48
F. Viallet, B. Teston, A. F. Viallet, B. Teston, A. Purson Purson , , L. L. Jankowski Jankowski Service de Neurologie, Centre Hospitalier du pays d Service de Neurologie, Centre Hospitalier du pays d Aix Aix Laboratoire Parole et Langage, UMR 6057, CNRS/Universit Laboratoire Parole et Langage, UMR 6057, CNRS/Universit é é de Provence de Provence Aix en Provence Aix en Provence Focused Focused Workshop 10: EFNS, Paris, Workshop 10: EFNS, Paris, 06/09/2004 06/09/2004 The The Objective Evaluation Objective Evaluation of of Dysprosody Dysprosody in in Neurological Neurological Practice: Practice: Acoustic Acoustic and and Aerodynamic Aerodynamic Methods Methods

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F. Viallet, B. Teston, A. F. Viallet, B. Teston, A. PursonPurson,, L. L. JankowskiJankowski

Service de Neurologie, Centre Hospitalier du pays dService de Neurologie, Centre Hospitalier du pays d’’AixAixLaboratoire Parole et Langage, UMR 6057, CNRS/UniversitLaboratoire Parole et Langage, UMR 6057, CNRS/Universitéé de Provencede Provence

Aix en ProvenceAix en Provence

FocusedFocused Workshop 10: EFNS, Paris,Workshop 10: EFNS, Paris,06/09/2004 06/09/2004

TheThe Objective Evaluation Objective Evaluation ofof DysprosodyDysprosody in in NeurologicalNeurological Practice: Practice: AcousticAcoustic andand

AerodynamicAerodynamic MethodsMethods

Speech Speech ProsodyProsody: : DefinitionsDefinitions

�� PhonologyPhonology:: AnyAny languagelanguage isis characterizedcharacterized by by itsits phonologicalphonological systemsystem includingincluding twotwo aspectsaspects1)1) Segmental:Segmental: PhonemesPhonemes

2)2) Suprasegmental:Suprasegmental: ProsodicProsodic featuresfeatures

�� PhysiologyPhysiology : : 3 stages for speech production3 stages for speech production

1)1) RespiratoryRespiratory:: expiration, subexpiration, sub--glottal pressureglottal pressure

2) 2) LaryngealLaryngeal:: phonation, glottal vibration phonation, glottal vibration

3)3) Vocal tract: Vocal tract: resonanceresonance andand articulationarticulation

PHONOLOGICAL PROCESSING

Speech production physiology Speech perception physiology

ACOUSTIC LEVEL

Encoding Decoding

PHONETIC LEVEL

PATIENT DOCTOR

Speech Speech ProsodyProsody: : DefinitionsDefinitions

�� ProsodyProsody ((restrictedrestricted to to itsits physicalphysical dimension):dimension):•• 2 "vertical" modulations2 "vertical" modulations

–– LaryngealLaryngeal vibration vibration frequencyfrequency, Fo (Hz): pitch, , Fo (Hz): pitch, melodymelody–– IntensityIntensity ofof thethe soundsound pressure pressure ofof thethe speech signal speech signal (dB)(dB)

•• 1 "horizontal" dimension1 "horizontal" dimension–– DurationDuration, pauses, rate, pauses, rate

•• Perturbation Perturbation �� DysprosodyDysprosody

�� Articulation : Articulation : •• Perturbations Perturbations �� DysarthriasDysarthrias

F0 = (1/2L)(T/ρ)0.5

T : tension of VC mucosa

ρ : tissue density

L : length of VC

ElasticElastic modelmodel ofof fundamentalfundamental frequencyfrequency (F(F00))

(Scherer, 1995)

Vocal fold mass, M=0.16G

Hz

(Scherer, 1995)

Vocal fold mass and subglottal pressure effect on fundamental frequency

PerceptualPerceptual analysisanalysis: : ClinicalClinical assessmentassessment toolstools

�� ClinicalClinical dysarthriadysarthria evaluationevaluation (ECD):(ECD):

(French adaptation (French adaptation ofof ""frenchayfrenchay DysarthriaDysarthria AssessmentAssessment": ": EnderbyEnderby (1983), (1983), AuzouAuzou & al (1998)& al (1998)

�� Speech Speech organsorgans assessmentassessment ((ReflexesReflexes, , respiratoryrespiratory functionfunction, , lipslips, , jawjaw, velum, larynx, , velum, larynx, tonguetongue))

�� Speech Speech intelligibilityintelligibility assessmentassessment: :

–– Reading Reading ofof wordswords andand sentencessentences

–– SpontaneousSpontaneous speech (Conversation)speech (Conversation)

PerceptualPerceptual analysisanalysis: ECD : ECD scalesscales

From Auzou et al, Evaluation clinique de la dysarthrie, L’Ortho-

Edition, Isbergues (1998).

