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FraLusoPark

Goal: The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in two different languages (French vs European Portuguese).

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Sonia Frota
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The phonology of prosody has received little attention in studies of motor speech disorders. The present study investigates the phonology of intonation (nuclear contours) and speech chunking (prosodic phrasing) in Parkinson's disease (PD) as a function of medication intake and duration of the disease. Following methods of the prosodic and intonational phonology frameworks , we examined the ability of 30 PD patients to use intonation categories and prosodic phrasing structures in ways similar to 20 healthy controls to convey similar meanings. Speech data from PD patients were collected before and after a dopaminomimetic drug intake and were phonologi-cally analyzed in relation to nuclear contours and intonational phrasing. Besides medication, disease duration and the presence of motor fluctuations were also factors included in the analyses. Overall, PD patients showed a decreased ability to use nuclear contours and prosodic phrasing. Medication improved intonation regardless of disease duration but did not help with dysprosodic phrasing. In turn, disease duration and motor fluctuations affected phrasing patterns but had no impact on intonation. Our study demonstrated that the phonology of prosody is impaired in PD, and prosodic categories and structures may be differently affected, with implications for the understanding of PD neurophysiology and therapy.
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Parkinson's disease (PD) is characterized by a neurodegenerative chronic disorder with a motor symptomatology presence (WHO 2006). ü This disease affects 1%-2% world's population (60+ y.o.) and is classically characterized by a symptomatic triad that includes rest tremor, akinesia and hypertonia. Although the motor expression of the symptoms involves mainly the limbs, the muscles implicated in speech production are also subject to specific dysfunctions. PD speech is characterized by an impairment in phonation, in articulation, and in prosody (Tykalova et al. 2014). ü Previous studies of (dys)prosody in PD focused on simple acoustic analysis of prosodic parameters to describe overall trends (Skodda et al. 2009, 2011; Tykalova et al. 2014; Harris et al. 2016; Barnish et al. 2017), or on professional listeners' judgments of prosodic communicative efficiency (Martens et al. 2011). Structural properties of prosody have not been examined. ü Sentence modality and chunking the speech stream into units are two of prosody's main functions. These functions affect phrase-level meanings in ways that are structured by the language-specific prosodic system, and play a crucial role in communication. Portuguese (EP) uses contrasting nuclear contours to express modality, and intonational phrase breaks for chunking (Frota 2014). Main Goals ü To examine the expression of sentence modality and prosodic phrasing in PD-considering disease duration (G1: 1-5 years; G2: ≥10 years) and medication (OFF: no medication vs. ON: 1 hour after a dopaminomimetic drug intake): (i) presence/absence and type of pitch accent and boundary tone, and (ii) presence/absence of intonational breaks. ü Research questions: Is the expression of various sentence types and pragmatic meanings disturbed (broad and narrow focus statements, requests, commands, yes-no questions, initial calls, insistent calls)? Is prosodic phrasing in utterances containing several intonational phrases disturbed (as in the case of parentheticals or topics)? FraLusoPark-Dysarthria in Parkinson's disease: Lusophony vs. Francophony (FCT-ANR/NEU-SCC/0005/2013) Sentence modality http://labfon.letras.ulisboa.pt/ sonia.frota@mail.telepac.pt UID/LIN/00214/2013 Figure 3. Narrow focus statement produced by a G2 speaker Off (top), and a G1 speaker ON (bottom). Phrasing Figure 2. PD: medication and disease duration. Left panel: Nuclear contours (data for all sentence types); Right panel: Phrasing (expected intonational phrase breaks). à The categorical prosody of sentence modality and chunking is disturbed in PD. However, the different prosodic functions are affected differently. à Medication improved the expression of sentence types and meanings regardless of disease progression, but did not help with dysprosodic speech chunking. à The underlying mechanisms of chunking (phrasing requires speech planning), unlike that of modality (which is more directly pitch-related), seem to be less dependent on dopaminergic deficits, with implications for PD neurophysiology and therapy, as well as for our understanding of models of prosody. Figure 1. Controls and PD. Left panel: Nuclear contours (data for all sentence types); Right panel: Phrasing (expected intonational phrase breaks). Figure 4. Presence/absence of intonational breaks (IP, level 4): 2-IP utterance produced by a G2 speaker ON (top); utterance with a parenthetical produced by a G1 OFF (bottom). 'e' marks phrasing deviations from the expected pattern.
