Speech is produced by coordinated movements of the speech organs, and speech disorders can be caused by disturbance of the neuromuscular system. Because a neurogenic speech disorder may impair the social life of an individual, it has been considered as one of the major speech-language disorders. This article is intended to present a historical review of neurogenic speech disorders (dysarthria) in terms of definition and terminology. After two classic papers on dysarthria appeared from Mayo Clinic (Darley et al. 1969), the definition of dysarthria has been unified with the following features: 1) any dimension of speech can be affected (not only articulation but also respiration, phonation, resonance and/or prosody); 2) it is caused by neuro-muscular dysfunction; and 3) it is a collective name for various types. Although "dysarthrias" and "pure dysarthria" have been used, "dysarthria" is the most used terminology in the literature. Although there has been confusion about terminology (translated labels) in Japan, "dysarthria" or a few proposed terms in Japanese are currently used.
A review of literature was performed to understand the current state of assessment of dysarthria and dysarthric speakers globally and in Japan. Assessment of dysarthria is composed of auditory-perceptual impression of speech, and neurological and kinematic characteristics of the speech organs. The traditional approach after a Mayo Clinic study has consisted of patient history, speech features, tests of speech function, and oral mechanism and physical examinations, providing confirmatory signs for neurological diagnosis and identification of dysarthria subtypes. Test batteries for dysarthria are available around the world and in Japan. They are composed of an auditory-perceptual test, speech function tests, and observation of speech organs, but measuring instruments are not employed. Instrumental assessment is classified into three means and targets, such as acoustic analysis of output speech signals, aerodynamic measurement of the vocal tract during speech production, and physiological and kinematic analysis of the speech organs. Both the traditional approach and the test batteries are based on a perceptual scaling method, and thus inherently possess limited quantification. In contrast, instrumental assessment provides quantified data showing physiologic-kinematic changes, but it is not commonly used in clinical practice. Advances in well-defined parameters and cost reduction of the instruments are needed.
A clinical study was made of 30 cases of vocal fold nodules who received voice therapy at the Department of Otolaryngology of Yokohama City University Hospital during the past 11 years. The indication of voice therapy was decided by clinical conference of otolaryngologists and voice therapists. The course of voice therapy consisted of indirect and direct training sessions. One of the 30 cases dropped out during the course of trainings, and the remaining 29 cases were eventually subjected to the present study. The results showed that voice therapy was found to be effective and the training sessions were successfully completed within 3 months in 23 of the 29 cases. The remaining 6 cases were classified as difficult-to-treat cases based on their clinical courses. Among these 6 cases, 3 were further classified as a “resistive group,” while the other 3 were classified as a “prolonged group.” In the present report, clinical courses of these 6 cases were presented and discussed in detail. The results suggested that close observation of each patient together with holistic treatment and a team approach were most important as therapeutic strategies for difficult-to-treat cases of vocal nodules.
Muscle tension dysphonia and adductor spasmodic dysphonia are regarded as different voice disorders. When voice symptoms and laryngeal endoscopic findings are similar or voice symptoms are lost during medical examination, it is difficult for therapists to differentiate between these two voice disorders. The role of the speech-language-hearing therapist in discriminating between them is to improve the functional factors by voice therapy and supplement the diagnosis. When attempting certain facilitation techniques in trial therapy, a good response suggests that voice therapy should be performed first. However, in cases where it is difficult to choose an appropriate facilitation technique or patients have psychological problems, intervention by a speech-language-hearing therapist may not be successful. It is important to collect and share the therapeutic effects on difficult-to-distinguish cases and collaborate with specialists in the psychosomatic medicine department.
