Ing. Michal Novotný, Ph.D.

Objective: This study assessed the relationship between speech and language impairment and outcome in a multicenter cohort of isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD).Methods: Patients with iRBD from 7 centers speaking Czech, English, German, French, and Italian languages underwent a detailed speech assessment at baseline. Story-tale narratives were transcribed and linguistically annotated using fully automated methods based on automatic speech recognition and natural language processing algorithms, leading to the 3 distinctive linguistic and 2 acoustic patterns of language deterioration and associated composite indexes of their overall severity. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow-up. The Cox proportional hazard was performed to evaluate the predictive value of language patterns for phenoconversion over a follow-up period of 5 years.Results: Of 180 patients free of parkinsonism or dementia, 156 provided follow-up information. After a mean follow-up of 2.7 years, 42 (26.9%) patients developed neurodegenerative disease. Patients with higher severity of linguistic abnormalities (hazard ratio [HR = 2.35]) and acoustic abnormalities (HR = 1.92) were more likely to develop a defined neurodegenerative disease, with converters having lower content richness (HR = 1.74), slower articulation rate (HR = 1.58), and prolonged pauses (HR = 1.46). Dementia-first (n = 16) and parkinsonism-first with mild cognitive impairment (n = 9) converters had higher severity of linguistic abnormalities than parkinsonism-first with normal cognition converters (n = 17).Interpretation: Automated language analysis might provide a predictor of phenoconversion from iRBD into synucleinopathy subtypes with cognitive impairment, and thus can be used to stratify patients for neuroprotective trials. ANN NEUROL 2023

Imprecise vowels represent a common deficit associated with hypokinetic dysarthria resulting from a reduced articulatory range of motion in Parkinson's disease (PD). It is not yet unknown whether the vowel articulation impairment is already evident in the prodromal stages of synucleinopathy. We aimed to assess whether vowel articulation abnormalities are present in isolated rapid eye movement sleep behaviour disorder (iRBD) and early-stage PD. A total of 180 male participants, including 60 iRBD, 60 de-novo PD and 60 age-matched healthy controls performed reading of a standardized passage. The first and second formant frequencies of the corner vowels /a/, /i/, and /u/ extracted from predefined words, were utilized to construct articulatory-acoustic measures of Vowel Space Area (VSA) and Vowel Articulation Index (VAI). Compared to controls, VSA was smaller in both iRBD (p = 0.01) and PD (p = 0.001) while VAI was lower only in PD (p = 0.002). iRBD subgroup with abnormal olfactory function had smaller VSA compared to iRBD subgroup with preserved olfactory function (p = 0.02). In PD patients, the extent of bradykinesia and rigidity correlated with VSA (r = -0.33, p = 0.01), while no correlation between axial gait symptoms or tremor and vowel articulation was detected. Vowel articulation impairment represents an early prodromal symptom in the disease process of synucleinopathy. Acoustic assessment of vowel articulation may provide a surrogate marker of synucleinopathy in scenarios where a single robust feature to monitor the dysarthria progression is needed.

Background The mechanisms underlying speech abnormalities in Parkinson's disease (PD) remain poorly understood, with most of the available evidence based on male patients. This study aimed to estimate the occurrence and characteristics of speech disorder in early, drug-naive PD patients with relation to gender and dopamine transporter imaging. Methods Speech samples from 60 male and 40 female de novo PD patients as well as 60 male and 40 female age-matched healthy controls were analyzed. Quantitative acoustic vocal assessment of 10 distinct speech dimensions related to phonation, articulation, prosody, and speech timing was performed. All patients were evaluated using [123]I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single-photon emission computed tomography and Montreal Cognitive Assessment. Results The prevalence of speech abnormalities in the de novo PD cohort was 56% for male and 65% for female patients, mainly manifested with monopitch, monoloudness, and articulatory decay. Automated speech analysis enabled discrimination between PD and controls with an area under the curve of 0.86 in men and 0.93 in women. No gender-specific speech dysfunction in de novo PD was found. Regardless of disease status, females generally showed better performance in voice quality, consonant articulation, and pauses production than males, who were better only in loudness variability. The extent of monopitch was correlated to nigro-putaminal dopaminergic loss in men (r = 0.39, p = 0.003) and the severity of imprecise consonants was related to cognitive deficits in women (r = -0.44, p = 0.005). Conclusions Speech abnormalities represent a frequent and early marker of motor abnormalities in PD. Despite some gender differences, our findings demonstrate that speech difficulties are associated with nigro-putaminal dopaminergic deficits.

Even though hypomimia is a hallmark of Parkinson’s disease (PD), objective and easily interpretable tools to capture the disruption of spontaneous and deliberate facial movements are lacking. This study aimed to develop a fully automatic video-based hypomimia assessment tool and estimate the prevalence and characteristics of hypomimia in de-novo PD patients with relation to clinical and dopamine transporter imaging markers. For this cross-sectional study, video samples of spontaneous speech were collected from 91 de-novo, drug-naïve PD participants and 75 age and sex-matched healthy controls. Twelve facial markers covering areas of forehead, nose root, eyebrows, eyes, lateral canthal areas, cheeks, mouth, and jaw were used to quantitatively describe facial dynamics. All patients were evaluated using Movement Disorder Society-Unified PD Rating Scale and Dopamine Transporter SinglePhoton Emission Computed Tomography. Newly developed automated facial analysis tool enabled high-accuracy discrimination between PD and controls with area under the curve of 0.87. The prevalence of hypomimia in de-novo PD cohort was 57%, mainly associated with dysfunction of mouth and jaw movements, and decreased variability in forehead and nose root wrinkles (p < 0.001). Strongest correlation was found between reduction of lower lip movements and nigro-putaminal dopaminergic loss (r = 0.32, p = 0.002) as well as limb bradykinesia/rigidity scores (r = −0.37 p < 0.001). Hypomimia represents a frequent, early marker of motor impairment in PD that can be robustly assessed via automatic video-based analysis. Our results support an association between striatal dopaminergic deficit and hypomimia in PD.

