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There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.

Dysprosody is a hallmark of dysarthria, which can affect the intelligibility and naturalness of speech. This includes sentence accent, which helps to draw listeners’ attention to important information in the message. Although some studies have investigated this feature, we currently lack properly validated automated procedures that can distinguish between subtle performance differences observed across speakers with dysarthria. This study aims for cross-population validation of a set of acoustic features that have previously been shown to correlate with sentence accent. In addition, the impact of dysarthria severity levels on sentence accent production is investigated. Two groups of adults were analysed (Dutch and English speakers). Fifty-eight participants with dysarthria and 30 healthy control participants (HCP) produced sentences with varying accent positions. All speech samples were evaluated perceptually and analysed acoustically with an algorithm that extracts ten meaningful prosodic features and allows a classification between accented and unaccented syllables based on a linear combination of these parameters. The data were statistically analysed using discriminant analysis. Within the Dutch and English dysarthric population, the algorithm correctly identified 82.8 and 91.9% of the accented target syllables, respectively, indicating that the capacity to discriminate between accented and unaccented syllables in a sentence is consistent with perceptual impressions. Moreover, different strategies for accent production across dysarthria severity levels could be demonstrated, which is an important step toward a better understanding of the nature of the deficit and the automatic classification of dysarthria severity using prosodic features.

Childhood apraxia of speech (CAS) commonly affects the production of lexical stress contrast in polysyllabic words. Automated classification tools have the potential to increase reliability and efficiency in measuring lexical stress. Here, factors affecting the accuracy of a custom-built deep neural network (DNN)-based classification tool are evaluated. Sixteen children with typical development (TD) and 26 with CAS produced 50 polysyllabic words. Words with strong–weak (SW, e.g., dinosaur) or WS (e.g., banana) stress were fed to the classification tool, and the accuracy measured (a) against expert judgment, (b) for speaker group, and (c) with/without prior knowledge of phonemic errors in the sample. The influence of segmental features and participant factors on tool accuracy was analysed. Linear mixed modelling showed significant interaction between group and stress type, surviving adjustment for age and CAS severity. For TD, agreement for SW and WS words was &gt, 80%, but CAS speech was higher for SW (&gt, 80%) than WS (~60%). Prior knowledge of segmental errors conferred no clear advantage. Automatic lexical stress classification shows promise for identifying errors in children’s speech at diagnosis or with treatment-related change, but accuracy for WS words in apraxic speech needs improvement. Further training of algorithms using larger sets of labelled data containing impaired speech and WS words may increase accuracy.

BACKGROUND Hyperkinetic dysarthria is often present in isolated dystonia (ID) and is still understudied. Four main clusters of deviant speech dimensions in dystonia hyperkinetic dysarthria were initially provided: articulatory inaccuracy, phonatory stenosis, prosodic excess and prosodic insufficiency. AIM The aim of our exploratory study was to provide preliminary data on both perceptual and acoustic analyses in relation to three out of these four main clusters. METHODS & PROCEDURES Eleven patients with ID and 11 healthy controls (HC) participated in this study. Clinical/perceptual assessments and acoustic analyses of speech recordings were performed, the latter allowing for the analysis of parameters referring to aerophonatory control, voice quality, prosodic features and speech intelligibility estimated by nine listeners. Between-group statistical comparisons were performed (Wilcoxon tests, p < 0.05). Single-case differences between each patient and the control group were also carried out (effect size index and t < 0.05). OUTCOMES & RESULTS Between-group comparisons confirmed the presence of a 'phonatory stenosis'; in addition, deficit in aerophonatory control and hypophonia was also displayed. 'Prosodic insufficiency' was confirmed, but not at the individual level. 'Prosodic excess' manifested only in patients with marked and severe dysarthria. Correlations between altered maximum phonation time, loudness variation, speech and articulatory rates on the one hand, and several clinical speech assessments on the other hand, were also found. CONCLUSIONS & IMPLICATIONS From these findings, altogether, perceptual characteristics of hyperkinetic dysarthria, as suggested by Darley et al., were quantified by the acoustic parameters we measured. As regards to our data obtained in a small participant sample, we would suggest that Darley et al.'s clusters of excess and insufficiency prosody should be questioned in future studies involving larger numbers of dystonic patients. Our study provides novel and preliminary results that demonstrate the relevance of using quantitative measures to further characterise speech/voice deficits in patients with ID.

