Expiratory and phonation times as measures of disease severity in patients with Multiple Sclerosis. A case-control study

Nordio, S; Bernitsas, Evanthia; Meneghello, Francesca; Palmer, Katie; Stabile, Maria Rosaria; Dipietro, Laura; Stadio, Arianna Di

doi:10.1016/j.msard.2018.04.010

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…Respiratory support was described in a total of 415 PwMS from six studies. Respiration (also cited as ventilation) was impaired in one third of PwMS in early studies (7,8) and expiratory and phonatory times were inversely correlated with EDSS scores in a high disabled cohort of 50 PwMS (average EDSS of 7.3) in the only study to test for nonspeech correlations (42). Respiration (rather than either articulation, phonation, oral motor performance, prosody and intelligibility) was found to be the speech-related domain that best differentiated MS from healthy participants in one study (4).…”

Section: Respirationmentioning

confidence: 99%

What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis

Noffs

Perera

Kolbe

et al. 2018

Autoimmunity Reviews

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IMPORTANCE: Multiple sclerosis produces neurological impairments that are variable in duration, severity and quality. Speech is frequently impaired, resulting in decreased communication skills and quality of life. Advancements in technology now makes it possible to use quantitative acoustic assessment of speech as biomarkers of disease progression. OBSERVATIONS: Four domains of speech have been identified: articulation (slow articulation and imprecise consonants), voice (pitch and loudness instability), respiration (decreased phonatory time and expiratory pressure) and prosody (longer and frequent pauses, deficient loudness control). Studies also explored predictive models for diagnosis of MS and ataxia through speech assessment, the relationship of dysarthria with cognition and very few studies correlated neuroimaging with dysarthria. We could not identify longitudinal studies of speech or dysarthria in Multiple Sclerosis. CONCLUSION AND RELEVANCE: Refinement of objective measures of speech has enhanced our understanding of Multiple Sclerosis-related deficits in cross-sectional analysis while both integrative and longitudinal studies are identified as major gaps. This review highlights the potential for using quantitative acoustic assessments as clinical endpoints for diagnosing, monitoring progression and treatment in disease modifying trials.

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Section: Respirationmentioning

confidence: 99%

What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis

Noffs

Perera

Kolbe

et al. 2018

Autoimmunity Reviews

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“…Both dysphonia and dysarthria may be correlated to an alteration of the expiratory and phonatory times 112 . Nordio et al showed that a reduction of the expiratory and phonatory time in patients with MS was directly correlated with the increase of the Expanded Disability Status Scale (EDSS) score 112 , reporting more speech difficulties during the relapsing phases of MS and suggesting that they may be correlated to the severity of the speech disorder 109,112 .…”

Section: Speech Disordersmentioning

confidence: 99%

“…They mainly follow a progressive weakness of the musculature that can involve all the speech mechanisms and provoke a relevant decrease of verbal communication skills. The "fatigue" component is extremely relevant in the expiration mechanism and the stiffness that affects muscle involved in speech production and emission may further worsen speech 112 .…”

Section: Speech Disordersmentioning

confidence: 99%

Otolaryngologic Symptoms in Multiple Sclerosis: A Review

Ralli¹,

Stadio²,

Visconti³

et al. 2018

The International Tinnitus Journal

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Many symptoms of multiple sclerosis may affect the ear, nose and throat. The most common otolaryngologic symptoms of multiple sclerosis are speech disorders, followed by sleep disorders, vertigo and disequilibrium, dysphagia, smell alterations, and hearing loss. Less common symptoms include sialorrhea, facial palsy, taste alterations, trigeminal neuralgia and tinnitus. The origin of otolaryngologic symptoms in multiple sclerosis is mainly central, although increasing evidence also suggests a peripheral involvement.

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“…Those postural changes may explain the decrease in SPI and MPT that we found in the guitarists [18,26,28,29,31]; we speculate that the typical "hard" voice of pop/ rock guitarists may be caused in part by the use of the guitar that is able to "stain" the voice and contributes to the typical "raucous sound. "…”

Section: Variation Of Body Posture Without and With Instrumentsmentioning

confidence: 88%

“…We also found that compared to singing only, playing an instrument while singing led to a statistically significant change in subjects' shoulder and back positions. It is known that shoulder and back position affect expiration capacity [8,26,27] and phonatory ability [26,27]; specifically, a straight back and extrarotated shoulders can increase resistance to the air passage in the superior airway tract and affect not only the length of expiration and phonation, but also the quantity of air injected into the lungs [26]. These mechanisms may explain the increase in noise and loss of harmonics we observed in the subjects' voice spectrogram [28] as well as the reduction in the extension of the voice (the voice signal's spectral content was below 4,000 Hz in musician-singers) [1,2,9,27,28].…”

Section: Variation Of Body Posture Without and With Instrumentsmentioning

confidence: 99%

Voice Parameter Changes in Professional Musician-Singers Singing with and without an Instrument: The Effect of Body Posture

Longo

Stadio

Ralli

et al. 2019

Folia Phoniatr Logop

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Background and Aim: The impact of body posture on vocal emission is well known. Postural changes may increase muscular resistance in tracts of the phono-articulatory apparatus and lead to voice disorders. This work aimed to assess whether and to which extent body posture during singing and playing a musical instrument impacts voice performance in professional musicians. Subjects and Methods: Voice signals were recorded from 17 professional musicians (pianists and guitarists) while they were singing and while they were singing and playing a musical instrument simultaneously. Metrics were extracted from their voice spectrogram using the Multi-Dimensional Voice Program (MDVP) and included jitter, shift in fundamental voice frequency (sF0), shimmer, change in peak amplitude, noise to harmonic ratio, Voice Turbulence Index, Soft Phonation Index (SPI), Frequency Tremor Intensity Index, Amplitude Tremor Intensity Index, and maximum phonatory time (MPT). Statistical analysis was performed using two-tailed t tests, one-way ANOVA, and χ² tests. Subjects’ body posture was visually assessed following the recommendations of the Italian Society of Audiology and Phoniatrics. Thirty-seven voice signals were collected, 17 during singing and 20 during singing and playing a musical instrument. Results: Data showed that playing an instrument while singing led to an impairment of the “singer formant” and to a decrease in jitter, sF0, shimmer, SPI, and MPT. However, statistical analysis showed that none of the MDVP metrics changed significantly when subjects played an instrument compared to when they did not. Shoulder and back position affected voice features as measured by the MDVP metrics, while head and neck position did not. In particular, playing the guitar decreased the amplitude of the “singer formant” and increased noise, causing a typical “raucous rock voice.” Conclusions: Voice features may be affected by the use of the instrument the musicians play while they sing. Body posture selected by the musician while playing the instrument may affect expiration and phonation.

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Expiratory and phonation times as measures of disease severity in patients with Multiple Sclerosis. A case-control study

Cited by 19 publications

References 23 publications

What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis

What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis

Otolaryngologic Symptoms in Multiple Sclerosis: A Review

Voice Parameter Changes in Professional Musician-Singers Singing with and without an Instrument: The Effect of Body Posture

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