Dysarthria in Friedreich Ataxia (FA) is difficult to quantify. This study evaluated a series of performance measures for speech in 22 patients with genetically confirmed FA and 16 age-matched controls. Tests included the PATA examination, the PATAKA examination, the Oral Motor component of the Boston Aphasia examination, the Boston Cookie Theft description task, and the Assessment of Intelligibility of Dysarthric Speech. All measures, except the Cookie theft description task, demonstrated significantly lower scores for patients with FA when compared with controls and correlated with measures of disease progression. Thus, four of five measures capture speech dysfunction in FA and may provide feasible, inexpensive, quantitative testing for therapeutic monitoring in FA.
Movement Disorder SocietyKey words: ataxia; sensory neuron; dysarthria; balance; clinical trial Friedreich ataxia (FA), an autosomal recessive neurodegenerative disorder, is characterized by ataxia, dysarthria, sensory loss, diabetes, and cardiomyopathy. 1 Although scientific advances in FA research have provided insight into potential therapies, a lack of reliable and valid clinical outcome measures has limited clinical trial initiatives. A variety of measures have been considered based on the neurologic examination and/or performance measures. 2,3 Performance measures quantify an individual's ability to perform basic tasks, without attempting to provide an anatomic basis for dysfunction. This approach has been used for assessment of diseases such as multiple sclerosis. A multicenter effort is underway to validate composite measures for FA. 4,5 Both individual performance measures (ninehole peg test, a timed 25-foot walk, low-contrast letter acuity) and a neurological examination-based scale correlate with disease duration. 3 Scores from each measure are predicted by age and triplet repeat length in linear regression models, strengthening their link with the progressive nature of FA. However, no continuous measure of speech dysfunction is at present adequate for inclusion in such a composite measure. It is important to develop such a measure for assessment of laterstage patients because such patients frequently are too severely impaired to be assessed with most measures of arm and leg function.Although dysarthria is pervasive in FA, the exact neurologic components have been less well defined. [4][5][6][7][8][9] Most speech dysfunction in FA reflects articulation deficits and is frequently classed with apraxic speech in that no true aphasia is present. Diagnostically, repetition of syllables (i.e., PATA), prolonged vowels, classification of changes in intonation, and rate of speech are traditionally used for characterization of ataxic speech. However, patient-related dysfunction may be more closely related to communicative ability and better measured by tests of intelligibility. 10,11 Previous studies show that PATA repetition does not correlate well with disease severity, suggesting that further measures need to be developed. In this ...