Speech intelligibility in people with Amyotrophic Lateral Sclerosis (ALS)
Inteligibilidade de fala em pessoas com Esclerose Lateral Amiotrófica (ELA)
Lavoisier Leite Neto; Marcondes Cavalcante França Júnior; Regina Yu Shon Chun
Abstract
Purpose: To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS). Methods: Quantitative-descriptive study approved by REC under No. CAAE 62912416.4.0000.5404, comprised of 19 individuals with sporadic or familiar ALS. Data were collected using the Dysarthria Protocol and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-Re). We used visual analogue scale (VAS) to assess speech intelligibility and summary measures; and Spearman’s coefficients of correlation for the instruments with significance level of 5%. Results: Speech intelligibility is compromised (41.37±39.73) in varied degrees with positive correlation with the general degree of dysarthria (p=<.0001), and with all the analyzed speech parameters, indicating impact on the speech deterioration of the studied group. There is negative correlation between speech intelligibility and the results of the bulbar sections – speech and deglutition (p=0.0166), arm – activities with the upper limb (p=0.0064) and leg – activities with the lower limb (p=0.0391). Breathing (p=0.0178), phonation (p=0.0334) and resonance (p=0.0053) parameters showed a negative correlation with the item “speech” of the ALSFRS-Re. Conclusion: Results show impaired speech intelligibility and dysarthria, and evidence breathing, phonation and resonance as important markers of the disease progression. A thorough and early evaluation of the oral motor production allows for a better management of alterations in ALS.
Keywords
Resumo
Objetivo: Avaliar a inteligibilidade de fala e disartria, correlacionando com a avaliação funcional da ELA. Método: Estudo quantitativo-descritivo aprovado pelo CEP, sob nº CAAE 62912416.4.0000.5404, constituído por 19 pessoas com ELA, esporádica ou familiar. Para coleta, aplicou-se o Protocolo de Disartria e Escala de Avaliação Funcional da Esclerose Lateral Amiotrófica (ALSFRS-Re). Para análise, foi utilizada escala visual analógica para inteligibilidade de fala e medidas de resumo e correlação dos instrumentos pelo Coeficiente de Spearman com nível de significância de 5%. Resultados: A inteligibilidade de fala está comprometida (41,37±39,73) em graus variados com correlação positiva com o grau geral de disartria (p=<,0001) e com todos os parâmetros de fala analisados, indicando impacto na deterioração da fala do grupo estudado. Há correlação negativa entre inteligibilidade de fala e resultados das seções bulbar – fala e deglutição (p=0,0166), braço – atividades com membro superior (p=0,0064) e perna – atividades com membro inferior (p=0,0391). Os parâmetros de respiração (p=0,0178), fonação (p=0,0334) e ressonância (p=0,0053) apresentaram correlação negativa com o item “fala” do ALSFRS-Re. Conclusão: Os achados mostram prejuízo da inteligibilidade de fala e disartria e evidenciam respiração, fonação e ressonância como importantes marcadores da progressão da doença. Uma avaliação criteriosa e precoce da produção motora oral permite melhor gerenciamento das alterações na ELA.
