Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech subsystems. There is widespread cross-discipline use of speech recordings for diagnostic and research purposes, despite which there are no specific guidelines for a standardized method. This review aims to combine the specific clinical presentations of patients with movement disorders, existing acoustic assessment protocols, and technological advances in capturing speech to provide a basis for future research in this field and to improve the consistency of clinical assessments. We considered 3 areas: the recording environment (room, seating, background noise), the recording process (instrumentation, vocal tasks, elicitation of speech samples), and the acoustic outcome data. Four vocal tasks, namely, sustained vowel, sequential and alternating motion rates, reading passage, and monologues, are integral aspects of motor speech assessment. Fourteen acoustic vocal speech features, including their hypothesized pathomechanisms with regard to typical occurrences in hypokinetic or hyperkinetic dysarthria, are hereby recommended for quantitative exploratory analysis. Using these acoustic features and experimental speech data, we demonstrated that the hyperkinetic dysarthria group had more affected speech dimensions compared with the healthy controls than had the hypokinetic speakers. Several contrasting speech patterns between both dysarthrias were also found. This article is the first attempt to provide initial recommendations for a standardized way of recording the voice and speech of patients with hypokinetic or hyperkinetic dysarthria; thus allowing clinicians and researchers to reliably collect, acoustically analyze, and compare vocal data across different centers and patient cohorts. © 2020 International Parkinson and Movement Disorder Society.

Columbia University New York New York USA

Department of Circuit Theory Faculty of Electrical Engineering Czech Technical University Prague Prague Czech Republic

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague Czech Republic

LSVT Global Inc Tucson Arizona USA

National Center for Voice and Speech Denver Colorado USA

UCL Institute of Neurology Department of Clinical and Movement Neurosciences and National Hospital for Neurology and Neurosurgery UCLH NHS Trust London UK

University of Colorado Boulder Boulder Colorado USA

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Mov Disord. 2021 Apr;36(4):1041. doi: 10.1002/mds.28537. PubMed

Komentář v

Mov Disord. 2021 Apr;36(4):1042-1043. doi: 10.1002/mds.28539. PubMed

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Patel RR, Awan SN, Barkmeier-Kraemer J, et al. Recommended protocols for instrumental assessment of voice: American speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function. Am J Speech Lang Pathol 2018;27:887-905.

Buder EH. Acoustic analysis of voice quality: a tabulation of algorithms 1902-1990. In: Kent RD, Ball MJ, eds. Voice Quality Measurement. San Diego, CA: Singular Publishing Group; 2000:119-244.

Titze IR. Summary statement: workshop on acoustic voice analysis. national center for voice and speech; NCVS, Denver, Colorado; 1995.

Svec JG, Grandvist S. Guidelines for selecting microphones for human voice production research. Am J Speech Lang Pathol 2010;19:356-368.

Svec JG, Grandvist S. Tutorial and guidelines on measurement of sound pressure level in voice and speech. J Speech Lang Hear Res 2018;61:441-461.

Titze IR, Baken RJ, Bozeman K, Granqvist S, Henrich N, Herbst CT. Toward a consensus on symbolic notation of harmonics, resonances, and formants in vocalization. J Acoust Soc Am 2015;137:3005-3007.

Kempster GB, Gerratt BR, Abbott KV, Barkmeier-Kraemer J, Hillman RE. Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol 2009;18:124-132.

Logemann JA, Fisher HB, Boshes B, Blonsky ER. Frequency and co-occurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. J Speech Hear Disord 1978;43:47-57.

Hartelius L, Carlstedt A, Ytterberg M, Lillvik M, Laakso K. Speech disorders in mild and moderate Huntington disease: results of dysarthria assessments of 19 individuals. J Med Speech Lang Pathol 2003;11:1-14.

Rusz J, Klempir J, Tykalova T, et al. Characteristics and occurence of speech impairment in Huntington's disease: possible influence of antipsychotic medication. J Neural Transm 2014;121:1529-1539.

Duffy JR. Motor speech disorders: substrates, differential diagnosis and management. 4th ed. St. Louis, MO: Mosby; 2020.

Rusz J, Hlavnicka J, Tykalova T, et al. Quantitative assessment of motor speech abnormalities in idiopathic REM sleep behaviour disorder. Sleep Med 2016;19:141-147.

