In this study, the frequency of occurrence of speech and voice symptoms in 200 Parkinson patients was defined by two expert listeners from high-fidelity tape recordings of conversational speech samples and readings of the sentence version of the Fisher-Logemann Test of Articulation Competence. Specific phonemes that were misarticulated were catalogued. Other vocal-tract dysfunctions, including laryngeal disorders, rate disorders, and hypernasality, were also recorded. Cooccurrence of symptoms in each patient was tabulated. Examination of the patterns of cooccurring dysfunctions permitted classifying the 200 patients into five groups: Group 1 (45% of the patients) with laryngeal dysfunction as their only vocal-tract symptom; Group 2 (13.5% of the patients) with laryngeal and back-tongue involvement; Group 3 (17% of the patients) with laryngeal, back-tongue, and tongue-blade dysfunction; Group 4 (5.5% of the patients) with laryngeal dysfunction, back-tongue involvement, tongue-blade dysfunction, and labial misarticulations; and Group 5 (9% of the patients) with laryngeal dysfunction and misarticulations of the back tongue, tongue blade, lips, and tongue tip. Disfluencies and hypernasality did not follow a systematic pattern of cooccurrence with other vocal-tract dysfunctions.
In a study of vocal tract and esophageal function during speech and swallowing, unmedicated Parkinson patients were found to have specific disorders in oral and esophageal stages of deglutition and a predictable sequence of deterioration in speech. To determine whether these disorders are exclusive to parkinsonism or are typical of all patients with tremor or of geriatric patients in general, a cinefluoroscopic study was initiated to examine the physiology of speech and swallowing in these other patients. Subjects were 10 normal geriatric patients and 10 patients with essential tremor. Results of the studies for these two groups were compared with data from earlier studies on unmedicated Parkinson patients. Parkinson patients showed most severely disordered swallowing and speech function. Patients with essential tremor showed only slight slowing in esophageal transit during swallowing and vocal tremor during speech, but no progressive deterioration. Normal geriatric patients revealed no swallowing or speech disturbances.
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