Introduction: While the role of physiotherapy as part of a comprehensive inpatient rehabilitation is indisputable, clear evidence concerning the effectiveness of different rehabilitation managements [interdisciplinary implementing the International Classification of Functioning, disability and health (ICF) vs. multidisciplinary model] and physiotherapy categories (neuroproprioceptive "facilitation, inhibition" vs. motor/skill acquisitions using technologies) are still lacking. In this study, four kinds of comprehensive inpatient rehabilitation with different management and content of physical therapy will be compared. Moreover, focus will be placed on the identification of novel biological molecules reflective of effective rehabilitation. Long non-coding RNAs (lncRNAs) are transcripts (>200 bps) of limited coding potential, which have recently been recognized as key factors in neuronal signaling pathways in ischemic stroke and as such, may provide a valuable readout of patient recovery and neuroprotection during therapeutic progression. Methods and analysis: Adults after the first ischemic stroke in an early sub-acute phase with motor disability will be randomly assigned to one of four groups and undergo a 3 weeks comprehensive inpatient rehabilitation of different types: interdisciplinary team work using ICF model as a guide; multidisciplinary teamwork implementing neuroproprioceptive "facilitation and inhibition" physiotherapy; multidisciplinary teamwork implementing technology-based physiotherapy; and standard multidisciplinary teamwork. Primary (the Goal Attainment Scale, the Patient-Reported Outcomes Measurement Information System, and the World Health Organization Disability Assessment Schedule) and secondary (motor, cognitive, psychological, speech and swallowing functions, functional independence) outcomes will be measured. A blood sample will be obtained upon consent (20 mls; representing pre-rehabilitation molecular) before and after the inpatient program. Primary outcomes will be followed up again 3 and 12 months after the end of the program. The overarching aim of this study is to determine the effectiveness of various rehabilitation managements and physiotherapeutic categories implemented by patients post ischemic stroke via analysis of primary, secondary and long non-coding RNA readouts. This clinical trial will offer an innovative approach not previously tested and will provide new complex analysis along with public assessable molecular biological evidence of various rehabilitation methodology for the alleviation of the effects of ischemic stroke.

Background Impairments of olfactory and speech function are likely early prodromal symptoms of alpha-synucleinopathy. Objective The aim of this study is to assess whether dysprosody is present in isolated rapid eye movement sleep behavior disorder (iRBD) with hyposmia/anosmia and a normal nigrostriatal system. Methods Pitch variability during speech was investigated in 17 iRBD subjects with normal olfactory function (iRBD-NOF), 30 iRBD subjects with abnormal olfactory function (iRBD-AOF), and 50 healthy controls. iRBD subjects were evaluated using the University of Pennsylvania Smell Identification Test and [123I]-2ss-carbomethoxy-3ss-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane dopamine transporter single-photon emission computed tomography (DAT-SPECT). All iRBD subjects completed the 24-month follow-up with DAT-SPECT, speech, and olfactory testing. Results At baseline, only iRBD-AOF showed monopitch when compared to iRBD-NOF (P = 0.04) and controls (P = 0.03), with no difference between iRBD-NOF and controls (P = 1). At follow-up, dysprosody progressed only in iRBD-AOF with abnormal DAT-SPECT (P = 0.03). Conclusion Prosody is impaired in hyposmic but not in normosmic iRBD subjects before the nigrostriatal dopaminergic transmission is affected (Braak stage 2). (c) 2021 International Parkinson and Movement Disorder Society

Background: Patients with synucleinopathies frequently display language abnormalities. However, whether patients with isolated rapid eye movement sleep behavior disorder (iRBD) have prodromal language impairment remains unknown. Objectives: We examined whether the linguistic abnormalities in iRBD can serve as potential biomarkers for conversion to synucleinopathy, including the possible effect of mild cognitive impairment (MCI), speaking task, and automation of analysis procedure. Methods: We enrolled 139 Czech native participants, including 40 iRBD without MCI and 14 iRBD with MCI compared to 40 PD without MCI, 15 PD with MCI, and 30 healthy controls. Spontaneous discourse and story tale narrative were transcribed and linguistically annotated. A quantitative analysis was performed computing 3 linguistic features. Human annotations were compared to fully-automated annotations. Results: Compared to controls, iRBD patients showed poorer content density, reflecting the reduction of content words and modifiers. Both PD and iRBD subgroups with MCI manifested less occurrence of unique words and a higher number of n-grams repetitions, indicating poorer lexical richness. The spontaneous discourse task demonstrated language impairment in iRBD without MCI with an area under the curve of 0.72, while the story tale narrative task better reflected the presence of MCI, discriminating both PD and iRBD subgroups with MCI from controls with an area under the curve of up to 0.81. A strong correlation between manually and automatically computed results was achieved. Conclusions: Linguistic features might provide a reliable automated method for detecting cognitive decline due to prodromal neurodegeneration in subjects with iRBD, providing critical outcomes for future therapeutic trials.

