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. 2017 Aug;18(5-6):358-366.
doi: 10.1080/21678421.2017.1303515. Epub 2017 Mar 29.

The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS

Kristen M Allison  1 , Yana Yunusova  2 , Thomas F Campbell  3 , Jun Wang  3 , James D Berry  4 , Jordan R Green  1
Affiliations

The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS

Kristen M Allison et al. Amyotroph Lateral Scler Frontotemporal Degener. 2017 Aug.

Abstract

Objective: This study aimed to determine the diagnostic utility of clinician speech ratings and patient self-report for detecting early bulbar changes associated with amyotrophic lateral sclerosis (ALS), compared to instrumentation-based speech measures.

Methods: Thirty-six individuals with ALS and 17 healthy control participants were included. Patients' awareness of early bulbar motor involvement was assessed using self-reported scores on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Clinicians' detection of early bulbar motor involvement was assessed through perceptual speech ratings by two experienced speech-language pathologists. Participants with ALS were grouped as 'bulbar pre-symptomatic' or 'bulbar symptomatic' based on self-report and clinician ratings, and compared to healthy controls on six instrumentation-based speech measures. ROC analysis was used to compare the sensitivity and specificity of perceptual and instrumentation-based measures for detecting bulbar changes in pre-symptomatic individuals.

Results: Early bulbar changes that were documented using instrumentation-based measures were undetected by both patients and clinicians. ROC analyses indicated that instrumentation-based measures outperformed clinicians' scaled severity ratings, and that percent pause time was the best measure for differentiating healthy controls from bulbar pre-symptomatic individuals with ALS.

Conclusions: Findings suggested that instrumentation-based measures of speech may be necessary for early detection of bulbar changes due to ALS.

Keywords: Bulbar; early detection; speech motor impairment.

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Conflict of interest statement

Disclosure of interest

The authors report no conflicts of interest. This research was funded by NIH-NIDCD grants R01DC009890 and R01DC0135470.

Figures

Figure 1
Figure 1
Group differences on instrumentation-based speech measures and clinicians’ perceptual speech severity ratings. Panel a) displays results from groups based on patient self-report (i.e., self-reported bulbar pre-symptomatic (Self_Pre), self-reported bulbar symptomatic (Self_Symp), and controls). Panel b) displays results from groups based on clinician’s dysarthria judgments (i.e., SLP-rated bulbar pre-symptomatic (SLP_Pre), SLP-rated bulbar symptomatic (SLP_Symp), and controls).
Figure 2
Figure 2
Cohen’s d effect sizes for pairwise contrasts between self-reported bulbar presymptomatic individuals with ALS and healthy controls.
Figure 3
Figure 3
ROC curves displaying the performance of instrumentation-based speech measures and clinicians’ speech severity ratings for differentiating between self-reported bulbar presymptomatic individuals with ALS and healthy controls.
See this image and copyright information in PMC

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