Despite these devastating consequences, no standardized diagnostic procedure for assessing bulbar dysfunction in ALS exists and adequate objective markers of bulbar deterioration have not been identifi ed. In this paper, we consider objective measures of speech motor function, which show promise for forming the basis of a comprehensive, quantitative bulbar motor assessment in ALS. These measures are based on the assessment of four speech subsystems: respiratory, phonatory, articulatory, and resonatory. The goal of this research is to design a non-invasive, comprehensive bulbar motor assessment instrument intended for early detection, monitoring of disease progression, and clinical trial application. Preliminary data from an ongoing study of bulbar motor decline are presented, which demonstrate the potential clinical effi cacy of the speech subsystem approach