Plowman-Prine EK, Okun MS, Sapienza CM, et al. Perceptual characteristics of parkinsonian speech: a comparison of the pharmacological effects of levodopa across speech and non-speech motor systems. NeuroRehabilitation 2009;24:131-144.

Skodda S, Rinsche A, Schlegel U. Progression of dysprosody in Parkinson's disease: a longitudinal study. Mov Disord 2009;24:716-722.

Skodda S, Gronheit W, Schlegel U. Impairment of vowel articulation as a possible marker of disease progression in Parkinson's disease. PLoS One 2012;7:e32132.

Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson's disease: randomized controlled trial (RCT). Mov Disord 2018;33:1777-1791.

Rusz J, Bonnet C, Klempir J, et al. Speech disorders reflect differing pathophysiology in Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. J Neurol 2015;262:992-1001.

Tripoliti E, Zrinzo L, Martinez-Torres I, et al. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 2011;76:80-86.

Barkmeier JM, Case JL, Ludlow CL. Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges. J Commun Disord 2001;34:21-37.

Yoshida K. Oromandibular dystonia screening questionnaire for differential diagnosis. Clin Oral Investig 2019;23:405-411.

Stock L, Krüger-Zechlin C, Deeb Z, Timmermann L, Waldthaler J. Natural reading in Parkinson's disease with and without mild cognitive impairment. Front Aging Neurosci 2020;12:120.

Peron J, Cekic S, Haegelen C, et al. Sensory contribution to vocal emotion deficit in Parkinson's disease after subthalamic stimulation. Cortex 2015;63:172-183.

Sapir S. Multiple factors are involved in the dysarthria associated with Parkinson's disease: a review with implications for clinical practice and research. J Speech Lang Hear Res 2014;57:1330-1343.

Moreau C, Pinto S. Misconceptions about speech impairment in Parkinson's disease. Mov Disord 2019;34:1471-1475.

Sramkova H, Granqvist S, Herbst CT, Svec JG. The softest sound levels of the human voice in normal subjects. J Acoust Soc Am 2015;137:407-418.

ANSI/ASA S1.4. ANSI/ASA S1.4-2014/Part 1/IEC 61672:1-2013 American National Standard Electroacoustics-Sound Level Meters-Part 1: Specifications (A Nationally Adopted International Standard), American National Standards Institute. Melville; Acoustical Society of America; 2014.

Ludlow CL, Kent R, Gray LC. Measuring voice, speech and swallowing in the clinic and laboratory. San Diego, CA: Plural Publishing; 2019:153-156.

Barkmeier-Kraemer JM, Clark HM. Speech-language pathology evaluation and management of hyperkinetic disorders affecting speech and swallowing function. Tremor Other Hyperkinet Mov (N Y) 2017;7:489.

Guiry S, Worthley A, Simonyan K. A separation of innate and learned vocal behaviors defines the symptomatology of spasmodic dysphonia. Laryngoscope 2019;129:1627-1633.

Vogel AP, Fletcher J, Snyder PJ, Fredrickson A, Maruff P. Reliability, stability, and sensitivity to change and impairment in acoustic measures of timing and frequency. J Voice 2011;25:137-149.

Fox CM, Ramig LO. Vocal sound pressure level and self-perception of speech and voice in men and women with idiopathic Parkinson disease. Am J Speech Lang Pathol 1997;6:85-94.

Burris C, Vorperian HK, Fourakis M, et al. Quantitative and descriptive comparison of four acoustic analysis systems: vowel measurements. J Speech Lang Hear Res 2014;57:26-45.

Boersma P, Weenink D. Praat: doing phonetics by computer [Computer program]. Version 6.1.08, 2019. http://www.praat.org/

Sjolander K, Beskow J. WaveSurfer (1.8.5). Stockholm; 2005. http://www.speech.kth.se/wavesurfer/. Accessed August 01, 2020.

Milenkovic P. TF32 (Alpha). Madison, WI; 2010. http://userpages.chorus.net/cspeech/

de Jong N, Wempe T. Praat script to detect syllable nuclei and measure speech rate automatically. Behav Res Method 2009;47:358-390. Accessed August 01, 2020.