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Referências
1 Hardiman O, Al-Chalabi A, Chio A, Corr EM, Logroscino G, Robberecht W, et al. Amyotrophic lateral sclerosis. Nat Rev Dis Primers. 2017;3(1):17071. http://dx.doi.org/10.1038/nrdp.2017.71. PMid:28980624. [ Links ]
2 Chiò A, Battistini S, Calvo A, Caponnetto C, Conforti FL, Corbo M, et al. Genetic counselling in ALS: facts, uncertainties and clinical suggestions. J Neurol Neurosurg Psychiatry. 2014;85(5):478-85. http://dx.doi.org/10.1136/jnnp-2013-305546. PMid:23833266. [ Links ]
3 de Andrade HM, de Albuquerque M, Avansini SH, de S Rocha C, Dogini DB, Nucci A, et al. MicroRNAs-424 and 206 are potential prognostic markers in spinal onset amyotrophic lateral sclerosis. J Neurol Sci. 2016;368:19-24. http://dx.doi.org/10.1016/j.jns.2016.06.046. PMid:27538595. [ Links ]
4 Rong P, Yunusova Y, Wang J, Green JR. Predicting early bulbar decline in amyotrophic lateral sclerosis: a speech subsystem approach. Behav Neurol. 2015;2015:183027. http://dx.doi.org/10.1155/2015/183027. PMid:26136624. [ Links ]
5 Rong P, Yunusova Y, Wang J, Zinman L, Pattee GL, Berry JD, et al. Predicting speech intelligibility decline in amyotrophic lateral sclerosis based on the deterioration of individual speech subsystems. PLoS One. 2016;11(5):e0154971. http://dx.doi.org/10.1371/journal.pone.0154971. PMid:27148967. [ Links ]
6 Makkonen T, Ruottinen H, Puhto R, Helminen M, Palmio J. Speech deterioration in amyotrophic lateral sclerosis (ALS) after manifestation of bulbar symptoms. Int J Lang Commun Disord. 2018;53(2):385-92. http://dx.doi.org/10.1111/1460-6984.12357. PMid:29159848. [ Links ]
7 Leite L No, Constantini AC. Dysarthria and quality of life in patients with amyotrophic lateral sclerosis. Rev CEFAC. 2017;19(5):664-73. http://dx.doi.org/10.1590/1982-021620171954017. [ Links ]
8 Makkonen T, Korpijaakko-Huuhka AM, Ruottinen H, Puhto R, Hollo K, Ylinen A, et al. Oral motor functions, speech and communication before a definitive diagnosis of amyotrophic lateral sclerosis. J Commun Disord. 2016;61:97-105. http://dx.doi.org/10.1016/j.jcomdis.2016.04.002. PMid:27110704. [ Links ]
9 da Costa Franceschini A, Mourão LF. Dysarthria and dysphagia in Amyotrophic Lateral Sclerosis with spinal onset: A study of quality of life related to swallowing. NeuroRehabilitation. 2015;36(1):127-34. http://dx.doi.org/10.3233/NRE-141200. PMid:25547774. [ Links ]
10 Barreto SS, Ortiz KZ. Medidas de inteligibilidade nos distúrbios da fala: revisão crítica da literature. Pró-Fono. 2008;20(3):201-6. http://dx.doi.org/10.1590/S0104-56872008000300011. PMid:18852969. [ Links ]
11 Chun RYS, Leite L No, Zaqueu VF, Mais ALW, Farias LP. Comunicação vulnerável em casos de alta complexidade: perspectiva de atuação e pesquisa fonoaudiológica em hospital-escola. In: Silva RM, Bezerra IC, Brasil CCP, Moura ERF, organizadores. Estudos qualitativos: enfoques teóricos e técnicas de coleta de informações. Sobral: Edições UVA, 2018. pp. 81-96. [ Links ]
12 Leite L No, Constantini AC, Chun RYS. Communication vulnerable in patients with Amyotrophic Lateral Sclerosis: a systematic review. NeuroRehabilitation. 2017;40(4):561-8. http://dx.doi.org/10.3233/NRE-171443. PMid:28222570. [ Links ]
13 Fracassi AS, Gatto AR, Weber S, Spadotto AA, Ribeiro PW, Schelp AO. Adaptação para a língua Portuguesa e aplicação de protocolo de avaliação das disartrias de origem central em pacientes com Doença de Parkinson. Rev CEFAC. 2011;13(6):1056-65. http://dx.doi.org/10.1590/S1516-18462011005000030. [ Links ]