Purpose: This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson’s disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech. Method: Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age-and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions. Results: All LTAS spectral moments including mean, standard deviation, skew-ness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups. Conclusions: Our findings confirmed that LTAS is a suitable approach to objec-tively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria.

The effect of dopaminergic medication on speech has rarely been examined in early-stage Parkinson's disease (PD) and the respective literature is inconclusive and limited by inappropriate design with lack of PD control group. The study aims to examine the short-term effect of dopaminergic medication on speech in PD using patients with good motor responsiveness to levodopa challenge compared to a control group of PD patients with poor motor responsiveness. A total of 60 early-stage PD patients were investigated before (OFF) and after (ON) acute levodopa challenge and compared to 30 age-matched healthy controls. PD patients were categorised into two clinical subgroups (PD responders vs. PD nonresponders) according to the comparison of their motor performance based on movement disorder society-unified Parkinson's disease rating scale, part Ill. Seven distinctive parameters of hypokinetic dysarthria were examined using quantitative acoustic analysis. We observed increased monopitch (p> 0.01), aggravated monoloudness (p> 0.05) and longer duration of stop consonants (p> 0.05) in PD compared to healthy controls, confirming the presence of hypokinetic dysarthria in early PD. No speech alterations from OFF to ON state were revealed in any of the two PD groups and speech dimensions investigated including monopitch, monoloudness, imprecise consonants, harsh voice, slow sequential motion rates, articulation rate, or inappropriate silences, although a subgroup of PD responders manifested obvious improvement in motor function after levodopa intake (p> 0.001). Since the short-term usage of levodopa does not easily affect voice and speech performance in PD, speech assessment may provide a medication state-independent motor biomarker of PD.

Purpose: This study aimed to evaluate the reliability of different approaches for estimating the articulation rates in connected speech of Parkinsonian patients with different stages of neurodegeneration compared to healthy controls. Method: Monologues and reading passages were obtained from 25 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 25 de novo patients with Parkinson's disease (PD), 20 patients with multiple system atrophy (MSA), and 20 healthy controls. The recordings were subsequently evaluated using eight syllable localization algorithms, and their performances were compared to a manual transcript used as a reference. Results: The Google & Pyphen method, based on automatic speech recognition followed by hyphenation, outperformed the other approaches (automated vs. hand transcription: r > .87 for monologues and r > .91 for reading passages, p < .001) in precise feature estimates and resilience to dysarthric speech. The Praat script algorithm achieved sufficient robustness (automated vs. hand transcription: r > .65 for monologues and r > .78 for reading passages, p < .001). Compared to the control group, we detected a slow rate in patients with MSA and a tendency toward a slower rate in patients with iRBD, whereas the articulation rate was unchanged in patients with early untreated PD. Conclusions: The state-of-the-art speech recognition tool provided the most precise articulation rate estimates. If speech recognizer is not accessible, the freely available Praat script based on simple intensity thresholding might still provide robust properties even in severe dysarthria. Automated articulation rate assessment may serve as a natural, inexpensive biomarker for monitoring disease severity and a differential diagnosis of Parkinsonism

Background and objectives: Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy. Methods: We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis. Results: Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002).

Substantial variability and severity of dysarthric patterns across Parkinson's disease (PD) patients may reflect distinct phenotypic differences. We aimed to compare patterns of speech disorder in early-onset PD (EOPD) and late-onset PD (LOPD) in drug-naive patients at early stages of disease. Speech samples were acquired from a total of 96 participants, including two subgroups of 24 de-novo PD patients and two subgroups of 24 age- and sex-matched young and old healthy controls. The EOPD group included patients with age at onset below 51 (mean 42.6, standard deviation 6.1) years and LOPD group patients with age at onset above 69 (mean 73.9, standard deviation 3.0) years. Quantitative acoustic vocal assessment of 10 unique speech dimensions related to respiration, phonation, articulation, prosody, and speech timing was performed. Despite similar perceptual dysarthria severity in both PD subgroups, EOPD showed weaker inspirations (p = 0.03), while LOPD was characterized by decreased voice quality (p = 0.02) and imprecise consonant articulation (p = 0.03). In addition, age-independent occurrence of monopitch (p < 0.001), monoloudness (p = 0.008), and articulatory decay (p = 0.04) was observed in both PD subgroups. The worsening of consonant articulation was correlated with the severity of axial gait symptoms (r = 0.38, p = 0.008). Speech abnormalities in EOPD and LOPD share common features but also show phenotype-specific characteristics, likely reflecting the influence of aging on the process of neurodegeneration. The distinct pattern of imprecise consonant articulation can be interpreted as an axial motor symptom of PD.

We read with great interest the recent study by Suppa et al., which performed voice analysis in patients with essential tremor (ET) with (ETVT+) and without (ETVT-) clinically overt voice tremor based on power spectral analysis and machine learning. Traditional spectral analysis showing a prominent oscillatory activity peak at 2–6 Hz in ETVT+ seems to be in agreement with a recent study reporting the occurrence of both low (<4 Hz) and medium (4–7 Hz) vocal tremor in ET.