• Reflexes status: cough, swallowing, salivation

• Respiratory function: at rest and during speech

• Lips movements: at rest, protraction, occlusion

• Jaw movements: at rest and during speech

• Velum movements: liquids, elevation, during speech

• Larynx : maximal phonation time, tonal range, volume control

(sustained vowel and during speech)

• Tongue movements: at rest, protrusion, elevation, lateral

movements, during speech

• Intelligibility: reading words and sentences, conversation

PerceptualPerceptual analysisanalysis: : VoiceVoice andandspeech speech assessmentassessment• GRBAS-I scale (Hirano, 1981 ; Dejonckère, 1985): Grade,

Breathiness, Roughness, Astheny, Strain, Instability

• « Evaluation perceptive de la dysarthrie » (Ozsancak, 2002)

• Pitch: mean value, variability, tremor

• Intensity: mean value, variability, control

• Timbre: roughness, breath, humidity, aphony

• Resonance: hypernasality, hyponasality

• Respiration: strained, inspiratory noise, control

• Prosodic features: stress, rate, rhythm, pauses

• Articulatory: phoneme lengthening, consonants and vowels

inaccuracy, pallilalia, initiation disorders

• Global intelligibility

EVA architectureEVA architecture

COMPUTERCOMPUTER

INTERFACEINTERFACE

SENSORSSENSORS

eva2 sensors

Oral airflow

Nasal airflow

Microphone

Pressures (ex: Intra-oral…)

5 Externalchannels

(ex: EGG, EMG…)

0 1 0 0 0 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0 6 0 0 0 7 0 0 0m s0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0H z

0 1 0 0 0 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0m s0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

H z

0 2 0 0 0 4 0 0 0 6 0 0 0 8 0 0 0 1 0 0 0 0 1 2 0 0 0m s0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

3 0 0

3 5 0

4 0 0

H z

Melodic curve of the sentence « C’est une affaire intéressante, qu’en pensez vous? il faut la faire sans

aucun regret » prononced by 3 speakers ; normal, parkinsonian et ataxic

Normal speaker

Parkinsonian patient

Ataxic patient

0 1 0 0 0 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0m s0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

H z

124.8 Hz, 5.1 %

0 50 100 150 200 250 300Hz0

2

4

6

8

10

%

17Target points

153Dynamic (Hz)

247Max (Hz)

93Min (Hz)

25Var-coef (% )

41Stand-var (Hz)

125-130Mode (Hz)

168Mean (Hz)

Melodic curve, histogram and statistic board of the Fo variations of the sentence « C’est

une affaire intéressante, qu’en pensez vous? il faut la faire sans aucun regret » pronounced

by a normal speaker

0 1 0 0 0 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0 6 0 0 0 7 0 0 0m s0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0H z

119 .4 H z , 7 .2 %

0 5 0 1 0 0 1 5 0 2 0 0H z0

2

4

6

8

1 0

1 2

1 4

%

1616Target pointsTarget points

8181DynamicDynamic (Hz)(Hz)

160160Max (Hz)Max (Hz)

7979Min (Hz)Min (Hz)

1616VarVar--coefcoef (%)(%)

1919StandStand--devdev (Hz)(Hz)

125125--130130Mode (Hz)Mode (Hz)

122122MeanMean (Hz)(Hz)

Melodic curve, histogram and statistic board of the Fo variations of the sentence « C’est une affaire

intéressante, qu’en pensez vous? il faut la faire sans aucun regret » pronounced by a parkinsonian

patient

0 2 0 0 0 4 0 0 0 6 0 0 0 8 0 0 0 1 0 0 0 0 1 2 0 0 0m s0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

3 0 0

3 5 0

4 0 0

H z

106.8 H z, 6 .0 %

0 5 0 1 0 0 1 5 0 2 00 2 5 0 3 0 0 3 5 0H z0

2

4

6

8

1 0

%

2424Target pointsTarget points

275275DynamicDynamic (Hz)(Hz)

377377Max (Hz)Max (Hz)

101101Min (Hz)Min (Hz)

3434VarVar--coefcoef (%)(%)

6767StandStand--devdev (Hz)(Hz)

145145--150150Mode (Hz)Mode (Hz)

