Over the years many studies have been conducted to document the treatment effects of Botulinum toxin type A in adductor spasmodic dysphonia. The results of these studies have led to the view that overall Botulinum toxin treatment is moderately effective. This study reviews efficacy research qualitatively and quantitatively to determine the extent to which this conclusion is fully supported by the data. Although the data indicate moderate overall improvement as a result of Botulinum toxin treatment, they also suggest significant variation across patients, measurements, and treatment conditions. This result, together with methodological limitations and lack of standardization in BT efficacy research, justifies caution when making inferences regarding BT treatment benefit in adductor spasmodic dysphonia.

The timing and intensity variability of 8 adults who stutter and 8 age-matched fluent speakers was investigated under metronomic conditions. Participants were required to produce double or triple-stress patterns at a slow speech rate (1 syllable/870 ms) when repeating the syllable /staet/or/straet/nine times. Measures that are sensitive to cyclic rather than overall variation in syllable timing and intensity were employed. Specifically, durational variation between successive syllable onsets as well as intensity variation of the beginning consonant and vowel in successive syllables were computed. Results revealed that, although intensity variation was similar, the timing of successive syllables of persons who stutter was significantly more variable than that of persons who do not stutter. These outcomes are discussed in relation to previous experiments of timing control of persons who stutter and normally fluent persons during metronomic stimulation.

This article will review types of perseveration from a neurolinguistic perspective. During the course of the article, continuous, stuck-in-set, and recurrent perseveration will be placed in contradistinction to several other types of repetitive behaviors commonly associated with neurogenic communication disorders. These include echolalia in mixed transcortical aphasia; conduite d'approche and conduite d'ecart in fluent aphasias; lexical and nonlexical automatisms in nonfluent aphasias; palilalia in neuromotor disorders, such as Parkinson's disease (PD); and sound, syllable, word, and phrase repetitions in neurogenic stuttering. When differentiating these phenomena from perseveration, it is helpful to consider the salient factors that condition observed behaviors in individual patients, such as overall speech fluency, inventory of available utterances, nature of eliciting tasks, and propositionality of responses. Information such as communication disorder diagnosis, underlying etiology, and known sites of lesion from each patient's total clinical profile may also assist with differentiation.

Background/Aims: Hypokinetic dysarthria in Parkinson disease (PD) hinders the ability to verbally communicate and interferes with activities of daily living. SPEAK OUT!® is a therapy program designed to improve functional communicative ability. In contrast to the Lee Silverman Voice Treatment program, SPEAK OUT!® promotes speaking with intent to effect loud speech. This study evaluated the efficacy of SPEAK OUT!® in persons with idiopathic PD in 3 domains: self-reported voice handicap, clinical ratings of dysarthria and prosody, and acoustic analysis of prosody. Participants and Methods: Pre-/post-therapy data included PD participants’ scores on the Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire, audio recordings, perceptual evaluation scores, and demographic data, such as age, sex, handedness, diagnosis, and onset of PD. Results: Participants achieved a statistically and clinically significant improvement in speech intensity, pitch range, normalized pairwise variability index for pitch, sustained vowel duration, reading intelligibility, and vocal quality after SPEAK OUT!® training, consistent with both of the self-report voice scores, i.e., the VHI and the V-RQOL, and with the perceptual speech evaluation scores. Longer PD duration was associated with lowered efficacy. Conclusions: SPEAK OUT!® is effective and should be administered as early as possible after disease onset.

Aims: Long-term phonatory instability can be quantified using cyclical and noncyclical measures. The objective of this study is to evaluate phonation in ataxic dysarthria and a control group of normal speakers to answer two main questions: (1) How common is elevated cyclical and noncyclical instability in ataxic dysarthria compared to that in a normal control group? (2) Is cyclical instability predictive of noncyclical instability? Methods: Vowel prolongations of ataxic-dysarthric and normal speakers were compared using the Motor Speech Profile module of the Computerized Speech Lab. Cyclical measures included tremor rate, amplitude and periodicity. Noncyclical measures included the coefficient of variation for loudness and frequency. Results: Noncyclical measures are elevated in a subset of speakers with ataxic dysarthria regardless of whether cyclical instability (vocal tremor) is present. Cyclical instability was detected in nearly half the patients. Interestingly, elevations in both types of measures also described phonation of a number of the participants in the control group. Conclusion: Combined use of cyclical and noncyclical measures can document aspects of phonation in ataxic dysarthria that have clinical implications.