Citations

Purpose: This study examined whether phoneme-level posterior probabilities generated by an articulatory-informed deep learning model (Phonet) can serve as interpretable and sensitive markers of articulatory impairment in motor speech disorders (MSDs). The goal was to determine whether these features distinguish individuals with and without MSDs and reflect varying severity levels of articulatory impairment. Method: A total of 676 participants (199 with MSDs, 477 without MSDs) completed a remotely captured word repetition task. Speech recordings were phonetically aligned, and posterior probabilities were extracted using a retrained version of the Phonet model, which estimates frame-level probabilities for 23 phonological classes. Segment-level posterior values were computed and compared across groups and severity levels using linear mixed-effects regression models. Results: Posterior probabilities were significantly reduced in the MSD group across all phoneme types. Within the MSD group, posterior probabilities decreased progressively with greater clinical severity, as measured by both perceptual sound distortion ratings and a cumulative articulation error score. Segment-specific analyses revealed systematic differences across phoneme classes, indicating that posterior probabilities capture distinct patterns of articulatory degradation associated with motor speech impairment. Conclusions: Phoneme-level posterior probabilities serve as interpretable, segment-specific indicators of articulatory impairment in MSDs. These features differentiate clinical status and reflect gradations of severity, making them promising tools for augmenting traditional perceptual speech assessments. Their linguistic transparency and scalability support future clinical applications in diagnosis, monitoring, and targeted intervention.

Purpose: Frontotemporal lobar degeneration (FTLD) is the neuropathology that underlies a collection of progressive clinical syndromes typically classified by the initial/primary symptom. For example, individuals with loss of word meaning as a first manifestation are often diagnosed with the semantic variant of primary progressive aphasia. Growing evidence suggests that language and communication can be impacted in all clinical syndromes across the FTLD spectrum, but the functional relevance of these symptoms has yet to be explored. Method: The Frontotemporal Degeneration (FTD) Insights Survey is the largest community survey of individuals affected by FTLD. It was administered online and included questions related to demographics, symptoms, life participation, quality of life, and experiences with and hopes for treatment. Self-reported diagnoses of respondents included the nonfluent/agrammatic, semantic, and unspecified variants of primary progressive aphasia, semantic dementia, corticobasal syndrome, progressive supranuclear palsy, and behavioral variant FTD. Here, we grouped respondents according to whether they had a language-predominant ( n = 43), motor-predominant ( n = 43), or behavior-predominant ( n = 90) variant of FTLD and used descriptive statistics to explore how they perceive their own communication difficulties and gauge their motivation for management. Results: Over 65% of respondents in each group identified changes to communication as a symptom; subsequent analyses focused on the responses of this cohort. Across groups, word finding and speaking were two of the most frequently endorsed difficulties. Over 50% of each group identified improved communication as a treatment priority, reflecting the impact that these symptoms have on their day-to-day life. Speech-language therapy is an important approach to manage these changes and minimize their impact. Whereas 76% of the language and motor groups had attended speech-language therapy, this was true for only 16% of the behavior group. Conclusions: Individuals across the FTLD spectrum experience changes to communication that impact their social engagement and quality of life. Management needs to be tailored to the needs of each individual, but recommendations are provided based on the insights and group-level preferences reported here. Future research is needed to identify current referral practices and how to increase engagement in skilled communication interventions, especially for individuals with the behavioral variant of FTD. Supplemental Material: https://doi.org/10.23641/asha.33940597

Abstract Purpose To evaluate whether two automated measures of nasality, Nasal Cognate Distinctiveness (NCD) and nasal posterior probability (NPP), provide clinically meaningful markers of hypernasality in speakers with motor speech disorders (MSDs) and to determine whether hypernasality-related information extends beyond stop consonants, which are typically targeted in cognate-based approaches. Method Sentence-level speech recordings were obtained from 561 patients, including 374 neurologically typical controls and 187 individuals with MSDs. NCD was computed for voiceless stops (/p/, /t/, /k/) using likelihood ratios between stops and their nasal cognates. NPP was extracted using a phonological feature-based neural network model and analyzed for stops, consonants, and vowels. Hypernasality severity was rated by speech-language pathologists. Group differences and associations with hypernasality severity were evaluated using linear mixed-effects models and Spearman correlations, and receiver operating characteristic (ROC) analyses were used to evaluate discrimination of absent versus present hypernasality. An additional 20 controls with repeat recordings were used to evaluate test-retest reliability and minimal detectable change (MDC). Results NCD generally decreased and NPP increased with increasing hypernasality severity, with phoneme-specific severity effects observed for NCD. Across stops, NCD and NPP were strongly inversely correlated and showed comparable discrimination of absent versus present hypernasality (AUCs = 0.796 and 0.730, respectively). Consonant and vowel NPP measures were both positively associated with hypernasality severity and demonstrated identical classification performance (AUC = 0.853). No significant differences in ROC performance were observed between NCD and NPP or between consonant and vowel NPP measures. Test-retest change exceeded the MDC threshold in 2 of 20 controls for NCD and 1 of 20 for NPP. Conclusions Both NCD and NPP provide objective markers of hypernasality in speakers with MSDs. The measures capture related aspects of nasalization and demonstrate comparable ability to identify clinically meaningful hypernasality. NPP captures hypernasality-related acoustic information across both consonants and vowels, with similar relationships to severity and classification performance across sound classes. Test-retest findings provide preliminary MDC benchmarks for interpreting longitudinal change.