194194MeanMean (Hz)(Hz)

Melodic curve, histogram and statistic board of the Fo variations of the sentence « C’est une affaire

intéressante, qu’en pensez vous? il faut la faire sans aucun regret » pronounced by an ataxic patient

343416162525VarVar--coefcoef (%)(%)

10110179799393Min (Hz)Min (Hz)

377377160160247247Max (Hz)Max (Hz)

242416161717Target pointsTarget points

2752758181153153DynamicDynamic (Hz)(Hz)

676719194141StandStand--devdev (Hz)(Hz)

145145--150150125125--130130125125--130130Mode (Hz)Mode (Hz)

194194122122168168MeanMean (Hz)(Hz)

AtaxicAtaxicParkinsonianParkinsonianNormalNormalSpeakerSpeaker

Comparative chart of the statistical values of the Fo variations on the sentence « C’est une affaire

intéressante, qu’en pensez vous? il faut la faire sans aucun regret », by normal, parkinsonian and ataxic

speakers

SubglottalSubglottal Pressure EvaluationPressure Evaluation

�� SGP SGP isis equivalentequivalent to to IntraIntra Oral Pressure (IOP) Oral Pressure (IOP) atatthethe release release ofof thethe occlusion (occlusion (phonemephoneme //papa/)/)

Signal acoustique d’une répétition de « pa, pa, pa, pa,... » (l’axe des abscisses est en millisecondes)

Variation curve of the intra oral pressure (hecto Pascal [hPa])

Variation curve of the oral airflow (décimeter cube per second [dm3/s])

Variation curve of the mean intensity (RMS) of the acoustic signal ( déci Bel [dB])

Intra oral pressure Mean intensity Mean oral

airflow

Glottal

efficiency

Laryngeal

efficiency

Unit hPa dB dm3/s dB/hPa dB/(hPa.dm3/s

)

value 12.2 99.4 0.32 8.18 25.59

time 3679 ms 3705+[147] ms 3705+[147] ms

Glottal efficiency in a normal subject

1 0 0 0 0 1 0 5 0 0 1 1 0 0 0 1 1 5 0 0m s

- 0 . 1

0 . 0

0 . 1

1 0 0 0 0 1 0 5 0 0 1 1 0 0 0 1 1 5 0 0m s- 1

0

1

2

3

4

5

6

7h P a P r e s s i o n

1 0 0 0 0 1 0 5 0 0 1 1 0 0 0 1 1 5 0 0m s

3 0

3 5

4 0

4 5

5 0

5 5

6 0

6 5

7 0d B I n t e n s i t é m o y e n n e

1 0 0 0 0 1 0 5 0 0 1 1 0 0 0 1 1 5 0 0m s- 0 . 1

0 . 0

0 . 1

0 . 2

0 . 3

d m 3 / s D é b i t d ' a i r o r a l m o y e n

5 0 0 0 1 0 0 0 0 1 5 0 0 0m s

- 0 . 4

- 0 . 3

- 0 . 2

- 0 . 1

0 . 0

0 . 1

0 . 2

0 . 3

0 . 4

0 . 5

Z o n e

5 0 0 0 1 0 0 0 0 1 5 0 0 0m s0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

H z Z o n e

5 0 0 0 1 0 0 0 0 1 5 0 0 0m s

3 0

4 0

5 0

6 0

7 0

8 0d B Z o n e

«Monsieur Seguin n’avait jamais eu de bonheur…………..et la haut, le loup les mangeait »: Text read by a

normal subject (62 years). From top to bottom: Acoustic signal (Spl), Fo curve (Hz), intensity curve (dB).

0 5 0 1 0 0 1 5 0 2 0 0 2 5 0H z0

1

2

3

4

5

6

7

8

9

%

Distribution of the Fo values relative to the sentence duration

Statistical chart of the Fo values Statistical chart of the breaks

118Dynamic (Hz)

219Max (Hz)

101Min (Hz)

17Var. coef. (%)

25Stand. dev. (Hz)

145-150Mode (Hz)

146Mean (Hz)

Mean duration (sec)

Number

Organization

Acumulated duration (sec)

Analysis duration

1.6570.457

89

76.3 %23.7 %

13.2604.117

SignalBreak

ParkinsonianParkinsonian speech: speech: ClinicalClinicalassessmentassessment

�� ""HypokineticHypokinetic DysarthriaDysarthria" : " : DarleyDarley, , AronsonAronson, Brown (1975), Brown (1975)