In clinical practice, patients with language impairments often exhibit suicidal ideation (SI) and suicidal behavior (SB, covering the entire range from suicide attempts, SA, to completed suicides). However, only few studies exist regarding this subject. We conducted a mini-review on the possible associations between neurologic language impairment (on the motor, comprehension, and semantic sides) and SI/SB. Based on the literature review, we hypothesized that language impairments exacerbate psychiatric comorbidities, which, in turn, aggravate language impairments. Patients trapped in this vicious cycle can develop SI/SB. The so-called “affective prosody” provides some relevant insights concerning the interaction between the different language levels and the world of emotions. This hypothesis is illustrated in a clinical presentation, consisting of the case of a 74-year old woman who was admitted to a psychiatric emergency department (ED) after a failed SA. Having suffered an ischemic stroke two years earlier, she suffered from incomplete Broca’s aphasia and dysprosody. She also presented with generalized anxiety and depressive symptoms. We observed that her language impairments were both aggravated by the exacerbations of her anxiety and depressive symptoms. In this patient, who had deficits on the motor side, these exacerbations were triggered by her inability to express herself, her emotional status, and suffering. SI was fluctuant, and—one year after the SA—she completed suicide. Further studies are needed to ascertain possible reciprocal and interacting associations between language impairments, psychiatric comorbidities, and SI/SB. They could enable clinicians to better understand their patient’s specific suffering, as brought on by language impairment, and contribute to the refining of suicide risk detection in this sub-group of affected patients.

While Parkinson's Disease (PD) impacts the production of prosody and may lead to dysprosody, its effect on the perception of prosody is less clear. In the current study, we investigated how people with PD (PwPD) segment continuous speech using prosodic cues. We used phonemically identical and prosodically different sequences in French. Twenty-three PwPD and 30 controls took part in the study. PwPD showed similar performance to controls (mean difference in terms of correct responses = 2%, 95% confidence interval = [-4%; 8%]). Using Bayesian statistics, our data is 3.6 times more in favour of the null model compared to the alternative model (i.e. difference between PwPD and controls). It thus seems unlikely that PD impacts the perception of prosody systematically. Furthermore, the cognitive performance of PwPD predicted their performance in our segmentation task. This suggests interesting pathways for future research on the mechanisms underlying the impact of PD on speech processing. Clinically, our findings suggest that adequate evaluation of the cognitive capacity of PwPD would help speech and language therapists in assessing speech processing skills in PwPD and in managing their speech impairments.

Purpose Speech in persons who stutter (PWS) is associated with disturbed prosody (speech melody and intonation), which may impact communication. The neural correlates of PWS’ altered prosody during speaking are not known, neither is how a speech-restructuring therapy affects prosody at both a behavioral and a cerebral level. Methods In this fMRI study, we explored group differences in brain activation associated with the production of different kinds of prosody in 13 male adults who stutter (AWS) before, directly after, and at least 1 year after an effective intensive fluency-shaping treatment, in 13 typically fluent-speaking control participants (CP), and in 13 males who had spontaneously recovered from stuttering during adulthood (RAWS), while sentences were read aloud with ‘neutral’, instructed emotional (happy), and linguistically driven (questioning) prosody. These activations were related to speech production acoustics. Results During pre-treatment prosody generation, the pars orbitalis of the left inferior frontal gyrus and the left anterior insula were activated less in AWS than in CP. The degree of hypo-activation correlated with acoustic measures of dysprosody. Paralleling the near-normalization of free speech melody following fluency-shaping therapy, AWS normalized the inferior frontal hypo-activation, sooner after treatment for generating emotional than linguistic prosody. Unassisted recovery was associated with an additional recruitment of cerebellar resources. Conclusions Fluency shaping therapy may restructure prosody, which approaches that of typically fluent-speaking people. Such a process may benefit from additional training of instructed emotional and linguistic prosody by inducing plasticity in the inferior frontal region which has developed abnormally during childhood in PWS.

