Although perceptual studies indicate the likelihood of voice disorders in persons with stroke, there have been few objective instrumental studies of voice dysfunction in dysarthria following stroke. This study reports automatic analysis of sustained vowel phonation for 61 speakers with stroke. The results show: (1) men with stroke and healthy elderly men exhibited an identical voice profile, and men with stroke had only one significantly larger noise parameter (SPI--soft phonation index) than young healthy men; and (2) women with stroke and healthy elderly women exhibited an identical voice profile, except that women with stroke exhibited a significantly higher SPI than healthy elderly women. Although there were no significant differences in smoothed pitch perturbation quotient (sPPQ) and SPI between healthy elderly women and healthy young women, women with stroke exhibited significantly larger sPPQ and SPI than healthy young women. It is suggested that studies on sub-groups of the stroke population that use a combination of perceptual and acoustic analyses will better illuminate the voice dysfunction in dysarthria following stroke.

Aims: The Diadochokinetic Rate Analysis (DRA) in the KayPENTAX Motor Speech Profile is a computer program for the analysis of diadochokinesis (DDK). The objective of this study is to evaluate the suitability, reliability, and concurrent validity of the results from the DRA protocol and hand measurement for individuals with ataxic dysarthria, which is characteristically associated with dysdiadochokinesis. Methods: Twenty-one participants with ataxic dysarthria were recorded as they repeated various syllables as quickly and steadily as possible. The DDK samples were executed by the DRA protocol at different thresholds and were also hand-measured. Analyses were based on the percentage of nonexecutable DDK samples, defined as samples in which the lowest peak intensity during CV syllables is lower than the highest peak intensity during intersyllable pauses, and the comparisons of the results between repeated analyses at different thresholds and between automatic and manual measuring methods. Results: (1) More than one third of the DDK samples were nonexecutable; (2) the reliability at different thresholds and concurrent validity between different measuring methods were both satisfactory, and (3) temporal variation parameters were more inconsistent between different measuring methods than intensity variation parameters. Conclusion: DRA has notable limitations in its clinical application but there is a considerable potential for improving its performance.

第１章 喉頭がん・舌がんの診断 第２章 呼吸、嚥下、会話に関する頭頚部の解剖 第３章 喉頭がん・舌がんの治療 第４章 放射線療法 第５章 化学療法 第６章 喉頭がんの手術 第７章 舌がんの手術 第８章 喉頭がんの手術後、病院ではどんなことがあるのでしょうか 第９章 がんの治療中および治療後の心理的対処の方法 第１０章 がん治療後の社会生活、趣味の生活、仕事、性生活

Prosodic abnormality is a common feature in the dysarthrias associated with traumatic brain injury (TBI), but very few analytic studies have been reported on the nature of the prosodic disturbances. This study, based on analyses of conversational and sentence speech samples, reports on breath group structure and its temporal and intonational components for 12 subjects with TBI and 8 healthy controls. It introduces the method of f₀ close-copy stylization to the study of intonational patterns in dysarthria. The subjects with TBI had reduced mean length and variation of breath groups along with frequent inappropriate locations of breath pause and lengthy and variable breath pauses. Prosodic features that were preserved in the subjects with TBI were phrase final lengthening, f₀ downtrend and a relatively normal f₀ distribution. However, these subjects had reduced speaking and articulation rates, reduced f₀ movement and reduced f₀ slope. The phrase final lengthening and f₀ downtrend phenomena, which can serve as prosodic cues of syntactic boundary, appear to be robust features of speech production, but the dynamic features of f₀ control were more vulnerable to the neurological damage. This study indicates the importance of breath group management in TBI-induced dysarthria and the need to use methods such as those used in this study for large-scale investigations that examine cognitive, linguistic and motoric factors that conspire to reduce communicative efficiency.

Prosodic abnormality is common in the dysarthria associated with traumatic brain injury (TBI), and adjustments of speaking rate and emphatic stress are often used as steps in treating the speech disorder in patients with TBI-induced dysarthria. However, studies to date do not present a clear and detailed picture of how speaking rate and emphatic stress are affected in this speech disorder. This study, based on the acoustic analyses of syllable repetitions and sentence speech samples, reports on speaking rate and emphatic stress for 12 subjects with TBI and 8 healthy controls. For speaking rate, the subjects with TBI had (1) both slow speaking and articulation rates, (2) smaller phonation proportion and larger pause proportion, and (3) larger percentage change in speaking rate and smaller percentage change in articulation rate. For emphatic stress, the subjects with TBI had (1) significant increases in the difference and percentage change between pre-stressed and pre-unstressed pause durations, (2) significantly smaller difference between stressed and unstressed word durations, but not the percentage change between stressed and unstressed word durations, and (3) significantly reduced differences in f(0) movement and f(0) slope between stressed and unstressed words, but not in RMS range. This study demonstrates the multidimensional nature of prosodic deficits in the dysarthria related to TBI and illustrates the ability of acoustic measures to give a picture of the dysprosody related to TBI-induced dysarthria.Learning outcomes: As a result of this activity, the participant will be able to (1) describe the prosodic disturbances that have been reported in studies of dysarthria associated with TBI; (2) define acoustic measures appropriate to the analysis of changes in speaking rate and emphatic stress; and (3) discuss the importance of prosody to spoken communication. (c) 2005 Elsevier Inc. All rights reserved.