Objective: This multilanguage study used simple speech recording and high-end pattern analysis to provide sensitive and reliable noninvasive biomarkers of prodromal versus manifest alpha-synucleinopathy in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and early-stage Parkinson disease (PD). Methods: We performed a multicenter study across the Czech, English, German, French, and Italian languages at 7 centers in Europe and North America. A total of 448 participants (337 males), including 150 with iRBD (mean duration of iRBD across language groups 0.5-3.4 years), 149 with PD (mean duration of disease across language groups 1.7-2.5 years), and 149 healthy controls were recorded; 350 of the participants completed the 12-month follow-up. We developed a fully automated acoustic quantitative assessment approach for the 7 distinctive patterns of hypokinetic dysarthria. Results: No differences in language that impacted clinical parkinsonian phenotypes were found. Compared with the controls, we found significant abnormalities of an overall acoustic speech severity measure via composite dysarthria index for both iRBD (p = 0.002) and PD (p < 0.001). However, only PD (p < 0.001) was perceptually distinct in a blinded subjective analysis. We found significant group differences between PD and controls for monopitch (p < 0.001), prolonged pauses (p < 0.001), and imprecise consonants (p = 0.03); only monopitch was able to differentiate iRBD patients from controls (p = 0.004). At the 12-month follow-up, a slight progression of overall acoustic speech impairment was noted for the iRBD (p = 0.04) and PD (p = 0.03) groups. Interpretation: Automated speech analysis might provide a useful additional biomarker of parkinsonism for the assessment of disease progression and therapeutic interventions.

Slow and irregular oral diadochokinesis represents an important manifestation of spastic and ataxic dysarthria in multiple sclerosis (MS). We aimed to develop a robust algorithm based on convolutional neural networks for the accurate detection of syllables from different types of alternating motion rate (AMR) and sequential motion rate (SMR) paradigms. Subsequently, we explored the sensitivity of AMR and SMR paradigms based on voiceless and voiced consonants in the detection of speech impairment. The four types of syllable repetition paradigms including /ta/, /da/, /pa/-/ta/-/ka/, and /ba/-/da/-/ga/ were collected from 120 MS patients and 60 matched healthy control speakers. Our neural network algorithm was able to correctly identify the position of individual syllables with a very high average accuracy of 97.8%, with the correct temporal detection of syllable position of 87.8% for 10 ms and 95.5% for 20 ms tolerance value. We found significantly altered diadochokinetic rate and regularity in MS compared to controls across all types of investigated tasks (p < 0.001). MS patients showed slower speech for SMR compared to AMR tasks, whereas voiced paradigms were more irregular. Objective evaluation of oral diadochokinesis using different AMR and SMR paradigms may provide important information regarding speech severity and pathophysiology of the underlying disease.

Purpose: The purpose of this article is to provide a performance comparison of available algorithms for the automated evaluation of oral diadochokinesis using speech samples from patients with amyotrophic lateral sclerosis (ALS). Method: Four different algorithms based on a wide range of signal processing approaches were tested on a sequential motion rate /pa/-/ta/-/ka/ syllable repetition paradigm collected from 18 patients with ALS and 18 age and gender-matched healthy controls. Results: The best temporal detection of syllable position for a 10 ms tolerance value was achieved for ALS patients using a traditional signal processing approach based on a combination of filtering in the spectrogram, Bayesian detection, and polynomial thresholding with an accuracy rate of 74.4%, and for healthy controls using a deep learning approach with an accuracy rate of 87.6%. Compared to healthy controls, a slow diadochokinetic rate (p < 0.001) and diadochokinetic irregularity (p < 0.01) were detected in ALS patients. Conclusions: The approaches using deep learning or multiple-step combinations of advanced signal processing methods provided a more robust solution to the estimation of oral DDK variables than did simpler approaches based on the rough segmentation of the signal envelope. The automated acoustic assessment of oral diadochokinesis shows excellent potential for monitoring bulbar disease progression in individuals with ALS.

As dysphonia is assumed to be the most prevalent feature of hypokinetic dysarthria in Parkinson’s disease (PD), several acoustic approaches have been introduced for its assessment. However, the sensitivity of different acoustic measures to the occurrence of dysphonia in drug-naïve de-novo patients with PD has not yet been explored. The goal of this study is to examine the performance of glottal source parametrization and compare it with traditional perturbation and cepstral measures. Sustained phonations of 40 de-novo drug-naïve PD participants and 40 age- and sex-matched healthy controls were recorded. Each utterance was ranked by a set of glottal source parameters obtained by inverse adaptive filtering, the perturbation parameters, and cepstral peak prominence measures. Our results revealed the significant differences in the glottal source parameter Harmonic Richness Factor (HRF: p <  0.01) and cepstral peak prominence parameter (p <  0.05). The support vector machine classification between PD and healthy controls reached the area under the curve of 0.78. The analysis of relationships showed significant negative correlations between HRF and total Movement Disorders Society – Unified Parkinson’s Disease Rating Scale III score (r=-0.35, p < 0.05), as well as its rigidity (r=-0.43, p < 0.01) and bradykinesia (r=-0.32, p < 0.05) sub-scores. Glottal source assessment appears to be a superior method to assess PD-related dysphonia compared to the traditional perturbation and cepstral approaches. Our results highlight that dysphonia and limb bradykinesia and rigidity in PD are controlled by similar underlying brain processes.

Although dysarthria is a common pattern in multiple sclerosis (MS), the contribution of specific brain areas to key factors of dysarthria remains unknown. Speech data were acquired from 123 MS patients with Expanded Disability Status Scale (EDSS) ranging from 1 to 6.5 and 60 matched healthy controls. Results of computerized acoustic analyses of subtests on spastic and ataxic aspects of dysarthria were correlated with MRI-based brain volume measurements. Slow articulation rate during reading was associated with bilateral white and grey matter loss whereas reduced maximum speed during oral diadochokinesis was related to greater cerebellar involvement. Articulation rate showed similar correlation to whole brain atrophy (r=0.46, p<0.001) as the standard clinical scales such as EDSS (r=-0.45, p<0.001). Our results support the critical role of the pyramidal tract and cerebellum in the modification of motor speech timing in MS.