�� MonotonousMonotonous speech,speech, paroxysticparoxystic tachyphemiatachyphemia, , articulatoryarticulatory inaccuraciesinaccuracies ((vowelsvowels, occlusive , occlusive consonants)consonants)

�� UPDRS (item 18): UPDRS (item 18): �� 0 Normal speech0 Normal speech

�� 1 1 SlightSlight lossloss ofof expression, expression, dictationdictation andand/or volume/or volume

�� 2 Monotone, 2 Monotone, slurredslurred but but understandableunderstandable; ; moderatelymoderately impairedimpaired

�� 3 3 MarkedMarked impairmentimpairment, , difficultdifficult to to understandunderstand

�� 4 4 UnintelligibleUnintelligible

ParkinsonianParkinsonian speech: speech: ClinicalClinicalassessmentassessment

" " HypokineticHypokinetic DysarthriaDysarthria " : " : AuzouAuzou & & alal. (2000). (2000)

�� Velum Velum functionfunction: : lessless impairedimpaired

�� SialorrheaSialorrhea, , lipslips atat restrest, , tonguetongue protrusionprotrusion: more : more impairedimpaired

SpecificSpecific impairmentsimpairments (76% (76% ofof parkinsoniansparkinsonians are are correctlycorrectly classifiedclassified): ): �� Velum Velum elevationelevation duringduring sustainedsustained vowelvowel (a)(a)

�� Velum Velum mobilitymobility duringduring speechspeech

�� ExcessExcess ofof ssialorrheaialorrhea

�� LipsLips position position atat restrest

�� TongueTongue protrusionprotrusion

ParkinsonianParkinsonian speech: speech: ClinicalClinicalassessmentassessment

PhoneticPhonetic test test ofof intelligibilityintelligibility ((OsçancakOsçancak et et alal., 2002)., 2002)

SpecificSpecific criteriacriteria: :

�� Stress Stress andand rate rate impairmentimpairment

�� Pitch Pitch impairmentimpairment

�� DecreaseDecrease in pitch in pitch andand intensityintensity variabilityvariability

ParkinsonianParkinsonian dysprosodydysprosodySubjectsSubjects caracteristicscaracteristics

Patients Controls

Id. Age

Durée maladie

(années)

UPDRS : motor score UPDRS : speech item

Id. Age

Dopa ON Dopa OFF Dopa ON Dopa OFF

1 57 12 22 60 2 2 I 60 2 43 11 10 26 0 0 II 59 3 47 10 16 28 1 1 III 60 4 67 20 46 61 3 3 IV 58 5 61 13 27 34 3 3 V 60 6 70 13 29 38 2 2 VI 40 7 68 10 20 36 1 2 VII 70 8 55 3 11 24 0 1 VIII 77 9 58 10 10 28 0 1+ IX 61 10 48 4 14 30 1 1+ X 47

Mean (S. D.)

57,4 (9,3) 10,6 (4,7) 20,5 (11,2) 36,5 (13,3) 1,3 (1,1) 1,6 (1,0) Mean (S. D.) 59,2 (10,3)

500 1000 1500 2000 2500 ms0

20

40

60

80

100

120

140

160

180

Hz

OFF

ON

500 1000 1500 2000 ms0

20

40

60

80

100

120

140

160

180

Hz

ParkinsonianParkinsonian dysprosodydysprosody: Fo : Fo curvecurve

ControlOFF ON

0 50 100 150 Hz0

5

10

15

20

%

ParkinsonianParkinsonian dysprosodydysprosody: : AcousticAcoustic analysisanalysisResultsResults: F0, tonal distributions: F0, tonal distributions

0,2388-0,71742-0,59114,702

(6,037)

14,111

(7,449)Unilat. L.

HNR

(dB)

0,43740,158430,077

6,236

(2,865)

6,313

(3,477)Unilat. R.

Var. Coef. Oral

airflow

(%)

0,0066-2,58843-0,0310,197

(0,081)

0,166

(0,074)Unilat. L.

Oral airflow

(dm3/s)

0,0085-2,48443-0,2632,652

(1,011)

2,389

(0,934)Unilat. L.

Glottial leakage

(cm3/s/dB)

0,27010,617430,0541,168

(0,528)

1,221

(0,526)Unilat. R.

Var. Coef. intensity

(%)

0,0030-2,8943-1,82173,746

(5,331)

71,925

(5,242)Unilat. L.

Mean Intensity

(dB)

0,46130,098430,0210,747

(1,087)

0,768

(1,047)Unilat. R.

