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. 2015:2015:183027.
doi: 10.1155/2015/183027. Epub 2015 Jun 2.

Predicting Early Bulbar Decline in Amyotrophic Lateral Sclerosis: A Speech Subsystem Approach

Panying Rong  1 , Yana Yunusova  2 , Jun Wang  3 , Jordan R Green  1
Affiliations

Predicting Early Bulbar Decline in Amyotrophic Lateral Sclerosis: A Speech Subsystem Approach

Panying Rong et al. Behav Neurol. 2015.

Abstract

Purpose: To develop a predictive model of speech loss in persons with amyotrophic lateral sclerosis (ALS) based on measures of respiratory, phonatory, articulatory, and resonatory functions that were selected using a data-mining approach.

Method: Physiologic speech subsystem (respiratory, phonatory, articulatory, and resonatory) functions were evaluated longitudinally in 66 individuals with ALS using multiple instrumentation approaches including acoustic, aerodynamic, nasometeric, and kinematic. The instrumental measures of the subsystem functions were subjected to a principal component analysis and linear mixed effects models to derive a set of comprehensive predictors of bulbar dysfunction. These subsystem predictors were subjected to a Kaplan-Meier analysis to estimate the time until speech loss.

Results: For a majority of participants, speech subsystem decline was detectible prior to declines in speech intelligibility and speaking rate. Among all subsystems, the articulatory and phonatory predictors were most responsive to early bulbar deterioration; and the resonatory and respiratory predictors were as responsive to bulbar decline as was speaking rate.

Conclusions: The articulatory and phonatory predictors are sensitive indicators of early bulbar decline due to ALS, which has implications for predicting disease onset and progression and clinical management of ALS.

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Figures

Figure 1
Figure 1
Scatter plot of the relation between speech intelligibility and speaking rate based on the SIT from all participants. The horizontal dashed line corresponds to 85% of intelligibility and the vertical dashed line corresponds to 120 WPM of speaking rate.
Figure 2
Figure 2
Scatter plots of the relation between speaking rate and each subsystem predictor accounting for time and subject effects: (a) respiratory, (b) phonatory, (c) articulatory, and (d) resonatory. On the x-axis is the subsystem predictor adjusted for time, which is the combination of each subsystem predictor and the effect of time on speaking rate. On the y-axis is the normalized speaking rate derived by subtracting the subject-dependent random effect from speaking rate. The lines are the linear fits based on the LME models.
Figure 3
Figure 3
Survival functions for speech intelligibility (black solid), speaking rate (black dashed), respiratory (red solid), phonatory (grey dashed), articulatory (magenta dash-dotted), and resonatory (blue dotted) subsystem predictors.
See this image and copyright information in PMC

References

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