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  • 1.
    Karlsson, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Hartelius, Lena
    Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
    How Well Does Diadochokinetic Task Performance Predict Articulatory Imprecision?: Differentiating Individuals with Parkinson's Disease from Control Subjects2019In: Folia Phoniatrica et Logopaedica, ISSN 1021-7762, E-ISSN 1421-9972, Vol. 71, no 5-6, p. 251-260Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether syllables produced in an oral diadochokinetic (DDK) task may be quantified so that persons with Parkinson's disease (PD) perceived to have reduced articulatory precision when reading may be correctly identified using that quantification.

    PATIENTS AND METHODS: Syllable sequences from 38 speakers with PD and 38 gender- and age-matched control speakers (normal controls [NC]) were quantified acoustically and evaluated in terms of (1) the speakers' ability to accurately predict speaker group membership (PD or NC) and (2) their ability to predict reduced/non-reduced articulatory precision.

    RESULTS: A balanced accuracy of 80-93% in predicting speaker group membership was achieved. The best measures were related to the proportion of a syllable made up of a vowel, amplitude slope and syllable-to-syllable variation in duration and amplitude. The best material was that based on /ka/. Reduced articulatory precision was accurately predicted from DDK measures in 89% of the samples. Release-transient prominence and voicing during the onset of plosives were particularly strong predictors.

    CONCLUSIONS: DDK sequences can predict articulatory imprecision as observed in another speech task. The linking of performance across speech tasks probably requires measures of stability in syllable durations and amplitudes, as well as measures of subsyllabic acoustic features.

  • 2.
    Karlsson, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hartelius, Lena
    Göteborgs universitet.
    How well does DDK task performance predict fluent speech articulation?2018Conference paper (Other academic)
    Abstract [en]

    The oral diadokochinesia (DDK) task is an established tool for assessing speech motor control that has been used across a range of conditions. The predominant outcome measure reported after the patient have performed the task is the maximum syllable rate achieved by the patient. More recent reports have also highlighted stability in pace of the sequence as quantifications that may be indicative of speech impairment. While the DDK task affords quick and easy administration, concerns have been raised regarding the strength of association between DDK task performance and patients’s articulation in fluent speech. It may not be assumed that a reduced DDK rate or rate stability will cause fluent speech also to be perceived as slowed or dysrhythmic. And, patients may well improve their syllable rate at the expense of articulatory quality, which is currently not easily captured in an objective outcome measure.

    We report here on an effort to assess to what degree information from an expanded quantification of DDK sequences may be used identify patients with dysarthria and to model clinical assessments of fluent speech. Acoustic quantifications of the consonant and consonant-vowel relationship are combined with previously used measures, and applied to manually processed DDK sequences produced by patients with Parkinson’s disease and normal control speakers. We observe how well these quantifications may form the basis for accurate identification of patients among normal controls, and predict the outcome of blinded and randomized clinical assessments of patients’ production of fluent speech.Rapid repetition of CV syllables (oral diadochokinesis, DDK) puts pressure on the speech motor system in order to afford detection of a deteriorating articulatory ability.

    This study assessed

    1.  how well objective quantifications of DDK

      sequences can be used to identify PD speakers

      among age matched controls (NC), and

    2. how well a reduced articulatory ability in PD

      speakers may be predicted using quantifications of DDK sequences performed in the same recording session.

    The comprehensive DDK sequence quantification achieved a 93% classification accuracy for speaker group and a 79% accuracy for reduced fluent speech articulatory quality. 

