Lingual–Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings

Abstract

Purpose: This preliminary study on lingual-alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility. Method: Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory-perceptual judgments.Results: LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility. Conclusions: It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

Neurogenic Orofacial Weakness and Speech in Adults With Dysarthria

“…The ultimate goal of this line of research is to answer the elusive question of the minimum level of lingual strength required for speech purposes. Various levels have been suggested from diverse patient populations (Jones et al, 2015;Lazarus et al, 2013;Neel et al, 2015;Searl et al, 2017). The present study contributes a small amount of data toward that end such that the eight weakest participants on the anterior-tongue elevation task (P max = 3-17 kPa) had moderately to severely impaired speech.…”

“…Those with no to slight dysarthria had significantly greater anteriortongue elevation P max (M = 38.2 kPa) than those with mild to moderate dysarthria (M = 25.3 kPa), providing general support for an association between lingual weakness and speech deficits. Searl et al (2017) used a small pressure transducer to document that anterior-tongue elevation P max in adults with ALS-B averaged 53% of NN controls (35.7 kPa) and that word intelligibility scores correlated strongly with anterior-tongue elevation P max for the ALS group (r = .852). Interestingly, in people with ALS-B, the proportion of strength used to produce coronal consonants was the same as healthy people, indicating that the weakness did not affect their functional reserve for speech.…”

“…First, Jones, Crisp, Asrani, Sloane, and Kishnani (2015) reported that patients with late-onset Pompe disease who had more severe dysarthria also had weaker tongues than those with less severe dysarthria. Second, Searl et al (2017) documented a strong correlation between wordlevel intelligibility and lingual weakness in adults with ALS-B. As Searl et al explained, skepticism toward using tongue strength as an indicator for speech deficits is rooted in variations across measurement approaches, insufficient data, and the submaximal requirements for executing speech.…”

Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence

“…Regarding the first evaluative criterion, there is consistent evidence of reduced tongue strength in PALS compared to typical speakers 34–39 . Evidence is less consistent for differences in lip and jaw strength 34,36 .…”

Sense of Effort and Articulatory Contact Pressure Associated with Talking by Individuals Using Tracheoesophageal Speech

“…The contact pressure measurement system has been described previously [22]. Briefly, a thin mold was made that covered the upper incisors and the alveolar ridge.…”