Evaluation of precision of consonant articulation is commonly used metric in assessment of pathological speech. However, up to date most of the research on consonant characteristics was performed on English while there are obvious language-specific differences. The aim of the current study was therefore to investigate the patterns of consonant articulation in Czech across 6 stop consonants with respect to age and gender. The database used consisted of 30 female and 30 male healthy participants. Four acoustic variables including voice onset time (VOT), VOT ratio and two spectral moments were analyzed. The Czech plosives /p/, /t/ and /k/ were found to be characterized by short voicing lag (average VOT ranged from 14 to 32 ms) while voiced plosives /b/, /d/ and /g/ by long voicing lead (average VOT ranged from -79 to -91 ms). Furthermore, we observed significantly longer duration of both VOT (p < 0.05) and VOT ratio (p < 0.01) of voiceless plosives in female compared to male gender. Finally, we revealed a significant negative correlation between age and duration of voiceless (r = -0.36, p < 0.05) as well as voiced VOT (r = -0.45, p = 0.01) in female but not in male participants.

The aim of this study was to evaluate associations of motor and non-motor symptoms with dopamine transporter binding in prodromal stage of synucleinopathies. We examined 74 patients with idiopathic REM sleep behavior disorder (RBD), which is a prodromal synucleinopathy, and 39 controls using Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment, University of Pennsylvania Smell Identification Test (UPSIT), Farnsworth-Munsell 100 hue test, orthostatic test, Scales for Outcomes in PD-Autonomic, Beck depression inventory-II, State-Trait Anxiety Inventory, and video-polysomnography. Electromyographic muscle activity during REM sleep was quantified according to Sleep Innsbruck-Barcelona criteria. In 65 patients, dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging was performed, putaminal binding ratio was calculated and scans were classified as normal, borderline, or abnormal. Compared to controls, RBD patients had significantly more severe scores in all examined tests. Patients with abnormal DAT-SPECT had higher MDS-UPDRS motor score (p = 0.006) and higher prevalence of orthostatic hypotension (p = 0.008). Putamina I binding ratio was positively associated with UPSIT score (p =0.03) and negatively associated with tonic (p = 0.003) and phasic (p = 0.01) muscle activity during REM sleep. These associations likely reflect simultaneous advancement of underlying pathology in substantia nigra and susceptible brainstem and olfactory nuclei in prodromal synucleinopathy.

Background: Impairment of cognition and speech are common in multiple sclerosis (MS) patients, but their relationship is not well understood. Objective: To describe the relationship between articulation rate characteristics and processing speed and to investigate the potential role of objective speech analysis for the detection of cognitive decline in MS. Methods: A total of 122 patients with clinically definite MS were included in this cross-sectional pilot study. Patients underwent three speaking tasks (oral diadochokinesis, reading text and monologue) and assessment of processing speed (Symbol Digit Modalities Test [SDMT], Paced Auditory Serial Addition Test-3 s [PASAT-3]). Association between articulation rate and cognition was analyzed using linear regression analysis. We estimated the area under the receiver operating characteristics curves (AUC) to evaluate the predictive accuracy of articulation rate measures for the detection of abnormal processing speed. Results: We observed an association between articulation rate and cognitive measures (rho = 0.45-0.58; p < 0.001). Faster reading speed by one word per second was associated with an 18.7 point (95% confidence interval ICI] 14.9-22.5) increase of the SDMT score and 14.7 (95% CI 8.9-20.4) point increase of PASAT-3 score (both p < 0.001). AUC values of articulation rate characteristics for the identification of processing speed impairment ranged between 0.67 and 0.79. Using a cutoff of 3.10 in reading speed, we were able to identify impairment in both the SDMT and PASAT-3 with 91% sensitivity and 54% specificity. Conclusion: Slowed articulation rate is strongly associated with processing speed decline. Objective quantitative speech analysis identified patients with abnormal cognitive performance. (C) 2019 Elsevier Ltd. All rights reserved.

Background: Motor speech disorders in multiple sclerosis (MS) are poorly understood and their quantitative, objective acoustic characterization remains limited. Additionally, little data regarding relationships between the severity of speech disorders and neurological involvement in MS, as well as the contribution of pyramidal and cerebellar functional systems on speech phenotypes, is available. Methods: Speech data were acquired from 141 MS patients with Expanded Disability Status Scale (EDSS) ranging from 1 to 6.5 and 70 matched healthy controls. Objective acoustic speech assessment including subtests on phonation, oral diadochokinesis, articulation and prosody was performed. Results: The prevalence of dysarthria in our MS cohort was 56% while the severity was generally mild and primarily consisted of a combination of spastic and ataxic components. Prosodic-articulatory disorder presenting with monopitch, articulatory decay, excess loudness variations and slow rate was the most salient. Speech disorders reflected subclinical motor impairment with 78% accuracy in discriminating between a subgroup of asymptomatic MS (EDSS < 2.0) and control speakers. Speech disorder severity was related to the severity of neurological involvement. Decreased articulation rate was moderately correlated to EDSS as well as all subtests of the multiple sclerosis functional composite. The strongest correlation was observed between irregular oral diadochokinesis and the 9-Hole Peg Test (r = -0.65, p < 0.001). Irregular oral diadochokinesis and excess loudness variations significantly separated pure pyramidal and mixed pyramidal-cerebellar MS subgroups. Conclusions: Automated speech analyses may provide valuable biomarkers of disease progression in MS as dysarthria represents common and early manifestation that reflects disease disability and underlying pyramidal-cerebellar pathophysiology.