Absolute Jitter

(Hz)

0,2795-0,58943-0,0751,373

(0,811)

1,298

(0,65)Unilat. L.

Var. Coef. F0

(%)

0,0206-2,10443-4,382122,43

(22,397)

118,048

(22,761)Unilat. L.

Mean F0

(Hz)

Sustained

/a/

ptdfMean

diff.

Mean

(S. D.)

ON-dopa

Mean

(S. D.)

OFF-dopa

TestParameterTask

Statistical analysis on the sustained /a/ of N=44 patients OFF Dopa vs. ON Dopa (αααα = 0,05)

ParkinsonianParkinsonian dysprosodydysprosody : : acousticacoustic analysisanalysisStatisticStatistic resultsresults

Parameter Mean diff.

df t p Mean (S. V.)

OFF Mean (S. V.)

ON Mean (S. V.)

Control

Mean Fo.(Hz) -12,23 9 -3,732 ,0047 120,47 (27,5) 132,7 (30,866) 143,46 (21,914)

Stan. Dev. F0 (Hz) -5,59 9 -4,35 ,0009 15 (7,032) 20,59 (8,483) 25,24 (4,816)

Var. Coef. F0 (Hz) -2,98 9 -5,553 ,0002 12,36 (4,872) 15,34 (4,822) 17,69 (2,62)

Stan. Dev. F0 (1/2 tons)

-0,47 9 -6,177 <,0001 2,01 (0,734) 2,48 (0,71) 2,82 (0,377)

Mean intensity (dB) -0,41 9 -0,222 0,4145 67,85 (4,784) 68,26 (3,607) 76,33 (7,609)

Stan. Dev. intensity (dB)

0,19 9 1,213 0,872 9,73 (0,775) 9,54 (0,712) 10,2 (1,02)

Statistical analysis on the reading task of N=10 patients OFF Dopa vs. ON Dopa (αααα = 0,05)

0,39400,271430,23214,200

(6,401)

14,432

(5,688)Unilat. R.Var. Coef.

(%)

0,0012-3,23243-5,186135,023

(20,421)

129,836

(21,594)Unilat. L.

Mean F0

(Hz)

Reading

ptdfMean

diff.

Mean

(S. D.)

ON-dopa

Mean

(S. T.)

OFF-dopa

TestParameterTask

Statistical analysis on the reading task of N=44 patients OFF Dopa vs. ON Dopa (αααα = 0,05)

0,1092-1,25928-2,09035,103

(11,547)

33,013

(11,908)Unilat. L.

Laryngeal resistance

(hPa/(dm3/s))

0,01412,315287,65646,465

(21,097)

54,121

(23,501)Unilat. R.

Laryngeal efficiency

(dB/(hPa*dm3/s))

0,00073,529281,07610,141

(2,579)

11,212

(2,341)Unilat. R.

Glottal efficiency

(dB/hPa)

0,0583-1,61928-0,0170,249

(0,088)

0,232

(0,071)Unilat. L.

Mean oral airflow

(dm3/s)

0,0093-2,50128-1,48676,928

(4,924)

75,441

(4,597)Unilat. L.

Mean intensity

(dB)

0,0018-3,18228-1,2008,279

(3,083)

7,079

(1,824)Unilat. L.

Intr oral pressure

(hPa)

Evaluation

of the

glottal

efficiency

ptdfMean

diff.

Mean

(S. D.)

ON-dopa

Mean

(S. D.)

OFF-

dopa

TestParameterTask

Statistic analysis of the glottal efficiency on N=44 patients OFF Dopa vs. ON Dopa

(αααα = 0,05)

Patient 1

Male, born June 02, 1951, manager

1 2

Patient 1

What is your diagnosis?

Which treatment does he receive?

ParkinsonianParkinsonian speech: speech: PerceptualPerceptual analysisanalysis

�� Case 1 : Idiopathic Parkinson’s Case 1 : Idiopathic Parkinson’s diseasedisease (OFF)(OFF)

•• HypokineticHypokinetic dysarthriadysarthria

•• HypophoniaHypophonia andand monotonousmonotonous voicevoice are dominant are dominant featuresfeatures, , withwith rate rate disordersdisorders duringduring evolutionevolution

1 2

ParkinsonianParkinsonian speech: speech: PerceptualPerceptual analysisanalysis

�� Case 1 : Idiopathic Parkinson’s Case 1 : Idiopathic Parkinson’s diseasedisease (ON)(ON)