Abstract Clinical syndromes of frontotemporal dementia present both distinct and overlapping neuroimaging abnormalities and, consequently, domains of impairment. The aim of this study was to determine how well covariance patterns from multiple neuroimaging modalities discriminate across clinical frontotemporal dementia syndromes. Four-hundred participants with a clinical frontotemporal dementia diagnosis, including behavioral variant of frontotemporal dementia, semantic variant of primary progressive aphasia, right temporal variant of frontotemporal dementia, primary progressive aphasia, apraxia of speech with agrammatic aphasia, primary progressive apraxia of speech, progressive supranuclear palsy and corticobasal syndrome, and 109 cognitively unimpaired participants underwent extensive neurological and neuropsychological assessments, structural MRI, flortaucipir-PET for tau and [18F] fluorodeoxyglucose-PET. Multimodal imaging covariance was investigated at the voxel-level using principal component analysis after adjusting for age and sex effects. Linear regression models were fit to investigate the relationship between principal components and clinical scores. Multinomial logistic regression models investigated the ability of imaging principal components to discriminate across syndromes. The first principal component, which describes the largest source of variability in the data, was a pattern of widespread cortical atrophy (21% variability explained) and of frontoparietal and temporal hypometabolism (21%): scores were lowest in behavioral variant of frontotemporal dementia and correlated with general cognitive impairment. On tau-PET, the first principal component (43% variability) was not significantly different among syndromes and captured a widespread cortical tau uptake, with a focus on the temporal lobe. In all three modalities, the second principal component captured temporal lobe imaging abnormalities, contrasting the motor and semantic clinical syndromes. Subsequent components described smaller variability. On cross-validation, the classifiers based on principal components from MRI (multiclass area under the receiver operating characteristic: 0.76) and [18F]fluorodeoxyglucose-PET (0.79) outperformed tau-PET (0.71), while combining all three modalities did not significantly improve the classifier performance. On cross-validation, the sensitivity of the image-based classifiers was heterogeneous across syndromes and modalities, with highest values for progressive supranuclear palsy and semantic variant of primary progressive aphasia and lowest for primary progressive aphasia and corticobasal syndrome. Our study found that the covariance components of structural and molecular neuroimaging underlying frontotemporal dementia clinical syndromes exist both as a continuum and with syndrome-specific patterns. More than one imaging model was able to correctly classify several frontotemporal dementia clinical syndromes with good specificity and sensitivity, highlighting the value of imaging in aiding patient diagnosis.

Purpose: This study aimed to evaluate how speech signal compression algorithms affect the acoustic and perceptual characteristics of dysarthric speech. As telepractice becomes more common in speech-language pathology, particularly in the assessment of dysarthria, understanding the impact of telecommunication compression on speech fidelity is essential for clinical decision making. Method: Speech samples were collected from 15 individuals with dysarthria, recorded locally and simultaneously via Zoom (Version 6.2.11). The Opus codec was used to process the locally recorded speech samples under fullband, wideband, and narrowband compression conditions. Acoustic measures were derived for all samples. Twenty experienced speech-language pathologists (SLPs) rated vocal quality and nasality for sustained vowels and rated articulatory precision and orthographically transcribed sentences across each condition. Results: Narrowband compression was associated with significantly degraded voice quality measures (e.g., harmonic-to-noise ratio, shimmer) and reduced transcription accuracy. Despite these changes in acoustics and intelligibility, ratings of articulatory precision, nasality, and vocal quality remained stable across conditions, suggesting SLPs could adjust for compression artifacts when making perceptual judgments. Conclusions: Speech compression, particularly in low-bandwidth (i.e., narrow) condition, impacts acoustic fidelity and intelligibility, though expert listeners maintain reliable perceptual judgments. These findings underscore the need to consider compression effects in telepractice and highlight the importance of developing optimized protocols for remote dysarthria assessment.