Sonia Frota
added a research item
The effects of medication and disease duration on the prosody of sentence modality and speech chunking in PD patients have been examined. It was found that the two prosodic functions are affected in different ways.
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Aim: The present study sought to make a cross-cultural adaptation of the Dysarthria Impact Profile (DIP) for European Portuguese (EP) and validate it for use in Parkinson's disease (PD) patients. Methods: The cross-cultural adaptation was carried out in accordance with the guidelines. The EP version of the DIP was administered to 80 people with PD, and 30 sex- and age-matched control participants. Psychometric properties, acceptability, feasibility reliability (internal consistency and intrarater agreement) and validity (construct, convergent and known-groups validity) were assessed using other assessment tools (motor disability and impairment, and voice impact). Results: Overall, the EP-DIP final version has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version. Statistical analyses showed adequate feasibility (missing data <5%), good acceptability (ceiling or floor effects <15%; high requests of assistance to complete the questionnaire), satisfactory internal consistency (Cronbach's α = 0.9), weak-to-moderate intrarater reliability, good construct validity, strong convergent validity (with the Voice Handicap Index; Spearman's P = -0.8) and good known-groups validity (between those with PD and control participants). Conclusions: The EP-DIP version displays the salient features of a valid patient-based assessment tool used to measure the psychosocial impact of slight-to-mild dysarthria in people with PD. Geriatr Gerontol Int 2018; ••: ••-••.
Rita Cardoso
added 2 research items
Introduction Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). Methods and analysis Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. Ethics and dissemination The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. Trial registration number NCT02753192, Pre-results.
Introdução: O Iowa Oral Performance Instrument é usado para medir a força e resistência linguais, sem dados normativos para a população com Parkinsonismo. Pretende-se avaliar a sua aplicabilidade em doentes com síndromas parkinsónicos com e sem declínio cognitivo. Materiais e métodos: Estudo transversal, participantes com diagnóstico de Doença de Parkinson idiopática e Parkinsonismos atípicos. O protocolo do estudo envolveu a avaliação da força lingual (máxima, resistência e força durante a deglutição de saliva e líquidos na consistência néctar) medida com o Iowa Oral Performance Instrument (em quilopascal), da motricidade lingual e deglutição (Frenchay Dysarthria Assessment, V2) e a opinião do indivíduo sobre a perturbação da deglutição (Swallowing Disturbance Questionnaire). Resultados: Foram incluídos 24 adultos (13 homens e 11 mulheres), com idade média de 73 anos (desvio padrão=8.8), diagnosticados com Parkinsonismos atípicos e Doença de Parkinson há 6.43 anos (desvio padrão=4.6) e com demência (25%). Verificaram-se dificuldades na aplicação do protocolo (33%) devido a demência (21%), incapacidade para iniciar a propulsão lingual (8%) e reflexo de vómito (4%). Não existem diferenças significativas na força lingual - (peak max (41.1±2.8), peak máx na deglutição saliva (21.5±2.6) e peak máx na deglutição de néctar (22.4±2.0) e resistência lingual (12.7±3.3) - ao género, idade e diagnóstico (p>.005). A motricidade lingual é significativamente diferente em função do diagnóstico da doença (p<0.05). Foram encontradas correlações positivas significativas fortes entre os valores de peak máx e resistência lingual (r=0.857) e, moderadas entre o peak máx e a avaliação subjectiva da deglutição (r=0.61) e o peak máx na deglutição saliva e de néctar (r=0.67) e a resistência e a opinião do individuo sobre o problema de deglutição (r=0.53). Conclusão e implicações clínicas ou terapêuticas: Os dados preliminares apresentados, de força e resistência linguais, para a população em estudo, confirmam a aplicabilidade clínica do Iowa Oral Performance Instrument na avaliação da motricidade lingual de indivíduos com Parkinsonismo.