•• ImprovementImprovement ofof bradyphreniabradyphrenia

•• Articulation more Articulation more accurateaccurate (but (but thethe resonanceresonance isis stillstillimpairedimpaired: : nasalitynasality))

•• ProsodicProsodic improvementimprovement: : fasterfaster andand easiereasier readingreading

0 50 100 150 200Hz0

5

10

15

20

25

%

ON

0 50 100 150 200 250Hz0

5

10

15

20

25

%

OFF

73Dynamic (Hz)

170Max (Hz)

97Min (Hz)

7.3Var. coef. (%)

9.1Stan. Dev. (Hz)

120-125Mode (Hz)

123.7Mean (Hz)

Fundamental frequency (Fo)

91.3Dynamic (Hz)

181.8Max (Hz)

90.5Min (Hz)

7.7Var. coef. (%)

10.1Stan. Dev. (Hz)

130-135Mode (Hz)

131.3Mean (Hz)

Fundamental frequency (Fo)

Patient 2

Female, born Nov. 12, 1946, psychologist

1 2

3 4

ParkinsonianParkinsonian speech: speech: PerceptualPerceptual analysisanalysis

�� Case 2 : Multiple Case 2 : Multiple SystemSystem AtrophyAtrophy ((cerebellarcerebellarformform))

•• MixedMixed dysarthriadysarthria: : PrevalentPrevalent ataxicataxic component component

220 230 240 250 260Hz0

5

10

15

20

25

%

220 230 240 250 260Hz

220

225

230

235

240

245

250

255

260

Hz

3.19Jitter ratio (‰)

0.32Jitter factor (%)

0.002R.A.P.

0.768Absolute jitter (Hz)

1.18Var. coef. Fo (%)

2.84Stan. Dev. Fo (Hz)

240.89Mean Fo (Hz)

Fondamental frequency (Fo)

Fo histogramFo scatter plot

0 1000 2000 3000 4000 5000 6000Hz

-10

0

10

20

30

40

50

60

70dB

0.23Shimmer factor

0.015APQ

0.196Absolute shimmer (dB)

1.10Var. Coef. (%)

0.80Stan. Dev. (dB)

72.9Mean (dB)

Intensity

1.82Var. Coef. (%)

0.004Stan. Dev. (dm3/s)

0.234Mean (dm3/s)

3.20Glottal leakage (cm3/s/dB)

Oral airflow

240Detected Fo (Hz)

43.8 %Signal ratio [f>1 kHz] (%)

- 23,2Normalysed noise energy (dB)

26.3Harmonic-noise ratio (HNR) (dB)

Noise analysis

Acoustic spectrum of the wowel /a/

Patient 3

Male, born Feb. 15, 1946, bank employee

1 2

ParkinsonianParkinsonian speech: speech: PerceptualPerceptual analysisanalysis

�� Case 3 : Progressive Case 3 : Progressive SupranuclearSupranuclear PalsyPalsy

•• MixedMixed dysarthriadysarthria: : PrevalentPrevalent spasticspastic componentcomponent

•• HypophoniaHypophonia andand palilaliapalilalia

•• OculoOculo--motormotor disordersdisorders andand subcorticalsubcortical dementiadementiacontributingcontributing to to readingreading disabilitydisability

125 130 135 140 145 150Hz0

5

10

15

20

25

30

35

40

45

%

125 130 135 140 145 150Hz

125

130

135

140

145

150

Hz

3.29Jitter ratio (‰)

0.33Jitter factor (%)

0.001R.A.P.

0.454Absolute jitter (Hz)

0.96Var. Coef. Fo (Hz)

1.33Stan. Dev. Fo (Hz)

137.8Mean Fo (Hz)

Fundamental frequency (Fo)

Fo histogram Fo scatter plot

0 500 1000 1500 2000 2500 3000Hz-10

0

10

20

30

40

50

60

70dB

-1Shimmer factor (%)

0.0A.P.Q.

0.0Absolute shimmer (dB)

0.95Var. Coef. (dB)

0.72Stan. Dev. (dB)

75.47Mean (dB)

Intensity

137Detected Fo (Hz)

22.2Ratio signal [f>1kHz] (%)

95.0Ratio signal (%)

-12.97Noise normalysed energy (dB)

12.42Harmonic noise ratio (HNR) (dB)

Noise analysis

7.13Var. Coef. (% )

0.020Stan. Dev. (cm3/s)

0.284Mean (cm3/s )

3.76Glottal leakage (cm3/s/dB)

Oral airflow

Acoustic spectrum of the wowel /a/