14 Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci. 1999;169(1-2):13-21. http://dx.doi.org/10.1016/S0022-510X(99)00210-5. PMid:10540002. [ Links ]
15 Yokoi D, Atsuta N, Watanabe H, Nakamura R, Hirakawa A, Ito M, et al. Age of onset differentially influences the progression of regional dysfunction in sporadic amyotrophic lateral sclerosis. J Neurol. 2016;263(6):1129-36. http://dx.doi.org/10.1007/s00415-016-8109-0. PMid:27083563. [ Links ]
16 Chiò A, Logroscino G, Traynor BJ, Collins J, Simeone JC, Goldstein LA, et al. Global epidemiology of amyotrophic lateral sclerosis: a systematic review of the published literature. Neuroepidemiology. 2013;41(2):118-30. http://dx.doi.org/10.1159/000351153. PMid:23860588. [ Links ]
17 Prado LG, Bicalho IC, Vidigal-Lopes M, Ferreira CJ, Mageste Barbosa LS, Gomez RS, et al. Amyotrophic lateral sclerosis in Brazil: case series and review of the Brazilian literature. Amyotroph Lateral Scler Frontotemporal Degener. 2016;17(3-4):282-8. http://dx.doi.org/10.3109/21678421.2016.1143011. PMid:26854959. [ Links ]
18 Yunusova Y, Graham NL, Shellikeri S, Phuong K, Kulkarni M, Rochon E, et al. Profiling speech and pausing in amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). PLoS One. 2016;11(1):1-18. http://dx.doi.org/10.1371/journal.pone.0147573. PMid:26789001. [ Links ]
19 De Marco M, Merico A, Berta G, Segato N, Citton V, Baglione A, et al. Morphometric correlates of dysarthric deficit in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2015;16(7-8):464-72. http://dx.doi.org/10.3109/21678421.2015.1056191. PMid:26121168. [ Links ]
20 Almeida SRM, Silva LBC, Guerreiro CAM, Nucci A. Amyotrophic lateral sclerosis: prospective study on respiratory parameters. Arq Neuropsiquiatr. 2010;68(2):258-62. http://dx.doi.org/10.1590/S0004-282X2010000200020. PMid:20464296. [ Links ]
21 Pontes RT, Orsini M, de Freitas MRG, Antonioli R S, Nascimento OJM. Alterações da fonação e deglutição na Esclerose Lateral Amiotrófica: revisão de Literatura. Rev Neurocienc. 2010;18(1):69-73. https://doi.org/10.34024/rnc.2010.v18.8505. [ Links ]
22 Wang J, Kothalkar PV, Kim M, Yunusova Y, Campbell TF, Heitzman D, et al. Predicting intelligible speaking rate in individuals with amyotrophic lateral sclerosis from a small number of speech acoustic and articulatory samples. Workshop Speech Lang Process Assist Technol. 2016;2016:91-7. http://dx.doi.org/10.21437/SLPAT.2016-16. PMid:29423454. [ Links ]
23 Mefferd AS, Pattee GL, Green JR. Speaking rate effects on articulatory pattern consistency in talkers with mild ALS. Clin Linguist Phon. 2014;28(11):799-811. http://dx.doi.org/10.3109/02699206.2014.908239. PMid:24724615. [ Links ]
24 Marchand DLP, Bonamigo AW. Atuação fonoaudiológica na voz do idoso: revisão sistemática exploratória de literatura. Distúrb Comun. [Internet]. 2015;27(2):309-17. [citado em 2019 Ago 21]. Disponível em: http://revistas.pucsp.br/dic/article/view/21349 [ Links ]
25 Caligari M, Godi M, Guglielmetti S, Franchignoni F, Nardone A. Eye tracking communication devices in amyotrophic lateral sclerosis: impact on disability and quality of life. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14(7-8):546-52. http://dx.doi.org/10.3109/21678421.2013.803576. PMid:23834069. [ Links ]
26 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Comm Disord Q. 2015;36(3):187-92. http://dx.doi.org/10.1177/1525740114545359. [ Links ]
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