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Background: Dysarthria is a common feature in Parkinson´s disease and actually there is a lack of validated instruments to assess speech in PD. FralusoPark is a multi-centric and international project to study speech disorders in PD and several instruments were translated, adapted and validated inside its framework. Purpose: To validate FDA-2 for the assessment of oro-motor function in People with Parkinson´s disease. Method(s): The FDA-2 was administered to 80 people with dysarthria. The psychometric properties, reliability (internal consistency and inter-judge reliability) and validity (face and convergent) were measured. Instruments to assess disease severity were applied at the same moment. Results: FDA-2 revealed high reliability for the total score (0.94), an excellent inter-rater agreement of the total score (0.96) and moderate to large construct validity for 81% of the items. It is well correlated with the gold standard tool, MDS-UPDRS, an instrument for disease severity assessment in Parkinson´s Disease (PD). Conclusion: The FDA-2 shows the salient features of a valid tool to be used by SLT in PD dysarthria assessment
Isabel Cristina Ramos Peixoto Guimarães
added 2 research items
Entre 70 a 90% das pessoas com Doença de Parkinson (DP) podem desenvolver disartria, contudo, encontra-se pouco documentado o impacto psicossocial da mesma. Objetivos: (i) Analisar o nível de preocupação com a disartria; (ii) Quantificar o impacto psicossocial da disartria; (iii) Avaliar a relação do impacto com a duração da doença e incapacidade. Metodologia: Estudo caso-controlo em que participaram 44 pessoas com DP e 44 pessoas sem perturbações de fala emparelhadas por idade e género sem defeito cognitivo valorizável. O parâmetro primário de avaliação foi o questionário do perfil do impacto da disartria. Resultados: As pessoas com DP (idade média de 63 anos, desvio padrão 11.2) têm a doença em média há 10.8 anos (desvio padrão=6.9) e um valor de MDS-UPDR total (média=73.2±desvio padrão=33.9). O nível de preocupação com a disartria auto-relatado era para 50% a menor preocupação, 29.5% ligeira preocupação, 9% preocupação, 4.5% muita preocupação e 4,5% a maior preocupação. O impacto psicossocial da disartria é significativamente mais negativo (p<0.05) nas pessoas com DP (184.3±26.3) do que nas pessoas sem perturbações da fala (217.3±9.6). As pessoas com DP que relataram a menor preocupação com a disartria apresentam um impacto piscossocial (174.2±25.6) significativamente (p<0.05) mais negativo do que as pessoas sem perturbações da fala. Existe correlação moderada negativa significativa (r=0.539) apenas com a duração da doença. Conclusão: Estes estudo revela que a pessoa com DP, sem defeito cognitivo e em estadio moderado de evolução da doença, apresenta um impacto psicossocial da disartria significativamente mais negativo do que a pessoa sem perturbações da fala, mesmo quando a disartira é a menor preocupação relativamente a outras queixas. Quanto maior a duração da doença maior o impacto da disartria.
Cross-linguistic studies aim at determining the similarities and differences in speech production by uncovering linguistic adaptations to specific constraints and environments. In the field of motor speech disorders, such a cross-language approach could be of great interest to understand not only the deficits of speech production that are induced by the pathology, but also the difficulties that are induced by the linguistic constraints specific to the patients' language. From a more clinical point of view, cross-linguistic studies should specifically focus on the relationship between speech disorders and speech intelligibility. The aim of this opinion article is to identify the currently scarce theoretical and clinical avenues for cross-linguistic studies of dysarthria in Parkinson's disease, and to establish guidelines that would lead future research in this direction. In turn, the practical and behavioral management of dysarthria in Parkinson's disease has so far only focused on the 'universal' dimensions of speech production and feedback (e.g., treatment of loudness and dysprosody). Such approaches could benefit immensely from proper recommendations that would be more 'language-driven' and individually adapted to the patients' language environment. An additional factor to consider for a better understanding and treatment of dysarthria in PD is the role of adjustment and cultural identity.
Isabel Cristina Ramos Peixoto Guimarães
added 2 research items
Determinar a velocidade e precisão de fala, na leitura de frases por pessoas com DP, comparar com pessoas sem DP, e verificar a relação com a idade, a escolaridade, a duração e gravidade da doença.
