Tongue-Palate Contact Pressure During Speech
Tongue-Palate Contact Pressure During Speech & Nonspeech Tasks in Amyotrophic Lateral Sclerosis Jeff Searl, Ph.D., CCC-SLP Stephanie Knollhoff, M.A., ABD
Disclosure Jeff Searl Relevant Financial Relationships Salaried in Hearing and Speech Dept. at the University of Kansas Medical Center Research funded by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179) Relevant Nonfinancial Relationships None
Disclosure Stephanie Knollhoff Relevant Financial Relationships Gradaute research assistant funded by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179) Relevant Nonfinancial Relationships None
Overview & Background Progressive tongue weakness in many with ALS Relevance to speech? Reasons to doubt Reliance on nonspeech indices – not good (e.g., Bunton, 2008; Forrest & Iuzzini, 2008; Kent, 2004; Weismer, 2006)
Nonspeech strength-to-speech correlations not overly encouraging (DePaul & Brooks, 1993; Langmore & Lehman, 1994) – speed is more positive (Green et al, 2013; Kuruvilla et al, 2012; Yunusova et al, 2010)
Speech doesn’t require much (Muller et al, 1984; Searl et al, 2007) PALS can maintain intelligible speech in presence of neurodegeneration
Overview & Background Reasons to still wonder??? Some minimal amount must be necessary – what is it? Non-bulbar disease effects and potential usefulness of low resistance exercise (…but still…relevance?)
More definitive data on what happens during speech are limited Where I came into this. (Searl, 2003; Searl et al, 2007; Searl, 2007; Searl & Evitts, 2013)
Aims 1. Can PALS reasonably do the task – not reported here (12 min vs. 7 min; no obvious fatigue)
2. PALS vs. non PALS contact pressure a) During lingua-alveolar consonants b) During isometric max
c) %IsoMax used during consonants
Procedures PALS: 13 • • • • •
>40yrs >25% verbal 8=clinical bulbar Sx 58% Male Range of severity
NonPALS: 12 Similar Age, gender distributions
“a tug is down”
“a sock is down”
“a lock is down”
“a dock is tall”
“a zig is down”
“a knock is loud”
Results Aim 1: PALS vs. Non-PALS during phonemes Kruskal-Wallis Results
χ2
df
α
α for Mann-Whitney U Post-hoc Comparisons Control v. Bulbar
Control v. Spinal
Bulbar v. Spinal
/t,d/
11.265
2
.004
.002
.278
.004
/s,z/
16.446
2
>.001
.001
.498
.006
/l/
6.96
2
.031
.596
.377
.202
/n/
6.27
2
.044
.082
.506
.127
Results Aim 2: PALS vs. non-PALS in isometric task Kruskal-Wallis Results χ2
Isometric Maximum
14.389
df
2
α
.001
α for Mann-Whitney U Post-hoc Comparisons Control v. Bulbar
Control v. Spinal
Bulbar v. Spinal
.001
.879
.019
Results Aim 3: PALS vs. non-PALS % of Isometric Max %Isometric Max for…
Χ2
df
α
/t,d/
4.07
2
.131
/s,z/
3.83
2
.147
/l/
4.12
2
.127
/n/
1.95
2
.377
Conclusions Weakness of tongue evident in those with bulbar Sx in both speech and non-speech lower pressures for stops and fricatives tested Lower isometric max BUT
Comparable %Max is intriguing - scaling of output based on physiological range?
Other analysis: correlations between pressures (speech and non-speech) and word intelligibility Suspect pressure measures may be reflective of severity of the disease
Of some interest – appeared that pressure above 2kPa pretty clearly distinguished higher and lower intelligibility
Follow-up needs …many Control for disease severity Of high interest internally = early detection of bulbar weakness & sensitive measure of progression early on
Track change over time … relative to speech parameters such as phoneme integrity or intelligibility – have now done
Clearly need more people to see if these data hold up.
Non-ALS specific Stability of the speech pressures in controls – 1st time looking at several time points
Constancy of %Max in the ALS group Relative to perceived effort? Is this similar in some way to effort calibration in other conditions such as PD If asked to change the speech pressure (incr.) how does that scale to perceived effort?
Acknowledgments
This work was supported by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.
Portions of this work have been accepted for publication in the Journal of Speech Language Hearing Researc.
