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Articulatory Deficits in Parkinsonian Dysarthria: an Acoustic Analysis

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Articulatory Deficits in Parkinsonian Dysarthria: an Acoustic Analysis Journal ofNeurology, Neurosurgery, and Psychiatry 1991;54:1093-1098 1093 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.54.12.1093 on 1 December 1991. Downloaded from Articulatory deficits in Parkinsonian dysarthria: an acoustic analysis H Ackermann, W Ziegler Abstract with increased articulatory effort."8 This raises Twelve patients with idiopathic Parkin- the question of how far patients with PD are son's disease had acoustic speech analysis able to produce such extra effort, suggesting of sentence utterances to provide infor- that sentence utterances rather than simple mation on speech tempo and accuracy of repetitive oral movements ought to be used in articulation. As a measure of rate of investigating Parkinsonian dysarthria. speech the duration of opening-closing We used acoustic data for the description of movements during articulation was hypokinesia and bradykinesia within the determined from speech wave variables. speech motor system of patients with PD. The intensity of sound emission during Acoustic analysis was based on variables articulatory closure as required for stop characterising the sound wave emitted during consonant production, for example, /p/, speaking and allows limited inferences about /t/, /k/, was used as an index of the degree articulatory features. A sentence repetition of closure. Speech tempo was not signifi- paradigm was used to approximate most closely cantly different from normal. The patien- the conditions ofnatural speech to ascertain the ts, however, had a reduced capacity of effectiveness of certain linguistic constraints, completing articulatory occlusion. This that is, sentence accent, on speech movements was interpreted as reflecting a reduction in Parkinsonian dysarthria. in movement amplitude of the articulators. Articulatory "undershoot" was not uniform but influenced by lin- Subjects and methods guistic demands in that the closures Subjects associated with a stressed syllable were Twelve patients with idiopathic Parkinson's performed at the expense of unstressed disease (seven men, five women, 47 to 76 years, ones. Furthermore, switching between median 62 years) participated in this study. opening and closing movements of the The clinical data are presented in the table. All articulators in sentence production patients were on drug therapy; none had seemed undisturbed. These results positive signs of dementia at psychopatho- indicate that motor planning of speech logical examination. The range ofoverall motor http://jnnp.bmj.com/ differs from arm movement control. impairment at the time of speech evaluation extended from slight akinetic-rigid states to severe disability. Two patients suffered from The motor deficits of hypokinesia (reduced levodopa induced on/off fluctuations; in both, range of simple limb movements with con- the speech recordings were obtained during the sequent target undershooting) and bradykin- offstate. The control group included 12 "young esia (slowness of movements) are characteristic normals" (seven men, five women, 19 to 35 of Parkinson's disease (PD).' In speech, per- years, median 29 years) and 12 "elderly nor- on October 2, 2021 by guest. Protected copyright. ceptual as well as acoustic signs of hypokinesia mals" (eight men, four women, 42 to 64 years, in articulation have been widely presumed.2" median 53 years). Moreover, kinematic analyses have provided Department of direct evidence of reduced and slowed Speech examination Neurology, University articulatory movements particularly of the lips All subjects underwent speech examination in a of Tiibingen, Germany and the jaw in patients with PD.'2-'7 Studies of sound attenuated room. Recordings were made H Ackermann limb motor control have shown not only slow- on a Nagra IV S tape recorder with a Senn- Clinical in Neuropsychology ness of single movements but also a delay heiser microphone positioned about 20 cm in Group, Municipal executing complex motor sequences due to front of the subject. Speech materials included Hospital, problems in "switching" from one motor sentences of the form "Ich habe /geCVCe/ Bogenhausen, Munich, to another. The in ("I have heard .. .") with C = Germany programme impairment gehort" /p/, /t/, W Ziegler running motor programmes seems to be closely /k/ and V = /i/, /y/, /u/, /a/. The formula of clinical together with the lists of consonants Correspondence to: related to the degree bradykinesia.' /geCVCe/ Dr Ackermann, Department Whether this principle applies to speech con- and vowels to substitute for C and V enabled of Neurology, University of Tubingen, Hoppe-Seyler-Str trol as well is not known. the use of 12 target words-for example, 3, 7400 Tubingen, Germany Prosodic features such as linguistic or "getite", "gepype", "gekuke". These "words" Received 19 November 1990 emotional stress influence speech movements represent regular phonological forms of stan- and in final revised form 10 April 1991. in