A 74-year-old woman presented with a 5-year history of progressive gait instability with recurrent falls, dysphonia, dysphagia, and sleep problems, which included insomnia, breathing difficulties, and complex vocalizations during sleep (talking, singing, laughing). Examination showed bilateral ptosis, upward gaze palsy, hoarseness, dysprosody, and gait instability (video 1). No parkinsonism, chorea, or dementia was detected.

Parkinson's disease is characterized not only by bradykinesia, rigidity, and tremor, but also by impairments of expressive and receptive linguistic prosody. The facilitating effect of music with a salient beat on patients' gait suggests that it might have a similar effect on vocal behavior, however it is currently unknown whether singing is affected by the disease. In the present study, fifteen Parkinson patients were compared with fifteen healthy controls during the singing of familiar melodies and improvised melodic continuations. While patients' speech could reliably be distinguished from that of healthy controls matched for age and gender, purely on the basis of aural perception, no significant differences in singing were observed, either in pitch, pitch range, pitch variability, and tempo, or in scale tone distribution, interval size or interval variability. The apparent dissociation of speech and singing in Parkinson's disease suggests that music could be used to facilitate expressive linguistic prosody. (C) 2016 The Authors. Published by Elsevier Inc.

Background Speech disorder is a common manifestation of Parkinson's disease with two main symptoms, dysprosody and dysphonia. Previous research studying objective measures of speech symptoms involved patients and examiners who were native language speakers. Measures such as cepstral separation difference (CSD) features to quantify dysphonia and dysprosody accurately distinguish the severity of speech impairment. Importantly CSD, together with other speech features, including Mel-frequency coefficients, fundamental-frequency variation, and spectral dynamics, characterize speech intelligibility in PD. However, non-native language speakers transfer phonological rules of their mother language that tamper speech assessment. Objectives This paper explores CSD's capability: first, to quantify dysprosody and dysphonia of non-native language speakers, Parkinson patients and controls, and secondly, to characterize the severity of speech impairment when Parkinson's dysprosody accompanies non-native linguistic dysprosody. Methods CSD features were extracted from 168 speech samples recorded from 19 healthy controls, 15 rehabilitated and 23 not-rehabilitated Parkinson patients in three different clinical speech tests based on Unified Parkinson's disease rating scale motor-speech examination. Statistical analyses were performed to compare groups using analysis of variance, intraclass correlation, and Guttman correlation coefficient µ2. Random forests were trained to classify the severity of speech impairment using CSD and the other speech features. Feature importance in classification was determined using permutation importance score. Results Results showed that the CSD feature describing dysphonia was uninfluenced by non-native accents, strongly correlated with the clinical examination (µ2>0.5), and significantly discriminated between the healthy, rehabilitated, and not-rehabilitated patient groups based on the severity of speech symptoms. However, the feature describing dysprosody did not correlate with the clinical examination but significantly distinguished the groups. The classification model based on random forests and selected features characterized the severity of speech impairment of non-native language speakers with high accuracy. Importantly, the permutation importance score of the CSD feature representing dysphonia was the highest compared to other features. Results showed a strong negative correlation (µ2 L -dopa administration and the CSD features. Conclusions Although non-native accents reduce speech intelligibility, the CSD features can accurately characterize speech impairment, which is not always possible in the clinical examination. Findings support using CSD for monitoring Parkinson's disease.