Although smartphone technology provides new opportunities for the recording of speech samples in everyday life, its ability to capture prodromal speech impairment in persons with a high risk of developing Parkinson's disease (PD) has never been investigated. Speech data were acquired through a smartphone as well as a professional microphone with a linear frequency response from 50 participants with a rapid eye movement sleep behavior disorder that are at a high risk of developing PD and related neurodegenerative disorders. Additionally, recordings of 30 newly diagnosed, untreated PD patients and 30 healthy participants were evaluated. Acoustic assessment of 11 speech dimensions representing the key aspects of hypokinetic dysarthria in the early stages of PD was performed. Smartphone allowed the detection of speech abnormalities in participants with a high risk of developing PD. Acoustic measurements related to fundamental frequency variability, duration of pause intervals, and rate of speech timing extracted from spontaneous speech were sufficiently sensitive to significantly separate groups (area under curve of 0.85 between PD and controls) and showed very strong correlation and reliability between the professional microphone and the smartphone. Speech-based biomarkers collected through smartphones may have the potential to revolutionize the diagnostic process in neurodegenerative diseases and improve stratification for future neuroprotective therapy in PD.

Although previous studies have reported the occurrence of velopharyngeal incompetence connected with ataxic dysarthria, there is a lack of evidence related to nasality assessment in cerebellar disorders. This is partly due to the limited reliability of challenging analyses and partly due to nasality being a less pronounced manifestation of ataxic dysarthria. Therefore, we employed 1/3-octave spectra analysis as an objective measurement of nasality disturbances. We analyzed 20 subjects with multiple system atrophy (MSA), 13 subjects with cerebellar ataxia (CA), 20 subjects with multiple sclerosis (MS) and 20 healthy (HC) speakers. Although we did not detect the presence of hypernasality, our results showed increased nasality fluctuation in 65% of MSA, 43% of CA and 30% of MS subjects compared to 15% of HC speakers, suggesting inconsistent velopharyngeal motor control. Furthermore, we found a statistically significant difference between MSA and HC participants (p<0.001), and significant correlation between the natural history cerebellar subscore and neuroprotection in Parkinson plus syndromes - Parkinson plus scale and nasality fluctuations in MSA (r=0.51, p<0.05). In conclusion, acoustic analysis showed an increased presence of abnormal nasality fluctuations in all ataxic groups and revealed that nasality fluctuation is associated with distortion of cerebellar functions.

It is currently unknown whether speech and limb motor effectors in Parkinson’s disease (PD) are controlled by similar underlying brain processes. Based on computerized objective analysis, the aim of this study was to evaluate potential correlation between speech and mechanical tests of upper limb motor function. Speech and upper limb motor tests were performed in 22 PD patients and 22 healthy controls. Quantitative acoustic analyses of eight key speech dimensions of hypokinetic dysarthria, including quality of voice, sequential motion rates, consonant articulation, vowel articulation, average loudness, loudness variability, pitch variability, and number of pauses, were performed. Upper limb movements were assessed using the motor part of the Unified Parkinson’s Disease Rating Scale, contactless three-dimensional motion capture system, blinded expert evaluation, and the Purdue Pegboard Test. Significant relationships were observed between the quality of voice assessed by jitter and amplitude decrement of finger tapping (r = 0.61, p = 0.003), consonant articulation evaluated using voice onset time and expert rating of finger tapping (r = 0.60, p = 0.003), and number of pauses and Purdue Pegboard Test score (r = 0.60, p = 0.004). The current study supports the hypothesis that speech impairment in PD shares, at least partially, similar pathophysiological processes with limb motor dysfunction. Vocal fold vibration irregularities appeared to be influenced by mechanisms similar to amplitude decrement during repetitive limb movements. Consonant articulation deficits were associated with decreased manual dexterity and movement speed, likely reflecting fine motor control involvement in PD.

Recently, based on voice cepstral analysis, (Benba et al, 2016) have reported discrimination between patientswith Parkinson’s disease and different neurological disorderswith high classificationaccuracyup to 90%. Using the same approach, wewere able to experimentally separate two groups of normal healthy speakers with 96% classification accuracy and showed that the method proposed by Benba et al. may not be appropriate for discrimination between different neurological diseases. In particular, voice cepstral analysis appears to be sensitive to specific speakers’ characteristics such as gender or age. Our findings emphasize several assumptions that can be considered as basic necessary conditions for research reporting speech data in progressive neurodegenerative diseases.

In this work we present the method that we have adopted in order to leave in search of the speaker through different measures of jitter and shimmer are measures of the fundamental frequency and of amplitude variations cycle to cycle. We have used these two indices as they characterize some aspects concerning the Voice individuals, so it helps us to have a certain degree of specificity of speaker. This study thus allows us on the one hand to better understand where these indices to discriminate the speakers and sets out criteria to distinguish the quality of the signal according to the conditions of registration for the automatic recognition of the speaker with the base TIMIT and NTIMIT.

In this work we present the method that we have adopted in order to leave in search of the speaker through different measures of jitter and shimmer are measures of the fundamental frequency and of amplitude variations cycle to cycle. We have used these two indices as they characterize some aspects concerning the Voice individuals, so it helps us to have a certain degree of specificity of speaker. This study thus allows us on the one hand to better understand where these indices to discriminate the speakers and sets out criteria to distinguish the quality of the signal according to the conditions of registration for the automatic recognition of the speaker with the base TIMIT and NTIMIT.