  • 3.
    Karlsson, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Schalling, Ellika
    Laakso, Katja
    Johansson, Kerstin M
    Hartelius, Lena
    Assessment of speech impairment in patients with Parkinson's disease from acoustic quantifications of oral diadochokinetic sequences2020In: Journal of the Acoustical Society of America, ISSN 0001-4966, E-ISSN 1520-8524, Vol. 147, no 2, p. 839-851Article in journal (Refereed)
    Abstract [en]

    This investigation aimed at determining whether an acoustic quantification of the oral diadochokinetic (DDK)task may be used to predict the perceived level of speech impairment when speakers with Parkinson's disease(PD) are reading a standard passage. DDK sequences with repeated [pa], [ta], and [ka] syllables were collectedfrom 108 recordings (68 unique speakers with PD), along with recordings of the speakers reading a standardizedtext. The passage readings were assessed in five dimensions individually by four speech-language pathologists ina blinded and randomized procedure. The 46 acoustic DDK measures were merged with the perceptual ratings ofread speech in the same recording session. Ordinal regression models were trained repeatedly on 80% of ratingsand acoustic DDK predictors per dimension in 10-folds, and evaluated in testing data. The models developedfrom [ka] sequences achieved the best performance overall in predicting the clinicians' ratings of passage readings. The developed [pa] and [ta] models showed a much lower performance across all dimensions. The additionof samples with severe impairments and further automation of the procedure is required for the models to be usedfor screening purposes by non-expert clinical staff.

  • 4.
    Lohmander, Anette
    et al.
    Karolinska institutet.
    McAllister, Anita
    Karolinska institutet.
    Hansson, Kristina
    Lunds universitet.
    Hartelius, Lena
    Göteborgs universitet.
    Blom Johansson, Monica
    Uppsala universitet.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Samuelsson, Christina
    Linköpings universitet.
    Schalling, Ellika
    Karolinska institutet.
    Södersten, Maria
    Karolinska institutet.
    Östberg, Per
    Karolinska institutet.
    van Doorn, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Kommunikations- och sväljstörningar genom hela livet: ett logopediskt ståndpunktsdokument2017Report (Other academic)
    Abstract [sv]

    Den forskning som bedrivs inom logopedi i Sverige idag spänner över ett brett spektrum av medfödda, utvecklingsrelaterade och förvärvade kommunikationsstörningar på grund av röst-, tal- och språksvårigheter samt sväljstörningar. Precis som i andra länder pågår en snabb utveckling både mot en breddning av det urval av områden som det forskas kring och ett ökat fokus på nationellt samarbete. Även om de framsteg som görs inom respektive fält kan mätas genom de forskningsrapporter som publiceras av respektive forskargrupper, finns det ett behov av att granska vilka forskningsinsatser som bedrivs jämte det demografiska sammanhanget. I detta ståndpunktsdokument ger vi en översikt över logopediämnet och den forskning som bedrivs i Sverige. I en kubmodell illustreras hur kommunikations- och sväljstörningar kan beskrivas. Stratifierade (per åldersintervall) uppskattningar av prevalensen av kommunikations- och sväljstörningar ges baserat på 2016 års befolkningsstruktur. Genom att presentera dessa två komponenter identifieras forskningsområden och riktningar inom logopedi som behöver ges ökad uppmärksamhet i det kommande forskningsarbetet.

  • 5.
    Sandström, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy. Umeå University.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hartelius, Lena
    Göteborgs universitet, Neurovetenskap och fysiologi, Sektionen för hälsa och rehabilitering.
    The effects of deep brain stimulation on speech intelligibility in persons with essential tremorIn: Journal of Speech, Language and Hearing Research, ISSN 1092-4388, E-ISSN 1558-9102Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate how deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech intelligibility in persons with essential tremor (ET).

    Method: Thirty-five participants were evaluated: off stimulation, on chronic stimulation optimized to alleviate tremor, and during unilateral stimulation at increasing amplitude levels. At each stimulation condition, the participants read 10 unique nonsense sentences from the Swedish Test of Intelligibility. Two listeners, blinded to stimulation condition, transcribed all recorded sentences orthographically in a randomised procedure. A mean speech intelligibility score for each patient and stimulation condition was computed, and comparisons were made between scores off- and on stimulation.

    Results: Chronic cZi-DBS had no significant effect on speech intelligibility, and there was no difference in outcome between bilateral and unilateral treatments. During unilateral stimulation at increasing amplitudes, nine participants demonstrated deteriorating speech intelligibility. These nine participants were on average older and had more superior contacts activated during the evaluation compared with the participants without deterioration.

