Objective: The use of speech measures is becoming a common practice in the assessment of bulbar disease progression in amyotrophic lateral sclerosis (ALS). This study aimed to establish psychometric properties (e.g., reliability, validity, sensitivity, specificity) of speech and pause timing measures during a standardized passage. Methods:A large number of passage recordings (ALS N=775; Neurotypical controls N=323) was analyzed using a semi-automatic method (Speech and Pause Analysis, SPA). Results:The results revealed acceptable reliability of the speech and pause measures across repeated recording by the control participants. Strong construct validity was established via significant group differences between patients and controls and correlation statistics with clinical measures of overall ALS and bulbar disease severity. Speaking rate, pause events, and mean pause duration were able to detect ALS participants at the presymptomatic stage of bulbar disease with a good discrimination ability (AUC 0.81).Conclusions: Based on the current psychometric evaluation, performing passage recording and speech and pause timing analysis was deemed useful for detecting early and progressive changes associated with bulbar ALS.

Objective To analyze intervention goals, protocols, and outcome measures used for oral and pharyngeal motor exercises in post-stroke recovery. Data sources MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane databases were searched in September 2022. Methods Studies were included if they (1) recruited post-stroke adult patients, (2) administered exercises for the oral and/ or pharyngeal muscles, and (3) reported results at baseline and post-exercise. The extracted data included intervention goals, protocols, and outcomes. All outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). Results A total of 26 studies were identified. Their intervention goals aimed to rehabilitate a broad spectrum of muscle groups within the oral cavity and pharynx and to improve the functions of swallowing, speech, facial expressions, or sleep breathing. Protocol duration ranged from 1 to 13 weeks, with various exercise repetitions (times per day) and frequency (days per week). Half of the studies reported using feedback to support the training, and these studies varied in the feedback strategy and technology tool. A total of 37 unique outcome measures were identified. Most measures represented the body functions and body structure component of the ICF, and several of these measures showed large treatment effects. Conclusions This review demonstrated inconsistency across published studies in intervention goals and exercise protocols. It has also identified current limitations and provided recommendations for the selection of outcome measures while advancing a multidisciplinary view of oral and pharyngeal exercises in post-stroke recovery across relevant functions.

<b><i>Introduction:</i></b> Telehealth/remote assessment using readily available 2D mobile cameras and deep learning-based analyses is rapidly becoming a viable option for detecting orofacial and speech impairments associated with neurological and neurodegenerative disease during telehealth practice. However, the psychometric properties (e.g., internal consistency and reliability) of kinematics obtained from these systems have not been established, which is a crucial next step before their clinical usability is established. <b><i>Methods:</i></b> Participants were assessed in lab using a 3 dimensional (3D)-capable camera and at home using a readily-available 2D camera in a tablet. Orofacial kinematics was estimated from videos using a deep facial landmark tracking model. Kinematic features quantified the clinically relevant constructs of velocity, range of motion, and lateralization. In lab, all participants performed the same oromotor task. At home, participants were split into two groups that each performed a variant of the in-lab task. We quantified within-assessment consistency (Cronbach’s α), reliability (intraclass correlation coefficient [ICC]), and fitted linear mixed-effects models to at-home data to capture individual-/task-dependent longitudinal trajectories. <b><i>Results:</i></b> Both in lab and at home, Cronbach’s α was typically high (&#x3e;0.80) and ICCs were often good (&#x3e;0.70). The linear mixed-effect models that best fit the longitudinal data were those that accounted for individual- or task-dependent effects. <b><i>Discussion:</i></b> Remotely gathered orofacial kinematics were as internally consistent and reliable as those gathered in a controlled laboratory setting using a high-performance 3D-capable camera and could additionally capture individual- or task-dependent changes over time. These results highlight the potential of remote assessment tools as digital biomarkers of disease status and progression and demonstrate their suitability for novel telehealth applications.