Hlavnicka J. Automated analysis of speech disorders in neurodegenerative diseases. Prague, Czechia; 2018. http://dysan.cz/. Accessed August 01, 2020.

Brabenec L, Mekyska J, Galaz Z, Rektorova I. Speech disorders in Parkinson's disease: early diagnostics and effects of medication and brain stimulation. J Neural Trans 2017;124:303-334.

Rumbach A, Aiken P, Novakovic D. Outcome measurement in the treatment of spasmodic dysphonia: a systematic review of the literature. J Voice 2019;33:810.e13-810.e39.

Ramig LA, Scherer RC, Titze IR, Ringel SP. Acoustic analysis of voices of patients with neurologic disease: rationale and preliminary data. Ann Otol Rhinol Laryngol 1988;97:164-172.

Zwirner P, Murry T, Woodson GE. Phonatory function of neurologically impaired patients. J Commun Disord 1991;24:287-300.

Zwirner P, Barnes GJ. Vocal tract steadiness: a measure of phonatory and upper airway motor control during phonation in dysarthria. J Speech Hear Res 1992;35:761-768.

Hertrich I, Ackermann H. Acoustic analysis of speech prosody in Huntington's and Parkinson's disease: a preliminary report. Clin Linguist Phon 1993;7:258-297.

Ackermann H, Hertrich I, Hehr T. Oral diadochokinesis in neurological dysarthrias. Folia Phoniatr Logop 1995;47:15-23.

Liss JM, White L, Mattys SL, Lansford K, Lotto AJ, Spitzer SM, Caviness JN. Quantifying speech rhythm abnormalities in the dysarthrias. J Speech Lang Hear Res 2009;52:1334-1352.

Rusz J, Megrelishvili M, Bonnet C, et al. A distinct variant of mixed dysarthria reflects parkinsonism and dystonia due to ephedrone abuse. J Neural Transm 2014;121:655-664.

Rusz J, Hlavnicka J, Cmejla R, Ruzicka E. Automatic evaluation of speech rhythm instability and acceleration in dysarthrias associated with basal ganglia dysfunction. Front Bioeng Biotechnol 2015;3:104.

Novotny M, Rusz J, Cmejla R, Ruzickova H, Klempir J, Ruzicka E. Hypernasality associated with basal ganglia dysfunction: evidence from Parkinson's disease and Huntington's disease. PeerJ 2016;4:e2530.

Hlavnicka J, Tykalova T, Ulmanova O, et al. Characterizing vocal tremor in progressive neurological diseases via automated acoustic analyses. Clin Neurophysiol 2020;131:1155-1165.

Skodda S, Visser W, Schlegel U. Vowel articulation in Parkinson's disease. J Voice 2011;25:467-472.

Moore BCJ. An introduction to the psychology of hearing, 5th ed. Boston, MA: Academic Press; 2003:1-413.

Simpson AP. Phonetic differences between male and female speech. Lang Linguist Compass 2009;3:621-640.

Hlavnicka J, Cmejla R, Klempir J, Ruzicka E, Rusz J. Acoustic tracking of pitch, modal and subharmonic vibrations of vocal folds in Parkinson's disease and parkinsonism. IEEE Access 2019;7:150339-150354.

Svec LG SHK, Miller DG. A subharmonic vibratory pattern in normal vocal folds. J Speech Lang Hear Res 1996;39:135-143.

Titze IR. Principles of voice production. Englewood Cliffs, NJ: Prentice-Hall; 1994.

Awan SN, Roy N, Zhang D, Cohen SM. Validation of the cepstral spectral index of dysphonia (CSID) as a screening tool for voice disorders: development of clinical cutoff scores. J Voice 2016;30:130-144.

Kent R, Weismer G, Kent J, Vorperian H, Duffy J. Acoustic studies of dysarthric speech: methods, progress, and potential. J Commun Disord 1999;32:427-445.

Kent R, Kim Y. Toward an acoustic typology of motor speech disorders. Clin Linguist Phon 2003;17:427-445.

Roy N, Nissen SL, Dromey C, Sapir S. Articulatory changes in muscle tension dysphonia: evidence for vowel space expansion following manual circumlaryngeal therapy. J Commun Disord 2009;42:124-135.