    Conclusions: Chronic cZi-DBS, optimized for tremor suppression, does not generally affect speech intelligibility in persons with ET. Furthermore, speech intelligibility may be preserved in many individuals, even when stimulated at high amplitudes. Adverse effects of high-amplitude unilateral stimulation observed in this study were associated with stimulation originating from a more superior location, as well as with the participants’ age. These results, highlighting age and stimulation location as contributing to speech intelligibility outcomes were, however, based on a limited number of individuals experiencing adverse effects with high-amplitude stimulation and should, therefore, be interpreted with caution.

  • 6.
    Sandström, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy. Umeå University.
    Schalling, Ellika
    Karolinska Institutet, Klinisk vetenskap, Intervention och teknik, Logopedi.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Hartelius, Lena
    Göteborgs universitet, Neurovetenskap och fysiologi, Sektionen för hälsa och rehabilitering.
    Speech following DBS for essential tremor: Effects of chronic and high-amplitude stimulation in the posterior subthalamic area2020Conference paper (Other academic)
    Abstract [en]

    Deep brain stimulation (DBS) can be very effective in alleviating tremor, but adverse effects on speech are frequently reported, especially following bilateral DBS. Most of the existing literature on DBS and speech deals with the effects of DBS targeting the subthalamic nucleus or the ventral intermediate nucleus of the thalamus, which are the traditional targets for Parkinson’s disease and essential tremor, respectively. More recently, the posterior subthalamic area (PSA) has been highlighted as a particularly effective target for tremor; however, there are limited studies of PSA-DBS effects on speech.

    We report speech outcomes for 14 persons with essential tremor during chronic PSA-DBS and at unilateral high-amplitude PSA-stimulation.

    The objectives were to answer the following questions:

    • To what extent is speech function, and in particular articulation and voice, affected by chronic PSA-DBS?
    • How is speech affected by unilateral high-amplitude stimulation
    • Is bilateral chronic PSA-DBS worse for speech than unilateral PSA-stimulation?
  • 7.
    Sandström, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy. Umeå University.
    Schalling, Ellika
    Karolinska Institutet, Klinisk vetenskap, Intervention och teknik, Logopedi.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hartelius, Lena
    Göteborgs universitet, Neurovetenskap och fysiologi, Sektionen för hälsa och rehabilitering.
    Speech function following deep brain stimulation of the caudal zona incerta: effects of habitual and high-amplitude stimulationManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: To investigate to what extent deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech function in persons with essential tremor (ET).

    Method: fourteen participants with ET were evaluated: off stimulation (OFF), with habitual stimulation optimized to treat the motor symptoms of ET (ON), and during unilateral stimulation at increasing amplitudes. At each stimulation condition, the participants read three 16-word sentences designed to elicit a variety of articulatory movements. Two listeners made consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method (VISOR). Rated function OFF and ON as well as during unilateral stimulation at the individual maximal amplitude level (MAX) was compared with Friedman nonparametric tests. The effects of bilateral and unilateral stimulation for the five participants treated with bilateral cZi-DBS were compared on a descriptive level.

    Results: Habitual cZi-DBS had no significant group-level effect on any of the investigated speech parameters. Articulation was adversely affected by MAX stimulation, and decreased articulation was associated with more medially located electrode contacts. Bilateral and unilateral stimulation were indicated to have similar effects on speech function.

    Conclusions: Habitual cZi-DBS did not have any systematic adverse effects on speech function, but response to stimulation was heterogeneous. Unilateral high-amplitude stimulation was found to have more consistent negative effects, particularly on articulation. Decreased articulatory function was associated with high-amplitude stimulation of medially located contacts, suggestive of cerebello-rubrospinal involvement. These results were, however, based on a limited number of individuals and should, therefore, be interpreted with caution.

1 - 7 of 7
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