Thanks to Richard Barohn, M.D., Dept. of Neurology, KUMC – Collaborator
Lindsey Heidrick, MA, CCC-SLP – participant recruitment
Doctoral students: Stephanie Knollhoff (lab leader), Kevin Pitt
Master’s students: Katherine Lier, Sarah Lynn, Nicole Griffith, Laila Al-Khasti, Jordan Martens, Sarah Orr, Leslie Ballinger, Hannah Bassett, Jenna Collins, Emily Foutch, Sydney Parriott, Justine Unruh, Lily Steil
Disclosure Jeff Searl Relevant Financial Relationships Salaried in Hearing and Speech Dept. at the University of Kansas Medical Center Research funded by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179) Relevant Nonfinancial Relationships None
Disclosure Stephanie Knollhoff Relevant Financial Relationships Gradaute research assistant funded by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179) Relevant Nonfinancial Relationships None
Overview & Background Progressive tongue weakness in many with ALS Relevance to speech? Reasons to doubt Reliance on nonspeech indices – not good (e.g., Bunton, 2008; Forrest & Iuzzini, 2008; Kent, 2004; Weismer, 2006)
Nonspeech strength-to-speech correlations not overly encouraging (DePaul & Brooks, 1993; Langmore & Lehman, 1994) – speed is more positive (Green et al, 2013; Kuruvilla et al, 2012; Yunusova et al, 2010)
Speech doesn’t require much (Muller et al, 1984; Searl et al, 2007) PALS can maintain intelligible speech in presence of neurodegeneration
Overview & Background Reasons to still wonder??? Some minimal amount must be necessary – what is it? Non-bulbar disease effects and potential usefulness of low resistance exercise (…but still…relevance?)
More definitive data on what happens during speech are limited Where I came into this. (Searl, 2003; Searl et al, 2007; Searl, 2007; Searl & Evitts, 2013)
Aims 1. Can PALS reasonably do the task – not reported here (12 min vs. 7 min; no obvious fatigue)
2. PALS vs. non PALS contact pressure a) During lingua-alveolar consonants b) During isometric max
c) %IsoMax used during consonants
Procedures PALS: 13 • • • • •
>40yrs >25% verbal 8=clinical bulbar Sx 58% Male Range of severity
NonPALS: 12 Similar Age, gender distributions
“a tug is down”
“a sock is down”
“a lock is down”
“a dock is tall”
“a zig is down”
“a knock is loud”
Results Aim 1: PALS vs. Non-PALS during phonemes Kruskal-Wallis Results
χ2
df
α
α for Mann-Whitney U Post-hoc Comparisons Control v. Bulbar
Control v. Spinal
Bulbar v. Spinal
/t,d/
11.265
2
.004
.002
.278
.004
/s,z/
16.446
2
>.001
.001
.498
.006
/l/
6.96
2
.031
.596
.377
.202
/n/
6.27
2
.044
.082
.506
.127
Results Aim 2: PALS vs. non-PALS in isometric task Kruskal-Wallis Results χ2
Isometric Maximum
14.389
df
2
α
.001
α for Mann-Whitney U Post-hoc Comparisons Control v. Bulbar
Control v. Spinal
Bulbar v. Spinal
.001
.879
.019
Results Aim 3: PALS vs. non-PALS % of Isometric Max %Isometric Max for…
Χ2
df
α
/t,d/
4.07
2
.131
/s,z/
3.83
2
.147
/l/
4.12
2
.127
/n/
1.95
2
.377
Conclusions Weakness of tongue evident in those with bulbar Sx in both speech and non-speech lower pressures for stops and fricatives tested Lower isometric max BUT
Comparable %Max is intriguing - scaling of output based on physiological range?
Other analysis: correlations between pressures (speech and non-speech) and word intelligibility Suspect pressure measures may be reflective of severity of the disease
Of some interest – appeared that pressure above 2kPa pretty clearly distinguished higher and lower intelligibility
Follow-up needs …many Control for disease severity Of high interest internally = early detection of bulbar weakness & sensitive measure of progression early on
Track change over time … relative to speech parameters such as phoneme integrity or intelligibility – have now done
Clearly need more people to see if these data hold up.
Non-ALS specific Stability of the speech pressures in controls – 1st time looking at several time points
Constancy of %Max in the ALS group Relative to perceived effort? Is this similar in some way to effort calibration in other conditions such as PD If asked to change the speech pressure (incr.) how does that scale to perceived effort?
Acknowledgments
This work was supported by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research #UL1TR000001 (formerly #UL1RR033179). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.
Portions of this work have been accepted for publication in the Journal of Speech Language Hearing Researc.
Thanks to Richard Barohn, M.D., Dept. of Neurology, KUMC – Collaborator
Lindsey Heidrick, MA, CCC-SLP – participant recruitment
Doctoral students: Stephanie Knollhoff (lab leader), Kevin Pitt
Master’s students: Katherine Lier, Sarah Lynn, Nicole Griffith, Laila Al-Khasti, Jordan Martens, Sarah Orr, Leslie Ballinger, Hannah Bassett, Jenna Collins, Emily Foutch, Sydney Parriott, Justine Unruh, Lily Steil