Prosody establishes sentence modality and chunks the speech stream into sense units. Both functions affect phrase-level meanings, playing a crucial role in communication. Portuguese uses nuclear contours to express modality and intonational breaks for chunking. This study examines the impact of Parkinson’s disease (PD) on these functions considering time from diagnosis (ToD:1-5 vs. ≥10 years) and medication (OFF vs. ON). Twenty sentences uttered by 6 controls and 12 PD patients in OFF and ON (20x30) were analyzed for nuclear contours and phrasing breaks. Results from non-parametric tests indicate that both prosodic functions distinguish patients from controls. Medication improves modality, which declines with time. Medication doesn’t help dysprosodic phrasing, which evolves differently. Implications for PD neurophysiology and therapy will be explored.
Isabel Cristina Ramos Peixoto Guimarães
added 2 research items
Hypokinetic dysarthria is a common symptom in those with Parkinson’s disease (PD); there is currently no standardized or validated tool for assessing speech in this population. To translate into European Portuguese (EP) the FDA-2 and perform a cultural adaptation followed by an evaluation of its psychometric properties in PD in a sample of people with PD in different stages of disease progression. Translation, back-translation, experts’ analysis, pre-test and final version test were performed. The EP version of the FDA-2 was administered to 80 people with PD (PwP) with dysarthria, feasibility and acceptability, reliability (internal consistency and inter-rater reliability) and validity (face and convergent) were measured. Overall, the EP-FDA-2 proved to be similar to the original demonstrating the same conceptual meanings, semantics, idiomatic and score equivalences. It has good feasibility (missing data <5 %), acceptability (ceiling and floor effects <15 %), a high reliability of the total score (0.94), an excellent inter-rater agreement for the total score (0.96) and moderate to large construct validity for 81 % of its items. It is well correlated with the gold standard for disease severity assessment in PD, the MDS-UPDRS. The EP-FDA-2 has shown the salient features of a valid tool that can be used by speech and language therapists in the assessment of dysarthria in PD in clinical practice as in the research field.
Establishing sentence modality and chunking the speech stream into units are two of prosody’s main functions. Both functions affect phrase-level meanings, playing a crucial role in communication. Portuguese uses contrasting nuclear contours to express modality, and intonational breaks for chunking (Frota, 2014). This study examines the impact of Parkinson’s disease (PD) on these functions considering time from diagnosis (G1: 1-5 years; G2: ≥10 years) and medication (OFF vs. ON state).
Isabel Cristina Ramos Peixoto Guimarães
added a research item
A Doença de Parkinson (DP) tradicionalmente caracterizada por uma tríade de sintomas que incluem o tremor de repouso, a bradicinesia e a rigidez. Os sinais motores envolvem principalmente os membros mas, também, são encontradas alterações motoras de produção da voz falada (disartria) e da deglutição (disfagia). Objetivo: Determinar os marcadores fisiológicos (motricidade orofacial e deglutição), fonatórios (voz), fala (velocidade articulatória e de fala), de perceção (inteligibilidade), linguísticos (prosódia) e de impacto psicossocial em doentes com Doença de Parkinson. Hipóteses em estudo: (1) os parâmetros fonatórios, articulatórios e deglutição estão alterados de forma semelhante e independentemente da língua (Português versus Francês); (2) os marcadores prosódicos nos controlos portugueses e franceses diferem significativamente de acordo com a língua; (3) os marcadores prosódicos em doentes portugueses e franceses não diferem significativamente em consequência do impacto da doença; (4) o impacto psicossocial das alterações na qualidade de vida é diferente nos doentes portugueses em comparação com os doentes franceses. Métodos: Serão avaliados indivíduos com Doença de Parkinson em Lisboa e em Aix-en-Provence. Os dois grupos experimentais, de 60 indivíduos cada, serão emparceirados para a idade com indivíduos saudáveis. A disfunção motora global será avaliada com a MDS-UPDRS em estádios sob o efeito (on) ou sem efeito (off) da medicação. A avaliação clínica decorrerá nos mesmos estadios on e off com diversas tarefas: (a) motricidade orofacial; (b) deglutição; (c) diadococinésia; (d) vogal sustentada; (e) tempo máximo de fonação; (f) leitura de palavras e frases; (g) leitura de um parágrafo; (h) discurso orientado. O projecto, financiado pela Fundação de Ciência e Tecnologia em Portugal e pela Agence Nationale de la Recherche em França decorre entre 2014 e 2016. Considerações finais: Este projecto original (pela sua estratégia trans-linguística), inovador (no âmbito europeu), federador (outra equipas internacionais encontram-se já a colaborar) e interdisciplinar (neurologia, terapia da fala, linguística) gerará um importante contributo nos domínios das doenças neurodegenerativas, ciências da fala e investigação clínica.
