|Year : 2015 | Volume
| Issue : 1 | Page : 24-25
Dysarthrophonia: A case report
Swetha Grandhi, Pawana P Poojary, BS Premalatha
Department of Speech Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, Karnataka, India
|Date of Web Publication||17-Dec-2015|
Dr. S. R Chandrasekhar Institute of Speech and Hearing, Hennur Road, Bengaluru - 560 084, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Voice analysis in dysarthria is challenging because of the complexity of the disorder and its effects on the speech production system. A combination of perceptual and acoustic analysis has become increasingly common because of its convenience. The aim of this report is to describe the voice analysis in a 66-year-old male diagnosed as spastic dysarthria. Based on the assessment, we can conclude that voice analysis reveals interesting data on the multiplicity of voice quality in spastic dysarthria.
Keywords: Acoustic analysis, dysarthria, voice quality
|How to cite this article:|
Grandhi S, Poojary PP, Premalatha B S. Dysarthrophonia: A case report. J Laryngol Voice 2015;5:24-5
| Introduction|| |
The vocal analysis in individuals with the neurological disease can contribute toward reaching an early diagnosis and also plays an important role in the follow-up as the disease progresses.  In recent years, acoustic analysis of the voice in individuals with different neurological diseases is being carried out.  Acoustic analysis always complements perceptual evaluation and gives acoustic correlates for perceptual judgments in aspects of monopitch, pitch breaks, loudness, voice quality, and dysarthria type. The aim of the current study was to analyze voice in a patient with spastic dysarthria and correlate the perceptual and acoustic parameters accordingly.
| Case report|| |
The participant (GV) was a 66-year-old male reported to the Department of Speech Language Studies with the complaint of weak voice, poor speech intelligibility, and difficulty in swallowing following a stroke. Medical and magnetic resonance imaging records revealed that client had opercular syndrome due to an acute infarct seen in the left frontal periventricular corona radiate and bilateral chronic ischemic lesions. As the primary concern of GV was a weak voice, detailed subjective and objective evaluation was done.
On examination, it was noted that the client was able to produce laryngeal tone, had a weak voluntary cough, fair vocal endurance with no musculoskeletal tension. Phonation breaks and pitch breaks were observed with hoarseness and unstable voice quality. The weak voice could neither be attributed to excessive talking nor to habits such as smoking or throat clearing. The stroboscopic evaluation revealed incomplete glottis closure with bilateral false vocal fold hypertrophy.
Perceptual analysis of voice quality was carried out by using the following rating scales such as grade, roughness, breathiness, asthenia, strain (GRBAS), Buffalo voice III profile, and voice handicap index (VHI).
The GRBAS is a scale in which stands for GRBA are assessed using a 4 point rating scale where 0 stands for normal and 3 stands for severe.  Perceptual rating on GRBAS revealed that GV has a moderate level of voice problem in the parameters of grade, breathiness and asthenia, but voice quality was impaired slightly for parameters of roughness and strain.
Buffalo III voice profile was used to measure laryngeal tone, pitch, loudness, and nasal resonance to get an overall voice rating. It is scored using a 5-point scale ranging from 1 which indicates normal to 5 which indicates very severe.  Laryngeal tone examination revealed a breathy component with mild impairment in the intensity of voice accompanied with hypernasality. Overall rating indicated a moderate impairment in terms of laryngeal tone, loudness, and nasal resonance.
VHI is a self-report questionnaire consisting of 120 questions to quantify the functional, physical, and emotional impacts of a voice disorder on a patient's quality of life. The scores obtained for GV for VHI are 25, 20 and 18 for functional, physical, and emotional aspects, respectively, and a total score of 63 is rated by GV implying that his voice problem is severe.
Objective voice analysis
Objective analysis of voice parameter was carried out using Multi-Dimensional Voice Program (MDVP) and Dr. Speech. MDVP results showed increased values of frequency and amplitude perturbation measures suggestive of irregular vocal fold vibration along with increased value of soft phonation index (SPI). Increased value of the degree of voiceless indicates the presence of phonatory gap as confirmed by stroboscopic findings.
Dr. Speech was used to measure the quality of voice based on harsh, breathy, and hoarse components. It indicated that client had a more breathy component (severity was 3) in a 0-3 scale where 1 indicates normal and 3 indicates severe impairment.
| Discussion|| |
The perceptual analysis is the primary tool used by SLP to gather information about speech production characteristics of persons with various speech disorders.  GRBAS is an effective perceptual tool in assessing voice quality changes in dysarthric population.  Acoustical analysis of the voice signal is one of the most useful methods to assess phonatory function or laryngeal pathology.  It is a noninvasive method and provides objective and quantitative data. 
Acoustic parameters such as fundamental frequency (F0), vocal intensity, perturbation of the frequency (jitter), perturbation of amplitude (shimmer), harmonic-to-noise ratio, and maximum phonation frequency range helps to identify the physiological changes of the laryngeal system.  Dysarthria results in abnormal values for several parameters in MDVP, including absolute jitter (Jita), percentage jitter (Jitt), relative average perturbation, pitch perturbation quotient (PPQ), smoothed PPQ, fundamental frequency variation, shimmer in dB, shimmer percent, amplitude perturbation quotient, smoothed amplitude perturbation quotient, peak amplitude variation, SPI, and amplitude tremor intensity index.  In GV, acoustic analysis of voice using MDVP revealed increased jitter parameters, shimmer parameters, amplitude and PPQs, noise to harmonic ratio and SPI.
A study on automatic analysis of sustained vowel phonation for 61 speakers with stroke revealed that men with stroke have a slightly higher SPI than young healthy men.  Hence, SPI is a sensitive measure in determining the changes affecting vocal fold closure.
| Conclusion|| |
Based on the information obtained on the perceptual-acoustic analysis of the client's voice, we can conclude that voice analysis is a useful tool in the identification of voice problems in dysarthria and can help the voice specialist focus on appropriate aspects in the intervention of these individuals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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