Abstract Motor speech disorders (MSDs) are early markers of neurological disease, but expert perceptual analysis is rarely available outside specialized centers. Automated speech analysis offers a scalable alternative, yet prior studies have not systematically compared modeling approaches or assessed clinically relevant metrics in independent datasets. This study compared static acoustic features, articulatory informed Phonet features, and self-supervised pretrained models for binary and multi label MSD classification. We trained and evaluated models on 583 speech samples using speaker level splits. Baseline models included logistic regression and Gated Recurrent Units (GRUs) trained on eGeMAPS and MFCCs. We extracted three types of Phonet derived features and evaluated pretrained HuBERT and SSAST models in frozen, partially fine-tuned, and fully fine-tuned configurations. Binary classification distinguished MSDs from controls, while multi label classification identified six MSD subtypes. Models were assessed using validation AUC, and cut points were tested on two independent datasets. Pretrained and Phonet based models substantially outperformed static acoustic features. In binary classification, HuBERT achieved the highest AUC (0.95), while compact Phonet derived GRUs achieved comparable performance (up to 0.94). These models generalized well to independent datasets, maintaining high sensitivity (0.94) and specificity (0.97). In multi label classification, Phonet models achieved the highest macro average AUC (0.86), but threshold-based subtype performance declined on unseen data. Automated MSD detection is feasible and clinically promising. Binary classification generalized well, whereas multi label classification showed limited threshold stability across datasets.

Abstract This study examined the extent to which goodness of pronunciation (GoP) scores and phonological posterior probabilities capture perceptual ratings of speech severity in individuals with motor speech disorders (MSD). Speech recordings of the word catastrophe were obtained from 489 participants, including 333 neurologically typical controls and 156 individuals with MSD. GoP scores were derived using traditional acoustic features and self-supervised speech representations, including WavLM and XLS-R, across multiple modeling approaches, while phonological posterior probabilities were extracted using Phonet. Model performance was evaluated using Kendall’s rank correlations, regression, and receiver operating characteristic analyses against speech-language pathologists’ perceptual ratings of sound distortion and intelligibility. Both GoP and phonological posterior probabilities were significantly associated with perceptual ratings. Self-supervised speech representations substantially outperformed traditional acoustic features, with WavLM-based GoP using k-nearest neighbors achieving the strongest performance. Across correlation, regression, and classification analyses, GoP consistently outperformed phonological posterior probabilities for both sound distortion and intelligibility. Age and gender had minimal influence on model-derived measures or their relationships with perceptual ratings. These findings demonstrate the value of self-supervised GoP as an objective measure of speech impairment while highlighting the complementary role of phonological posterior probabilities in characterizing articulatory aspects of motor speech disorders.

Background Frontotemporal dementia is an umbrella term that encompasses several clinical syndromes with impaired behavioral, language, and motor functions. These syndromes show considerable overlap in clinical features and imaging patterns. Therefore, there is a need to investigate the syndromic heterogeneity in FTD using unbiased data-driven approaches. Methods We used data-driven clustering analysis of structural magnetic resonance imaging (MRI) data on 400 patients with clinical FTD diagnoses [behavioral variant of frontotemporal dementia (bvFTD), semantic variant of primary progressive aphasia (svPPA), right temporal variant of frontotemporal dementia (rtvFTD), apraxia of speech with agrammatic aphasia (AOS-PAA), primary progressive apraxia of speech (PPAOS), progressive supranuclear palsy (PSP), corticobasal syndrome (CBS) and primary progressive aphasia who did not fit into the other diagnostic categories (PPA-other)]. MR images were w-scored relative to cognitively unimpaired individuals, and principal component analysis was performed. A clustering ensemble approach, including hierarchical algorithms, was applied to the MR-based principal components, and imaging and clinical characteristics of the clusters were investigated. Various numbers of clusters ( K = 2, 3, or 4) were evaluated. Results The K = 3 solution offered the most clinically meaningful separation of FTD syndromes. The first cluster captured mostly frontal MRI abnormalities related to the speech, language and behavioral clinical dimensions, including patients with AOS-PAA, PPAOS, PPA-other, and bvFTD. The second cluster captured mostly temporal abnormalities and included mainly patients with svPPA and rtvFTD, but also bvFTD, AOS-PAA, and PPA-other. The third cluster captured cortical and subcortical atrophy, particularly in the midbrain, and included atypical Parkinsonian syndromes, with all PSP and CBS patients captured in this cluster, as well as most PPAOS patients. Considerable overlap of clinical syndromes was noted across these clusters, whereby patients with AOS-PAA, svPPA, PPA-other, and bvFTD were captured in more than one cluster. Discussion Our findings highlight heterogeneity in FTD, which mainly exists along three axes: speech, language and behavioral deficits reflecting frontal atrophy, language deficits reflecting temporal atrophy, and motor and motor speech deficits reflecting mostly midbrain and subcortical atrophy, with cortical involvement.