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Objectives: (1) To determine and identify the nature and pattern of oromotor movements specifically reflexes, respiration, lips, palate, larynx, tongue and intelligibility in Idiopathic Parkinson’s Disease (PD) patients according to gender. (2) To predict which variables, age, PD disease duration; sight, hearing, teeth, mood, posture and oral sensory feedback are associated with oromotor performance. Methods: Idiopathic PD patients were assessed using the Frenchay Dysarthria Assessment version two (FDA-2). The total possible FDA-2 score is 104 corresponding to the best patients’ performance. For statistical analysis, Student’s test for comparative purposes and multiple linear regression to find which variable combinations are associated mostly with the key dependent measure (FDA total score) were used. For both tests, the critical level of significance was 5%. Results: 80 Idiopathic Parkinson Disease patients, 44 males (mean age=66±1. 5) and 36 females (mean age=67. 6±1.9), with a PD duration of 11.9±1.1 and 9.9±1.2 years, respectively, were included. FDA-2 total score according to gender was 40.4±4.3 and 46.8±4.1 for males and females respectively. Although females present a worst oromotor performance than males the difference was not statistically significant. The results of the multiple regression analysis indicate that the overall model is a highly significant predictor (p<.001) model of the FDA total score accounting for 44% of its variance (R squared=.441). Moreover, t and p-values within the model show that only PD disease duration and mood variables are significant independent predictors. Beta weight coefficients show that the best predictor in the model is disease duration (.495) followed by mood (.246), hearing (.133), age (.117), teeth (.110), posture (.067), oral sensory feedback (.063) and sight (-.078). Conclusions: The results of this study failed to indicate a statistically significant difference between PD females and males. The combining predictor of 8 variables is a highly significant model accounting for 44% explanation of the nature and pattern of PD oromotor movements. The data collected will provide an important reference information for speech-language therapists with the purpose of oromotor dysfunction diagnosis in PD patients.
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Background: Psychosocial impact of dysphonia in people with Parkinson disease (PD) has been described with the Voice Handicap Index (VHI); however, its psychometric properties when applied in this population are not described. Objective: The objective of this study was to examine the psychometric properties of the VHI in people with PD. Methods: A cross-sectional study of 151 subjects without cognitive impairment (90 people with PD and 61 controls) was carried out. The VHI was applied along with clinician-based (Mini Mental State Examination, Hoehn and Yahr staging, and Movement Disorder Society-Unified Parkinson's Disease Rating Scale) and patient-based (self-rated voice severity) outcome measures. The psychometric properties of the VHI analyzed were the feasibility, reliability, and construct validity. Results: The average age of the PD population studied was 67 years; 51% had a primary level of education and 81% were retired. On average, they had disease onset duration of 11 years, a mild disease stage, mild to moderate global motor disability and impairment, and a normal to mild self-rated voice severity. The psychometric attributes of the VHI demonstrated that the questionnaire is feasible (missing data less than 1%), reliable (Cronbach α > 0.9), and valid (71.5% of the total variance is explained by five factors, correlates with voice severity, PD disability, and impairment, and differentiates subjects with PD from subjects without PD). Conclusion: The VHI is a reliable and valid tool that can be recommended for the population under study although further work is required to investigate its utility in advanced stages of disease.
Isabel Cristina Ramos Peixoto Guimarães
added an update
 
Isabel Cristina Ramos Peixoto Guimarães
added a research item
Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, three major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; (3) particular speech modifications that may be language-specific, that is dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in two different languages (French vs European Portuguese).
Isabel Cristina Ramos Peixoto Guimarães
added a project goal
The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in two different languages (French vs European Portuguese).