The task of syllable alternating motion rate (AMR) (also called diadochokinesis) is suitable for examining speech disorders of varying degrees of severity and in individuals with varying levels of linguistic and cognitive ability. However, very limited information on this task has been published for subjects with traumatic brain injury (TBI). This study is a quantitative and qualitative acoustic analysis of AMR in seven subjects with TBI. The primary goal was to use acoustic analyses to assess speech motor control disturbances for the group as a whole and for individual patients. Quantitative analyses included measures of syllable rate, syllable and intersyllable gap durations, energy maxima, and voice onset time (VOT). Qualitative analyses included classification of features evident in spectrograms and waveforms to provide a more detailed description. The TBI group had (1) a slowed syllable rate due mostly to lengthened syllables and, to a lesser degree, lengthened intersyllable gaps, (2) highly correlated syllable rates between AMR and conversation, (3) temporal and energy maxima irregularities within repetition sequences, (4) normal median VOT values but with large variation, and (5) a number of speech production abnormalities revealed by qualitative analysis, including explosive speech quality, breathy voice quality, phonatory instability, multiple or missing stop bursts, continuous voicing, and spirantization. The relationships between these findings and TBI speakers' neurological status and dysarthria types are also discussed. It was concluded that acoustic analyses of the AMR task provides specific information on motor speech limitations in individuals with TBI.

Near-total laryngectomy provides oncologic control of hypopharyngeal and laryngeal cancers that are not amenable to conservation procedures. The resulting myomucosal shunt provides a prosthesis-free method of voice rehabilitation. This review presents indications, technique, and speech rehabilitation for a near-total laryngectomy.

Although ataxic dysarthria has been studied with various methods in several languages, questions remain concerning which features of the disorder are most consistent, which speaking tasks are most sensitive to the disorder, and whether the different speech production subsystems are uniformly affected. Perceptual and acoustic data were obtained from 14 individuals (seven men, seven women) with ataxic dysarthria for several speaking tasks, including sustained vowel phonation, syllable repetition, sentence recitation, and conversation. Multidimensional acoustic analyses of sustained vowel phonation showed that the largest and most frequent abnormality for both men and women was a long-term variability of fundamental frequency. Other measures with a high frequency of abnormality were shimmer and peak amplitude variation (for both sexes) and jitter (for women). Syllable alternating motion rate (AMR) was typically slow and irregular in its temporal pattern. In addition, the energy maxima and minima often were highly variable across repeated syllables, and this variability is thought to reflect poorly coordinated respiratory function and inadequate articulatory/voicing control. Syllable rates tended to be slower for sentence recitation and conversation than for AMR, but the three rates were highly similar. Formant-frequency ranges during sentence production were essentially normal, showing that articulatory hypometria is not a pervasive problem. Conversational samples varied considerably across subjects in intelligibility and number of words/ morphemes in a breath group. Qualitative analyses of unintelligible episodes in conversation showed that these samples generally had a fairly well-defined syllable pattern but subjects differed in the degree to which the acoustic contrasts typical of consonant and vowel sequences were maintained. For some individuals, an intelligibility deficit occurred in the face of highly distinctive (and contrastive) acoustic patterns.

Rapid syllable repetition (diadochokinesis or alternating movement rate) is routinely used in the assessment of dysarthria. This report presents diadochokinetic data for 28 subjects with stroke. Acoustic analyses were used to obtain quantitative information on several parameters, including syllable rates, means and variability for syllable duration and intersyllable gap duration, and acoustic energy present during the intended stop-gap interval. The group as a whole demonstrated slow and variable performance on the repetition task, with slowness being related to lengthening of both syllables and the intersyllable gaps. In addition, the subjects frequently exhibited voicing or noise energy (spirantization) during the intersyllable gap, including the intended stop gap. A quantitative analysis procedure is outlined for the acoustic description of rapid syllable repetition.