This study investigates the acoustic correlates of prosody and vowel articulation in Dutch individuals with Parkinson’s Disease (PD). We compared prosodic and segmental acoustic measures in spontaneous monologues in PD patients to those in elderly healthy controls matched for age and gender. For the prosodic measurements of pitch variability, span and speech rate, we analysed fundamental frequency and intensity. For articulation measurements, the first two formants were calculated from Dutch corner vowels extracted from the speech signal. Results show a monopitch trend, reduced speech rate, centralization of the formant frequencies and reduced first formant variability in individuals with PD compared to control group.

This study investigates the acoustic correlates of prosody and vowel articulation in Dutch individuals with Parkinson’s Disease (PD). We compared prosodic and segmental acoustic measures in spontaneous monologues in PD patients to those in elderly healthy controls matched for age and gender. For the prosodic measurements of pitch variability, span and speech rate, we analysed fundamental frequency and intensity. For articulation measurements, the first two formants were calculated from Dutch corner vowels extracted from the speech signal. Results show a monopitch trend, reduced speech rate, centralization of the formant frequencies and reduced first formant variability in individuals with PD compared to control group.

This study investigates the acoustic correlates of prosody and vowel articulation in Dutch individuals with Parkinson’s Disease (PD). We compared prosodic and segmental acoustic measures in spontaneous monologues in PD patients to those in elderly healthy controls matched for age and gender. For the prosodic measurements of pitch variability, span and speech rate, we analysed fundamental frequency and intensity. For articulation measurements, the first two formants were calculated from Dutch corner vowels extracted from the speech signal. Results show a monopitch trend, reduced speech rate, centralization of the formant frequencies and reduced first formant variability in individuals with PD compared to control group.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. "Background: Parkinson’s disease (PD) patients are affected by hypokinetic dysarthria, characterized by hypophonia and dysprosody, which worsens with disease progression. Levodopa’s (l-dopa) effect on quality of speech is inconclusive; no data are currently available for late-stage PD (LSPD). Objective: To assess the modifications of speech and voice in LSPD following an acute l-dopa challenge. Method: LSPD patients [Schwab and England score 3 (MED ON)] performed several vocal tasks before and after an acute l-dopa challenge. The following was assessed: respiratory support for speech, voice quality, stability and variability, speech rate, and motor performance (MDS-UPDRS-III). All voice samples were recorded and analyzed by a speech and language therapist blinded to patients’ therapeutic condition using Praat 5.1 software. Results: 24/27 (14 men) LSPD patients succeeded in performing voice tasks. Median age and disease duration of patients were 79 [IQR: 71.5–81.7] and 14.5 [IQR: 11–15.7] years, respectively. In MED OFF, respiratory breath support and pitch break time of LSPD patients were worse than the normative values of non-parkinsonian. A correlation was found between disease duration and voice quality (R = 0.51; p = 0.013) and speech rate (R = −0.55; p = 0.008). l-Dopa significantly improved MDS-UPDRS-III score (20%), with no effect on speech as assessed by clinical rating scales and automated analysis. Conclusion: Speech is severely affected in LSPD. Although l-dopa had some effect on motor performance, including axial signs, speech and voice did not improve. The applicability and efficacy of non-pharmacological treatment for speech impairment should be considered for speech disorder management in PD." info:eu-repo/semantics/publishedVersion

Up to 90 % of patients with Parkinson's disease (PD) suffer from hypokinetic dysarthria (HD). In this work, we analysed the power of conventional speech features quantifying imprecise articulation, dysprosody, speech dysfluency and speech quality deterioration extracted from a specialized poem recitation task to discriminate dysarthric and healthy speech. For this purpose, 152 speakers (53 healthy speakers, 99 PD patients) were examined. Only mildly strong correlation between speech features and clinical status of the speakers was observed. In the case of univariate classification analysis, sensitivity of 62.63% (imprecise articulation), 61.62% (dysprosody), 71.72% (speech dysfluency) and 59.60% (speech quality deterioration) was achieved. Multivariate classification analysis improved the classification performance. Sensitivity of 83.42% using only two features describing imprecise articulation and speech quality deterioration in HD was achieved. We showed the promising potential of the selected speech features and especially the use of poem recitation task to quantify and identify HD in PD.