The present study investigated the reliability and fitness of the Chinese translated “Autism-Spectrum Quotient (AQ)” via the frameworks of the theoretically-derived five-factorial model (Baron-Cohen et al., 2001) and the statistically-derived five-factorial model (Lau & Gau et al., 2013). The AQ was administered to 355 native Chinese in the general population, and the model fitness indices for the overall confirmatory factor analyses indicated that neither model exhibited appropriate fitness with the data of the present study. Thus, we calculated the contribution scores from each of the AQ sub-categories by confirmatory factor analyses and extracted five items from each category of the AQ50 (a total of 50 items) developed by Baron-Cohen et al. (2001). This resulted in an AQ consisting of 25 question items (AQ25), which we proposed as the new Chinese AQ. The data distribution of the AQ25 was close to normal distribution. Cronbach's reliability coefficient (N=355, α=.78) and the test-retest reliability coefficient (N=15, r=.85) were both high. The Chinese version AQ25, consisting of half the question items of Baron-Cohen et al.'s AQ50 English version (2001), can measure the autistic spectrum from a Chinese general population and should be effective for clinical purposes.
Vocal fold atrophy causes permanent dysphonia and remains a therapeutic challenge. The purpose of the present study was to assess the efficacy of modified vocal function exercise (VFE) for vocal fold atrophy. The study included 10 participants who received modified VFE for vocal fold atrophy: 5 patients with accompanying muscle tension dysphonia (MTD group), and 5 patients who were not complicated with muscle tension dysphonia (None group). Data from aerodynamic analysis (MPT, MFR), pitch range, lowest pitch, highest pitch, acoustic analysis (jitter, shimmer, HNR) and VHI-10 were collected, both at the initiation of the exercise program and again at its conclusion. In all patients, measurements for MPT, pitch range, jitter, shimmer, HNR, and VHI-10 were significantly improved after modified VFE. In the None group, measurements for pitch range, jitter, shimmer, HNR and VHI-10 were significantly improved after modified VFE. In the MTD group, only the measurements for jitter and HNR improved after modified VFE. Modified vocal function exercise is effective for vocal fold atrophy patients. However, in vocal fold atrophy patients with compensatory movement, obtaining efficacy from modified vocal function exercise may be difficult.
We conducted a questionnaire survey on 48 pairs of parents of stuttering children to clarify changes over time of their agreement or disagreement in their emotions and collaborative feelings toward child rearing. In the questionnaire, we asked about their feelings at the time of onset of stuttering and now, regarding seven aspects: grasp of stuttering symptoms, feelings of anxiety, understanding of stuttering, spouse's response, feelings of guilt, feelings of isolation, and enlightenment. We also asked about their satisfaction level at the time of consultation for stuttering and at the time of participation in parents' groups. The results indicated that, compared with the fathers, the mothers more strongly wanted the spouses to listen to them from the time of onset up to now. Also, at the time of onset, mothers held stronger feelings of guilt than fathers, but now both fathers and mothers showed decreases in such feelings and there was no significant difference between them. Regarding consultation for stuttering, there was a noticeable difference in parent satisfaction level between the group who consulted experts and the group who consulted non-experts. The group who participated in the parents' groups had a higher level of satisfaction with participation. In this study, we obtained basic data for considering future parental support.
Incomplete closure for stop consonants for oral diadochokinesis (O-DDK) results in a reduced speech intensity (SI) gap in patients with dysarthria. This case report is intended to show changes in the SI gap and in the clinical index of speech assessment over the course of a tongue-cancer patient. A 63-year-old man was admitted with tongue cancer and underwent a partial resection. The O-DDK task with fixed rates (1 to 3 Hz) and maximum rates was performed before surgery, immediately after the surgery, and on discharge. Using acoustic analysis, peak and dip levels for consonant and vowel segments were identified and measured with their intensity contour. To normalize the intensity reduction for consonant closure, SI dip levels in percent (percent dip) were computed in reference to assignment of the average level for ten peaks (100%) and the average level of silent intervals (0%). Immediately after the surgery, the speech intelligibility score of 100 morae was slightly reduced and the percent dip for /ta/ at maximum rate was increased (80.6%), while such score and measure were within normal limits on discharge. The SI dip in O-DDK may be an indicator of articulatory ability in patients with mild articulatory deficit.