sentence production. In normal speech the dard German, so that to a certain extent the Accepted 26 April 1991 production of stressed syllables is associated sentences fulfil natural speech demands. The 1094 Ackermann, Ziegler J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.54.12.1093 on 1 December 1991. Downloaded from Table Clinical data ofpatients with Parkinson's disease Duration Motor signs (limbs) of disease CT-scan Patient Age Sex (years) akinesia rigidity tremor Depression (atrophy) Medication 1 47 m 12 (+) - - - - Id,am 2 60 m 4 (+) - + - (+) ld,ac 3 69 f 1 + (+) - - - Id 4 63 m 5 (+) (I)- (±) - ld,am 5 73 f 10 ( ) (+) - - (+) Id,am,br 6 58 f 10 (+) (+) (+) - - ld,br,ac 7 57 m 9 + + (+) (I)(+) Id,br 8 71 m 2 + (+) + - - ac 9 66 m 12 + (+) - - - Id,br 10 52 f 8 + (+) - - - ld,br 11 60 f 6 + + + - - - ld,br,ac 12 76 m 13 + + + + (+) (+) ld,br Id = levodopa, br = bromocriptine, am amantadine, ac = anticholinergic drugs- = missing, (±) = slight, + = moderate, + + = distinct. test sentences were read by the examiner in a reduced to the level of the tape noise, whereas quasi-randomised order and repeated by the vocal tract opening for a vowel is associated subjects at a suitable rate and loudness level. with an intensity peak. Incomplete closure The entire test, consisting of 12 test sentences, resulting from reduced extension of man- was run twice by all speakers. dibular, labial, or lingual movements or from reduced occlusive force may be expected to Perceptual evaluation result in an increase of sound pressure during To obtain perceptual judgments the patients' stop realisation (as seen in the lower half of recordings were evaluated by five experienced figure 1) as acoustic energy is still emitted from speech therapists. The evaluation protocol the mouth.'9 SPL contours allow calculation of included seven-point ratings of variables such syllable durations and of the amount of sound as a patient's overall articulatory and vocal emission during closure, and moreover reflect impairment and his or her speech tempo. dynamic aspects of sound pressure change during closing and opening movements. Acoustic evaluation Mean syllable duration (MSD) The dura- Sound pressure level (SPL) contours Speech tions of four syllables of each test utterance signals were digitised at a sampling rate of were measured: /be/, /ge/, /CV/, /Ce/ (such as 20 kHz after low-pass filtering at 9 kHz and /be/, /ge/, /pi/, /pe/ in the example of figure 1). were fed into a LSI 11/73 for further process- Syllable duration was determined by measur- ing. Sound pressure level (SPL) contours were ing the time period ofa syllabic peak in the SPL calculated for each of the 24 sentences. The contour. Specifically the duration of a syllable SPL was determined every 3-2 ms over a 1-2-6 was defined as the time interval between the two ms window and the resulting contour was points where the SPL contour crossed the 5% smoothed by a 30 Hz low-pass filter. Figure 1 threshold between the SPL maximum corres- provides examples for the test sentence "Ich ponding to the syllabic peak and the minima habe gepipe gehort" as spoken by a normal left and right ofit.'9 The four syllable durations http://jnnp.bmj.com/ subject and a patient with PD. During com- of a sentence were averaged and the median plete closure (as required for the stop conson- value ofthe 24 test utterances ofthe subject was ant sequence /b/, /g/, /p/, /p/, /g/ of the test calculated. We called this measure the mean sentence of figure 1) intensity is normally syllable duration (MSD). As the syllables used in the computation of MSD consisted of a stop consonant and a vowel each, MSD may be Figure 1 Sound pressure beig ap i peg level (SPL) contours of considered here as reflecting the time interval of test sentence "Ich habe an opening-closing cycle. By virtue of its on October 2, 2021 by guest. Protected copyright. gepipe gehort" obtained definition MSD provides an index of speech from normal speaker (upper half) andfrom tempo which is unaffected by pausing, syllable patient with Parkinson's iteration, or by difficulties in word-finding or disease (lower half). speech initiation problems that may also be Trace at top shows in oscillogram of test sentence present PD.20 as spoken by normal Intensity during closure (IDC) For the two subject. Vertical lines stop consonants preceding and following the mark syllable boundaries, (stressed) target vowel of a test word triangle indicates onset of (for stressed vowel. Above instance the two /p/s in the example offigure 1) oscillogram part of test intensity minima were computed. As men- sentence "ich habe gepipe tioned above this variable measures the acous- gehort" is depicted. Reversed "e" represents tic quality of stop consonant production and is phonetic symbol denoting particularly sensitive to incompleteness of short and centralised e- closure sound. (undershooting). Median values of SPL (dB) intensity minima were determined over all 24 sentences of a subject for each of the pre- and post-stressed closures, respectively. We called the resulting measure the intensity during Time (s) *.
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