Cross-linguistic studies aim at determining the similarities and differences in speech production by uncovering linguistic adaptations to specific constraints and environments. In the field of motor speech disorders, such a crosslanguage approach could be of great interest to understand not only the deficits of speech production that are induced by the pathology, but also the difficulties that are induced by the linguistic constraints specific to the patients’ language. From a more clinical point of view, cross-linguistic studies should specifically focus on the relationship between speech disorders and speech intelligibility. The aim of this opinion article is to identify the currently scarce theoretical and clinical avenues for cross-linguistic studies of dysarthria in Parkinson’s disease, and to establish guidelines that would lead future research in this direction. In turn, the practical and behavioral management of dysarthria in Parkinson’s disease has so far only focused on the ‘universal’ dimensions of speech production and feedback (e.g., treatment of loudness and dysprosody). Such approaches could benefit immensely from proper recommendations that would be more ‘language-driven’ and individually adapted to the patients’ language environment. An additional factor to consider for a better understanding and treatment of dysarthria in PD is the role of adjustment and cultural identity. info:eu-repo/semantics/publishedVersion

医学部神経内科学教室 内山真一郎教授退任記念特別号

Maria Shoaib,1 Muhammad Taimoor Khan2 1Department of Medicine, Dow Medical College, Karachi, Pakistan; 2Department of Neurology, Charleston Area Medical Center/West Virginia University, Charleston, WV, USAWe read this article, “Altered emotional recognition and expression in patients with Parkinson’s disease” by Jin et al1 with great interest and appreciate the novel information provided on altered emotional processing in pre-deep brain stimulation (DBS) Parkinson’s disease (PD) patients and we would like to add our feedback on the role of DBS on nonmotor and emotional components of PD.View the original paper byJinand colleagues.&nbsp

Introduction Individuals with Parkinson9s disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). Methods and analysis Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. Ethics and dissemination The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. Trial registration number NCT02753192, Pre-results.

Much of the recent emphasis on prosody (the melody and rhythm of speech) and its disorders (dysprosody) has been on cognitive-affective functions attributed to cortical areas of the right cerebral hemisphere, with little further behavioral or neuroanatomical specification. This focus is inappropriately narrow both from the perspectives of neuropathogenesis and neurobehavioral phenomenology, and it is based on a limited view of prosody. Current models of brain organization for prosody propose lateralized representation based on functional (affective vs. linguistic) or featural (timing vs. pitch) properties of prosodic material. However, a role for subcortical structures in prosody is being increasingly described, and prosodic functions are now known to span a broad range in communication. In this article we describe normal prosody and present an overview of neurobehavioral disorders associated with acquired adult dysprosody. From these considerations we propose a neurobehavior-based approach to a more effective study of prosodic disturbance, and eventually, to better insight into normal prosody.

According to the functional lateralization hypothesis (FLH) the lateralization of speech prosody depends both on its function (linguistic = left, emotional = right) and on the size of the units it operates on (small = left, large = right). In consequence, according to the FLH, lexical stress should be processed by the left (language-dominant) hemisphere, given its linguistic function and small unit size.We performed an exhaustive search for case studies of patients with acquired dysprosody due to unilateral brain damage. In contrast to previous reviews we only regarded dysprosody at the lexical level (excluding phrasal stress). Moreover, we focused on the representational stage of lexical stress processing, excluding more peripheral perceptual or motor deficits.Applying these criteria, we included nine studies reporting on eleven patients. All of these patients showed representational deficits in word stress processing following a lesion in their language-dominant hemisphere. In nine out of eleven patients, it was the left hemisphere which was affected. This is a much more consistent pattern as found in previous reviews, in which less rigorous inclusion criteria may have blurred the pattern of results.We conclude that the representation of lexical stress crucially relies on the functioning of the language-dominant (mostly left) hemisphere.

