Document Type : Original Article
Authors
- Mahnoosh Fazeli 1
- negin moradi 2
- Majid Soltani 2
- Ehsan Naderifar 3
- Nastaran Majdinasab 4
- Seyed Mahmood Latifi 5
1 Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Assistant Professor, Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Instructor, Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Associate Professor, Musculoskeletal Rehabilitation Research Center, Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5 Ph.D. Candidate, Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background: Since in multiple sclerosis (MS), changes in speech and voice quality often precede other signs and symptoms; early diagnosis of these changes is necessary. In this study, an acoustic examination of phonation subsystem was performed. Due to the progressive nature of multiple sclerosis, the aim of this study was to examine the correlation between acoustic parameters of voice quality and disease severity and duration.
Methods:This descriptive-analytic study was performed on 43 patients with multiple sclerosis. The disease severity was detected by a neurologist based on the Expanded Disability Status Scale (EDSS) for each patient. Acoustic analysis was performed during the production of sustained vowel /a/ and accordingly, the maximum phonation time (MPT), perturbation of the frequency (jitter), perturbation of amplitude (shimmer), the maximum and minimum frequency, and the highest and lowest intensity were evaluated. All the acoustic analyses were performed using PRAAT software. Data were statistically analyzed using Spearman's correlation coefficient by SPSS version 21.
Results:The lowest intensity showed a significant correlation with disease severity (P=0.00). Also, the highest and lowest intensity showed a significant correlation with disease duration
(P=0.022 and P=0.002).
Conclusion:One of the earlier symptoms of central nervous system impairment resulting from multiple sclerosis is changes in phonation subsystem and voice quality. These changes may appear at any clinical stages; however, the symptoms might get worse over time, with the progression of the disease. Therefore, immediate acoustic assessments and interventions can prevent more degradation of voice quality.
Keywords
- Hartelius L, Nord L, Buder EH. Acoustic analysis of dysarthria associated with multiple sclerosis. Clinical Linguistics & Phonetics. 1995; 9(2):95-120.
- Duffy J. Motor Speech Disorders: Substrates. Differential Diagnosis and Management, 2nd ed, Mosby, New York. 2005:592.
- Darley FL, Brown JR, Goldstein NP. Dysarthria in multiple sclerosis. Journal of Speech, Language, and Hearing Research. 1972; 15(2):229-45.
- LaDuke KM. Speech characteristics in multiple sclerosis [dissertation]. Laramie, Wyoming: University of Wyoming; 2001.
- Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis results of an international survey. Neurology. 1996; 46(4):907-11.
- Hartelius L, Runmarker B, Andersen O. Prevalence and characteristics of dysarthria in a multiple-sclerosis incidence cohort: relation to neurological data. Folia phoniatrica et logopaedica. 2000; 52(4):160-77.
- Miller PH. Dysarthria in Multiple Sclerosis. National Multiple Sclerosis Society. 2008.
- Dogan M, Midi I, Yazıcı MA, Kocak I, Günal D, Sehitoglu MA. Objective and subjective evaluation of voice quality in multiple sclerosis. Journal of Voice. 2007; 21(6):735-40.
- Skodda S, Grönheit W, Schlegel U. Impairment of vowel articulation as a possible marker of disease progression in Parkinson's disease. PloS one. 2012; 7(2):e32132.
- Sapir S, Ramig LO, Spielman JL, Fox C. Formant centralization ratio: a proposal for a new acoustic measure of dysarthric speech. Journal of Speech, Language, and Hearing Research. 2010; 53(1):114-25.
- Boone DR, McFarlane SC, Von Berg SL, Zraick RI. The voice and voice therapy: Pearson Higher Ed; 2013.
- Compston A, McDonald I, Noseworthy J, Lassmann H, Miller D, Smith K, et al. McAlpine's multiple sclerosis2006.
- Rong P, Yunusova Y, Wang J, Green JR. Predicting early bulbar decline in amyotrophic lateral sclerosis: A speech subsystem approach. Behavioural neurology. 2015; 2015.
- Hartelius L, Theodoros D, Cahill L, Lillvik M. Comparability of perceptual analysis of speech characteristics in Australian and Swedish speakers with multiple sclerosis. Folia phoniatrica et logopaedica. 2003; 55(4):177-88.
- Yamout B, Fuleihan N, Hajj T, Sibai A, Sabra O, Rifai H, et al. Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis. European Archives of Oto-Rhino-Laryngology. 2009; 266(11):1759-65.
- Bauer V, Aleric Z, Jancic E, Knezevic B, Prpic D, Kacavenda A. Subjective and perceptual analysis of voice quality and relationship with neurological disfunction in multiple sclerosis patients. Clinical neurology and neurosurgery. 2013; 115:S17-S20.
- Eskandarieh S, Heydarpour P, Minagar A, Pourmand S, Sahraian MA. Multiple sclerosis epidemiology in East Asia, South East Asia and South Asia: a systematic review. Neuroepidemiology. 2016; 46(3):209-21.
- Kurtzke JF. Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology. 1983; 33(11):1444-.
- American Speech-Language-Hearing Association. Scope of practice in speech-language pathology; 2016. [cited 2016 May 16] Available from www.asha.org/policy/.
- Feijó AV, Parente MA, Behlau M, Haussen S, De Veccino MCl, de Faria Martignago BC. Acoustic analysis of voice in multiple sclerosis patients. Journal of Voice. 2004; 18(3):341-7.
- Aghadoost O, Amiri-Shavaki Y, Moradi N, Jalai S. A comparison of Dysphonia Severity Index in female teachers with and without voice complaints in elementary schools of Tehran, Iran. Nursing and Midwifery Studies. 2013; 1(3):133-8.
- Hakkesteegt MM, Brocaar MP, Wieringa MH, Feenstra L. The relationship between perceptual evaluation and objective multiparametric evaluation of dysphonia severity. Journal of Voice. 2008; 22(2):138-45.
- Maryn Y, Morsomme D, De Bodt M. Measuring the Dysphonia Severity Index (DSI) in the program Praat. Journal of Voice. 2017.
- Hartelius L, Buder EH, Strand EA. Long-term phonatory instability in individuals with multiple sclerosis. Journal of Speech, Language, and Hearing Research. 1997; 40(5):1056-72.
- Gerald FJF, Murdoch BE, Chenery HJ. Multiple sclerosis: Associated speech and language disorders. Australian Journal of Human Communication Disorders. 1987; 15(2):15-35.
- Yorkston KM, Klasner ER, Bowen J, Ehde DM, Gibbons LE, Johnson K, et al. Characteristics of multiple sclerosis as a function of the severity of speech disorders. Journal of Medical Speech-Language Pathology. 2003; 11(2):73-85.
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