Sapir S, Ramig LO, Spielman JL, Fox C. Formant centralization ratio: a proposal for a new acoustic measure of dysarthric speech. J Speech Lang Hear Res 2010;53:114-125.

Rusz J, Cmejla R, Tykalova T, et al. Imprecise vowel articulation as a potential early marker of Parkinson's disease: effect of speaking task. J Acoust Soc Am 2013;134:2171-2181.

Kim H, Hasegawa-Johnson M, Perlman A. Vowel contrast and speech intelligibility in dysarthria. Folia Phoniatr Logop 2011;63:187-194.

Fisher E, Goberman AM. Voice onset time in Parkinson's disease. J Commun Disord 2010;43:21-34.

Novotny M, Rusz J, Cmejla R, Ruzicka E. Automatic evaluation of articulatory disorders in Parkinson's disease. IEEE/ACM T Audio Speech Lang Process 2014;22:1366-1378.

Tykalova T, Rusz J, Klempir J, Cmejla R, Ruzicka E. Distinct patterns of consonant articulation among Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. Brain Lang 2017;165:1-9.

Goberman AM. Correlation between acoustic speech characteristics and non-speech motor performance in Parkinson's disease. Med Sci Monit 2005;11:CR109-CR116.

Hlavnicka J, Cmejla R, Tykalova T, Sonka K, Ruzicka E, Rusz J. Automated analysis of connected speech reveals early biomarkers of Parkinson's disease in patients with rapid eye movement sleep behaviour disorder. Sci Rep 2017;7:12.

Rusz J, Cmejla R, Ruzickova H, Ruzicka E. Quantitative acoustic measurements for characterization of speech and voice disorders in early untreated Parkinson's disease. J Acoust Soc Am 2011;129:350-367.

Skodda S, Schlegel U. Speech rate and rhythm in Parkinson's disease. Mov Disord 2008;23:985-992.

Styler W. Using Praat for Linguistic Research. Version 1.4.5. http://savethevowels.org/praat. Accessed August 01, 2020.

Rusz J, Tykalova T, Salerno G, Bancone S, Scarpelli J, Pellecchia MT. Distinctive speech signature in cerebellar and parkinsonian subtypes of multiple system atrophy. J Neurol 2019;266:1394-1404.

Yorkston K, Beukelman DR, Tice R. Sentence Intelligibility Test [Measurement Instrument]. Tice Technologies: Lincoln, NE; 1996.

Levy ES, Moya-Gale E, Chang YHM, et al. The effects of intensive speech treatment on intelligibility in Parkinson's disease: a randomised controlled trial. EClinicalMedicine 2020;24:100429.

Dimauro G, Di Nicola V, Bevilacqua V, Caivano D, Girardi F. Assessment of speech intelligibility in Parkinson's disease using a speech-to-text system. IEEE Access 2017;5:22199-22208.

An automatic measure for speech intelligibility in dysarthrias-validation across multiple languages and neurological disorders

Acoustic assessment in mandarin-speaking Parkinson's disease patients and disease progression monitoring and brain impairment within the speech subsystem

Automatic speech-based assessment to discriminate Parkinson's disease from essential tremor with a cross-language approach

Computerized analysis of hypomimia and hypokinetic dysarthria for improved diagnosis of Parkinson's disease

Speech and gait abnormalities in motor subtypes of de-novo Parkinson's disease

COMIRESTROKE-A clinical study protocol for monitoring clinical effect and molecular biological readouts of COMprehensive Intensive REhabilitation program after STROKE: A four-arm parallel-group randomized double blinded controlled trial with a longitudinal design

Speech acoustic indices for differential diagnosis between Parkinson's disease, multiple system atrophy and progressive supranuclear palsy

Articulatory undershoot of vowels in isolated REM sleep behavior disorder and early Parkinson's disease

Study protocol for using a smartphone application to investigate speech biomarkers of Parkinson's disease and other synucleinopathies: SMARTSPEECH

Short-term effect of dopaminergic medication on speech in early-stage Parkinson's disease

Distinct patterns of speech disorder in early-onset and late-onset de-novo Parkinson's disease

Speech Biomarkers in Rapid Eye Movement Sleep Behavior Disorder and Parkinson Disease