Background. Although increased nasality can originate from basal ganglia dysfunction, data regarding hypernasality in Parkinson's disease (PD) and Huntington's disease (HD) are very sparse. The aim of the current study was to analyze acoustic and perceptual correlates of velopharyngeal seal closure in 37 PD and 37 HD participants in comparison to 37 healthy control speakers. Methods. Acoustical analysis was based on sustained phonation of the vowel /i/ and perceptual analysis was based on monologue. Perceptual analysis was performed by 10 raters using The Great Ormond Street Speech Assessment '98. Acoustic parameters related to changes in a 1/3-octave band centered on 1 kHz were proposed to reflect nasality level and behavior through utterance. Results. Perceptual analysis showed the occurrence of mild to moderate hypernasality in 65% of PD, 89% of HD and 22% of control speakers. Based on acoustic analyses, 27% of PD, 54% of HD and 19% of control speakers showed an increased occurrence of hypernasality. In addition, 78% of HD patients demonstrated a high occurrence of intermittent hypernasality. Further results indicated relationships between the acoustic parameter representing fluctuation of nasality and perceptual assessment (r D 0:51, p<0:001) as well as the Unified Huntington Disease Rating Scale chorea composite subscore (r D0:42, pD0:01). Conclusions. In conclusion the acoustic assessment showed that abnormal nasality was not a common feature of PD, whereas patients with HD manifested intermittent hypernasality associated with chorea.

Although a number of speech disorders reflect varying involvement of brain areas, recently published automatic speech analyses have primarily been limited to hypokinetic dysarthria in Parkinson's disease (PD). Therefore, the aim of the present study was to provide an automatic algorithm suitable for the assessment of voice onset time (VOT) in various dysarthria types.

Práce se zabývá výskytem hypernazality v dyasrtrických promluvách pacientů trpících Parknsonovou nemocí a Huntingtonovou nemocí.

Although speech disorder is frequently an early and prominent clinical feature of Parkinson's disease (PD) as well as atypical parkinsonian syndromes (APS) such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), there is a lack of objective and quantitative evidence to verify whether any specific speech characteristics allow differentiation between PD, PSP and MSA. Speech samples were acquired from 77 subjects including 15 PD, 12 PSP, 13 MSA and 37 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analysis of 16 speech dimensions. Dysarthria was uniformly present in all parkinsonian patients but was more severe in PSP and MSA than in PD. While PD speakers manifested pure hypokinetic dysarthria, ataxic components were more affected in MSA while PSP subjects demonstrated severe deficits in hypokinetic and spastic elements of dysarthria. Dysarthria in PSP was dominated by increased dysfluency, decreased slow rate, inappropriate silences, deficits in vowel articulation and harsh voice quality whereas MSA by pitch fluctuations, excess intensity variations, prolonged phonemes, vocal tremor and strained-strangled voice quality. Objective speech measurements were able to discriminate between APS and PD with 95% accuracy and between PSP and MSA with 75% accuracy. Dysarthria severity in APS was related to overall disease severity (r=0.54, p=0.006). Dysarthria with various combinations of hypokinetic, spastic and ataxic components reflects differing pathophysiology in PD, PSP and MSA. Thus, motor speech examination may provide useful information in the evaluation of these diseases with similar manifestations.

Although articulatory deficits represent an important manifestation of dysarthria in Parkinson’s disease (PD), the most widely used methods currently available for the automatic evaluation of speech performance are focused on the assessment of dysphonia. The aim of the present study was to design a reliable automatic approach for the precise estimation of articulatory deficits in PD. Twenty-four individuals diagnosed with de novo PD and twenty-two age-matched healthy controls were recruited. Each participant performed diadochokinetic tasks based upon the fast repetition of /pa/-/ta/-/ka/ syllables. All phonemes were manually labeled and an algorithm for their automatic detection was designed. Subsequently, 13 features describing six different articulatory aspects of speech including vowel quality, coordination of laryngeal and supralaryngeal activity, precision of consonant articulation, tongue movement, occlusion weakening, and speech timing were analyzed. In addition, a classification experiment using a support vector machine based on articulatory features was proposed to differentiate between PD patients and healthy controls. The proposed detection algorithm reached approximately 80% accuracy for a 5 ms threshold of absolute difference between manually labeled references and automatically detected positions. When compared to controls, PD patients showed impaired articulatory performance in all investigated speech dimensions (p < 0.05). Moreover, using the six features representing different aspects of articulation, the best overall classification result attained a success rate of 88% in separating PD from controls. Imprecise consonant articulation was found to be the most powerful indicator of PD-related dysarthria. We envisage our approach as the first step towards development of acoustic methods allowing the automated assessment of articulatory features in dysarthrias.

