The subject of this study is a multidimensional voice analysis in patients with Broca's
aphasia. The acoustic tests were done on twelve female patients with Broca's aphasia and
twelve female control subjects without speech and language disorders. Each subject was
asked to perform maximal vowel 'a' phonation. The several acoustic parameters were
analyzed. The Multi-dimensional Voice Program and Computerized Speech Lab were used.
The results showed that analyzed acoustic parameters in the Broca's aphasics are significantly
different from the acoustic characteristics of voice in control group of subjects. It
was pointed out that acoustic analysis of voice could have significance in the evaluation of
speech production deficits in Broca's aphasia

Petrović Lazić, Mirjana

Vuković, Mile

rFASPER - Repository of the Faculty of Special Education and Rehabilitation

UNIVERZITET U BEOGRADU FAKULTET ZA SPECIJALNU EDUKACIJU I REHABILITACIJU  UNIVERSITY OF BELGRADE FACULTY OF SPECIAL EDUCATION AND REHABILITATION     V međunarodni naučni skup SPECIJALNA EDUKACIJA I REHABILITACIJA DANAS Zlatibor, 24-27. septembar 2011.  The Fifth International Scientific Conference SPECIAL EDUCATION AND REHABILITATION TODAY Zlatibor, September, 24-27. 2011.  Zbornik radova Proceedings               Beograd, 2011. Belgrade, 2011 2│ SPECIJALNA EDUKACIJA I REHABILITACIJA DANAS SPECIAL EDUCATION AND REHABILITATION TODAY Zbornik radova Proceedings  V međunarodni naučni skup The Fifth International Scientific Conference Zlatibor, 24-27. septembar 2011.  Izdavač/Publisher: Univerzitet u Beogradu, Fakultet za specijalnu edukaciju i rehabilitaciju University of Belgrade, Faculty of Special Education and Rehabilitation Visokog Stevana 2, 11 000 Beograd www.fasper.bg.ac.rs  Za izdavača/For publisher: Prof. dr Jasmina Kovačević, dekan  Urednici: Prof. dr Nenad Glumbić, Doc. dr Vesna Vučinić  Štampa/Printing:  AKADEMIJA Beograd  Tiraž/Circulation: 300  ISBN               │291 UDC 376.1:616.89-008.434.5                                                                                                                                               616.89-008.434.5  MULTIDIMENSIONAL VOICE ANALYSIS IN PATIENTS WITH BROCA' S APHASIA1  Mile Vuković, Mirjana Petrović Lazić University of Belgrade, Faculty of Special Education and Rehabilitation  The subject of this study is a multidimensional voice analysis in patients with Broca's aphasia. The acoustic tests were done on twelve female patients with Broca's aphasia and twelve female control subjects without speech and language disorders. Each subject was asked to perform maximal vowel 'a' phonation. The several acoustic parameters were analyzed. The Multi-dimensional Voice Program and Computerized Speech Lab were used. The results showed that analyzed acoustic parameters in the Broca's aphasics are signifi-cantly different from the acoustic characteristics of voice in control group of subjects. It was pointed out that acoustic analysis of voice could have significance in the evaluation of speech production deficits in Broca's aphasia.  Key words: acoustic characteristics of voice, Broca's aphasia, speech production defi-cits    INTRODUCTION Damage to Broca’s area, motor and premotor regions, together with the underlying white matter, the basal ganglia, and the insula leads to Boca’s aphasia (Bradshaw and Mat-tingley, 1995; 2010). The core features of Broca’s aphasia include nonfluent, halting verbal output that is characterized by syntactically simplified sentences, reduced phrase length, a prosodic impairment and awkward articulation (Kearns, 1997; Vuković, 2010).  Measurement of acoustic voice parameters has been used in several studies for the ob-jective assessment of the nature of speech errors production in aphasic patients (Baum and Kim, 1997, Katz, 1988). Impairments in the production of both consonant and vowels have revealed. These data are mostly based on examination of sillables or utterances production, while examination of isolated vowels voicing in the aphasics, according to our knowledge, didn`t attract particular science attention. In view of the fact that some aphasic patients have severe impairement of speech pro-duction, which sometimes appear to be complete inability of voicing, our aim was to inve-stigate the measurements of acoustic voice parameters, using objective methods in patients with Broca’s aphasia.  