Growth curve model for articulatory precision Mixed-effects models for comparisons between healthy controls and all ALS Mixed-effects models for comparisons between healthy controls and ALS with normal bulbar function The ALS sample was divided according to the following categories: We evaluated whether the automatic analysis of remotely-collected speech could (1) detect early speech changes and (2) sensitively track speech changes longitudinally. Although it is possible to analyze a large number of speech features, we focused on articulatory precision (AP) and speaking rate (SR) as they relate to articulation and rate, both of which are known to decline in dysarthria 15 secondary to ALS. Speech was collected via a mobile application and assessed through automated speech analysis. Participants were recruited, screened, enrolled, and assessed daily from home. We used a cohort of healthy and ALS patients from ALS at Home 14, a longitudinal, observational study that was conducted entirely remotely. We defined sensitive tracking as the ability to detect longitudinal within-person changes in speech. We defined early changes as speech changes that occurred before any changes in the ALSFRS-R bulbar subscales. In this study, we assessed speech features digitally and evaluated their sensitivity to detecting early changes and tracking progression. However, no study has assessed the sensitivity of remote speech analysis in detecting and tracking bulbar change. Several studies have found that speech features, such as jitter, shimmer, articulatory rate, speaking rate, and pause rate, are affected in ALS 10, 11, and that these can be measured from remotely-collected speech samples 12, 13. Both instruments, however, lack sensitivity to early bulbar changes 9. The standard ways of assessing bulbar dysfunction are the ALS functional rating scale-revised (ALSFRS-R) and, less commonly, the Center for Neurologic Study Bulbar Function Scale (CNS-BFS) 8. Studies have found that while 30% of individuals in the population present with bulbar symptoms at the onset of ALS, most ALS patients eventually develop them and lose their ability to speak and swallow safely 7. Bulbar deterioration is particularly devastating, impairing the ability to communicate, leading to faster decline, shorter survival (less than 2 years from diagnosis), and reduced quality of life 4– 6. Social and economic consequences of ALS include cost of care for the patients, loss of employment, and cost of treatment, medications, and orthopedic devices 1– 3.
ALS causes individuals to become progressively weaker and lose motor function, eventually resulting in death.
Amyotrophic lateral sclerosis (ALS) is characterized by a progressive loss of motor function due to central nervous system damage and loss of spinal and bulbar motor neurons.
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