V soucasne dobe, je mereni hypernazality venovana znacna pozornost zejmena pri zkoumani strukturnich vad mekkeho patra (rozstep patra, pripadne poskozeni z duvodu chirurgickeho zakroku). Tento fakt vychazi ze skutecnosti, ze pri strukturnim poskozeni si mohou byt autori jisti, ze hodnoti prave vliv hypernazality. Clem teto prace je aplikovat poznatky ziskane pri hodnocen akustickych vlastnosti promluv pacientu se strukturni vadou patra na dysartricke promluvy, ve kterych muze dochazet k projevum tzv. halo efektu. K tomuto jevu dochazi, kdyz dalsi vlivy maskuji dopady hypernazality. Pro ucely prace vyuzvame tri skupiny sestavajici se z 29 zdravych ucastniku pouzitych jako normy, 38 ucastniku trpicich Parkinsonovou nemoci (PN) jako zastupcu hypokineticke dysartrie a 40 ucastniku trpicich Huntingtonovou nemoc (HN) jako zastupcu hyperkineticke dysartrie. Pro analyzu dat je vyuzita analyza tretino-oktavovych frekvencnich pasem. V pripade obou dysartrickych skupin byly nalezeny statisticky nejvyznamnejsi rozdily v pasmu kolem 1000 Hz (PN: p < 0; 05, HN: p < 0; 001).

Huntingtonova nemoc (HN) je vzácné dědičné neurodegenerativní onemocnění, které je charakteristické nekoordinovanými trhavými pohyby těla. Mezi hlavní motorické příznaky patří chorea, bradykineze a ve vyšších stádiích pak i rigidita, dystonie a ztráta stability. Poruchy hlasu a řeči, označované jako hyperkinetická dysartrie, jsou dalším běžným projevem HN a rozvíjejí se v průběhu nemoci až u 90% pacientů. Mezi charakteristické deficity vyskytující se v hlasu osob s HN patří tzv. voice break (nízkofrekvenční segmenty fonace, ve kterých dochází ke zhruba jedno oktávovému poklesu proti běžnému hlasu) a vocal arrest (segmenty fonace, ve kterých dochází k úplnému zastavení funkce hlasivek). Nepřesná artikulace hlásek u HN je charakterizována zejména poklesem F1a, F2a a F2i a zvýšením F2u frekvence. Tyto změny odrážejí sníženou schopnost pacientů s HN pohyboval mluvidly, zejména jazykem, v rozsahu odpovídajícímu zdravým normám a mohou vést k výraznému snížení srozumitelnosti řeči. Mezi nejčastěji pozorované poruchy v oblasti prosodie patří zpomalená rychlost řeči, větší počet pauz, neschopnost udržet jednoduchý rytmus, neschopnost vyjádřit větný důraz a zvýšená variabilita v hlasitosti a délce slabik . Akustické analýzy jsou neinvazivní, objektivní, citlivá a jednoduchá metoda pro hodnocení hlasu a řeči u neurologických onemocnění. Matlab může být vhodným programem pro návrh algoritmů pro automatickou detekci řečových parametrů.

Přestože je Parkinsonova nemoc v současné době jedním z nejčastějších neurodegenerativních onemocnění, existuje pouze symptomatická léčba a studie ukazují, že k diagnóze může dojít až 10 let po výskytu prvních příznaků.

V současné době dochází k stále užšímu propojování různých vědních obrů. Tento trend přináší vyšší nároky na kompatibilitu využívaných nástrojů. Proto bylo navrženo grafické rozhraní, které usnadňuje a urychluje pořizování a kontrolu dat využívaných v dalších analýzách.

Parkinsonova nemoc je pomalu progresivní onemocnění nervového systému, které celosvětově postihuje více než 8 miliónů jednotlivců...

Problematika analýzy a zpracování řečového signálu je na katedře teorie obvodů ČVUT FEL systematicky řešena od počátku devadesátých let minulého století.

Hypokinetic dysarthria is a common manifestation of Parkinson's disease (PD). Articulation characteristics can provide useful information to distinguish dysarthric speakers from healthy subjects and monitor the severity of disease and treatment effects. The aim of this study was to design an algorithm for automatic segmentation of consonants and vowels based upon a rapid steady /pa/-/ta/-/ka/ syllable repetition.

Analýza artikulace může být užitečným nástrojem pro rozlišování zdravých a dysartrických mluvčích s Parkinsonovou nemocí (PN). Cílem této práce je návrh algoritmu pro automatickou segmentaci konsonant a vokálů v promluvě, založené na rychlém opakování slabik /pa/-/ta/-/ka/.

Práce se zabývá využitím programového prostředí Matlab pro zpracování pa- tologických promluv pacientů trpících Parkinsonovou nemocí (PN).

V současné době je Parkinsonova nemoc druhé nejběžnější neurodegenerativní onemocnění. které začne být klinicky zřejmé až po projevení jednoho ze čtyř základních motorických symptomů.

The resonant ultrasound spectroscopy is a well known laboratory technique used to obtain second order elastic coefficients. This method takes irreplaceable part in the exploration of shape memory alloy elastic coefficients.

Parkinson's disease (PD) is the second most common neurodegenerative disorder after the Alzheimer's disease and with the aging of the worldwide population, the higher incidence is predicted. In 70 % - 90 % of PD cases, the hypokinetic dysarthria is manifested as a prodromal syndrom.

Parkinsonovou nemocí (PN) trpí přes osm milionů lidí a v České republice je diagnostikováno mezi deseti a dvanácti tisíci nemocných. Mezi nejznámější projevy Parkinsonovy nemoci patří nekontrolovatelný tremor, akinesie nebo bradykineze, svalová rigidita a charakteristický shrbený postoj. Zároveň studie ukázaly, že se u 70%-90% případů projevují patologie řeči, zejména hypokinetická dysartrie.

Hypokinetic dysarthria is a common manifestation of Parkinson's disease (PD). Articulation characteristics can provide useful information to distinguish dysarthric speakers from healthy subjects and monitor the severity of disease and treatment effects.