METHOD Aphasic subjects. Twelve female patients aged from 37 to 67 years (mean: 56.7) with Broca’s aphasia who were at least 3 months post onset were selected to participate in the present study. Inclusion in the study was limited to those who had suffered a single cerebro-                              1 This research study was supported by the Ministry of Education and Science of the Republic of Serbia under project no. 179068  “Evaluation of Treatment of Acquired Speech and Language Disorders”.  292│ vascular accident resulting in a localized infarct. Patient selection was also restricted to tho-se without oral cavity anomalies, or prior speech, neurological and hearing impairment. All patients were native speakers of Serbian. Patients were diagnosed on the basis of clinical assessment reports and results of the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1983).   Table 1 –  Demographic and neurologic data of aphasic subjects Patient  Code Age Handedness history Time post onset (months) Site of lesion (CT or MRI) TIK  LIM 47 59 right-handed  right-handed 3 6 Left frontoparietal region  Left Sylvian region with  Ventricular displacement PAM  DEM  BAV 37 60 61 right-handed right-handed right-handed 4 4,5 3 Left MCA territory  Left frontoparietal region  Left motor cortex, nucleus  Caudate RIB 58 right-handed 5, 5 Left motor cortex, nucleus  Caudate, internal capsule  SOP 67 right-handed 5 Left Sylvian region with  Basal ganglia involvement GAD 57 right-handed 5 Left motor cortex, nucleus  Caudate, extending to anterior  KEN 63 right-handed 7 Limb of internal capsule Left frontal lobe lesion which extends to the anterior limb of the internal capsule, basal ganglia and insula RIS 54 right-handed 5 Left MCA territory DEG 62 right-handed 4 Left motor cortex, nucleus Caudate, internal capsule  MIT 56 right-handed 3 Left Sylvian region with  Basal ganglia involvement  Control subjects. The control group was composed of twelve female subjects ranging from 37 to 67 years in age (mean: 57. 1) who did not have any vocal complaints, laringeal  pathology, heraing disorder or history of neurological damage. All were native speakers of Serbian. The two groups were comparable with regard to age. No significant differences were found (p>0,05).  Procedure At first, all patients were examined by clinical aphasiologist. After that, they were examined by an otorhinolaryngologist and there was no evidence of laryngeal pathology. After both examinations, a voice recording was made. Multi-dimensional voice program, model 4300; Kay Elemetrics corp., Lincoln Park, NJ and Computerized Speech Lab ha-rdware for signal-acquisition analysis and interpretation of data were used. The research was carried out individualy while the subject seated in a quiet room. Digital voice recorder WS 2105 was placed at 5,0 cm distance from the patient's mauth. The patients were instructed to attempt to sustain the vowel /a/ at the optimal pitch level several times. As the patients became more skilled at pitch-level control and vocal pitch level became habitual, recording started. Each group repeated the sustained vowel /a/ at their habitual pitch and  │293 loudness level for at least three times, the token with median value being considered relevenat for the analysis. Acoustic voice parameters were recorded and saved as digital fi-le, on a laptop.  RESULTS The mean values and SDs of the acoustic voice parameters in the aphasic subjects and in the control group are presented in Table 2. The obtained values in the aphasic subjects were higher than in the control group. These groups differnces were statistically significant for the all parameters (P<0,05). A mi-nimal value of jitter was 1.890 and maximal value was 5.120. For shimer, these values were 2.120 and 8.182. In the control group, the minaimal value for jitter was  0.290 and the maximal  value was 0.780, and for shimmer, the values were 1.125  and 2.132 respectively.   Table 2 – Mean acoustic voice parameters of aphasic subjects and control group  Aphasic subjects (n =12) Control Group (n= 12 ) Difference Acoustic Voice  Parameters  Mean SD Mean  SD  Probability (P)  F0 (Hz) 185.676 14.019 243.727 0.645  0.01 Jitter (%) 2.692 3.233 0.359 0.156  0.05 Shimmer (%)  6.534 2.470 1.998 0.546  0.05 HNR 0.282 0.134 0.112 0.014  0.05  DISCUSSION Considering that Broca's aphasics frequently show complete inability of speech production in the acute phase, and that with improvement of speech abilities clinically are observed some voice variations, the main focus of this study was to collect acoustic analysis of voice in post-acute period. Our results sugested that voice quality is impaired in patients with Broca's aphasia. Higher mean values of all parameters were present in the aphasic subjects than in the control group. Increased values of jitter and shimmer are associated with changes in dysphonia and various laryngeal pathologies (Titze and Liang, 1993). Jitter refers cycle-to-cycle, short-term peturbation in the fundamental frequency of the voice, and describes how much a given pitch period differs form one or severall pitch periods that immediately precede or follow it (Key Elemetrics corporation, 1993). On the other side, shimmer values are related to waveform amplitude perturbation (Hauang et al., 1995).  Acoustic analysis of sustained vowel phonation showed higher habitual Fo values (200. 015) compared with a standard male voice. Increased vallues of jitter (3.796) and shimmer (3.647) are evidence of unperiodical vocal fold vibrations. The differnces in values for hramonic-to- noise ratio compared with controls suggest that Broca's aphasics have an insufficiency of glottal closure. In the absence of any laringeal pathology detected by an otorinolaringologist, it can be presume that the higher Fo frequency is to the neurological damage.  It was shown that anterior aphasics have deficits in laringeal control for voicing (Baum et al., 1990), and deficits of larinegal timing or coordination with the supralaryngeal vocal tract (Kurowski et al, 2003). Classical approaches have generally characterized phonetic/ articulatory impairments as occuring in patients with lesion involving both cortical and  294│ subcortical structure that are suprasylvian and anterior to the central sulcus (Damassio, 1991). The presence of both cortical and subcortical lesions in patients who participated in this study perhaps could explain increased values of jitter and shimmer.  CONCLUSION Results of this study have showed that patients with Broca's aphasia have increased values of all examined voice parameters. Therefore, this results suggest that variations in quality of voice, at least in some stages, may be an integral part of clinical picture of Broca's aphasia, wich has to be considered during evaluation of speech production deficits. In order to reveal the nature of voice imapirments in patients with Broca's aphasia, it is necessary to investigate precize correlation analyses of site and extent of brain lesion versus  deviations of vocal parameters, which wasn`t conducted in present study.   REFERENCES 1. Baum, S. R., and Kim, J.A. (1997). Compensation for jaw fixation by aphasic patients. Brain and language, 56, 354-376. 2. Baum, S., Blumstein, S., Naeser, M. and Palumbo, C. (1990). Temporal dimensions of consonant and vowel production: An acoustic and CT scan analysis of  aphasic speech. Brain and language., 39, 33-56.  3. Bradshaw, J. L. and J.B.Mattingley (1995). Clinical neuropsychology: Bihevioral and brain sciences. San Diego: Academic press. 4. Damasio, H. (1991). Neuronatomical correlates of the aphasia. In M.T. Sarno (Ed.), Acquired aphasia. New York: Academic Press, Second edition.  5. Goodglass, H. And Kaplan E. (1983). The assessment of aphasia and related disorders. Philadelphia: Lea & Febiger.  6. Hauang, Z., Minife, F. Kasuya, H. Lin X. (1995).Measures of vocal function during change in vocal effort level. J Voice, 9 (4): 429-38. 7. Katz., W.F. (1988). Anticipatory coarticulation in aphasia: Acoustic and perceptual data. Barin and language, 35, 340-368.  8. Kearns K. P. (1997). Broca's aphasia. In L.L. LaPointe (Ed.), Aphasia and related neu-rogenic language disorders. New York: Thieme, Second edition. 9. Key Elemetrics corporation (1993). MDVF Manual Version 2.7.0. Lincoln Park, NJ: Kay Elemetrics. 10. Kurowski, K., Hazen, E, and Blumstein, S. (2003). The nature of speech production impairments in anterior aphasics: An acoustic analysis of voicing in fricative consonants. Brain and Language, 84, 353-371. 11. Titze, IR, Liang, H. (1993). Comparison of Fo extraction methods for high-precision voice perturbation measurements. J. Speech Hear Res, 36 (6): 1120. 12. Vukovic, M. (2010). Aphasiology, second edition. Beograd: Arhipelag. In Serbian    

Multidimensional voice analysis in patients with Broca' s aphasia

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Multidimensional voice analysis in patients with Broca' s aphasia

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