Objectives—Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status. Methods—Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence “Je m’en vais samedi matin” (I am leaving saturday morning) under six diVerent prosodic intonations (neutral, aYrmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA). Results—Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data. Conclusions—Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output. (J Neurol Neurosurg Psychiatry 1998;64:482‐485)

International audience; We present a study where we examined the influence of a regional accent in the perception of voice and/or speech disorders. These aspects are most of the time overshadowed in clinical context. This protocol, involving multiple sources of speech variations, is also interesting in perception theories. For the experiment, speakers with or without a Southern French accent and with or without speech/voice disorders were recorded on reading a text. The samples were then randomly played back to two groups of listeners (familiar vs non familiar with the regional accent), specialists in speech therapy. The task was the perceptual evaluation of voice quality, articulation disorders and dysprosody. We focused in this paper on the voice dimension. The main results on this part concern the weak influence of regional accent on the perception of moderate or severe dysphonia, where the speech signal is strongly disturbed by the disorder. By contrast, the effect of regional accent is important on normal voices perception: listeners non familiar with the regional accent judge speakers with accent without voice disorder as slightly dysphonic. This last result can be interpreted as a form of perceptual interference between different dimensions of speech variations around a central position.

Although advances have been made regarding how the brain perceives emotional prosody, the neural bases involved in the generation of affective prosody remain unclear and debated. Two models have been forged on the basis of clinical observations: a first model proposes that the right hemisphere sustains production and comprehension of emotional prosody, while a second model proposes that emotional prosody relies heavily on basal ganglia. Here, we tested their predictions in two functional magnetic resonance imaging experiments that used a cue-target paradigm, which allows distinguishing affective from sensorimotor aspects of emotional prosody generation. Both experiments show that when participants prepare for emotional prosody, bilateral ventral striatum is specifically activated and connected to temporal poles and anterior insula, regions in which lesions frequently cause dysprosody. The bilateral dorsal striatum is more sensitive to cognitive and motor aspects of emotional prosody preparation and production and is more strongly connected to the sensorimotor speech network compared with the ventral striatum. Right lateralization during increased prosodic processing is confined to the posterior superior temporal sulcus, a region previously associated with perception of emotional prosody. Our data thus provide physiological evidence supporting both models and suggest that bilateral basal ganglia are involved in modulating motor behavior as a function of affective state. Right lateralization of cortical regions mobilized for prosody control could point to efficient processing of slowly changing acoustic speech parameters in the ventral stream and thus identify sensorimotor processing as an important factor contributing to right lateralization of prosody.

Behavioral, acoustic, and imaging data on two patients with dysprosodic speech following basal ganglia strokes led to a new account of some forms of acquired dysprosody. Both patients displayed neutral facial expression, reduction in facial gestures, monotone vocal expression, and mood changes (apathy and irritability, respectively). Comparison with premorbid speech samples confirmed postmorbid changes in intonation variability and verbal expressiveness. Evaluation of affective speech prosody using listeners' rating tasks as well as acoustic analyses indicated significant differences in repetition over spontaneous production, indicating little or no role of motor or cognitive programming in dysprosodic output. Subcortical damage differentially affecting frontosubcortical circuits involved in modulating motivation (apathy) and mood (irritability) may also account for changes in speech prosody.

While the left hemisphere is important for semantic and grammatical language, the right hemisphere appears to be important for prosody.

It has been suggested that the non-dominant hemisphere is specialized for receptive and expressive music and prosody. The present report describes a patient who experienced a series of non-dominant hemisphere transient ischemic attacks (TIA's) which included an inability to perceive intonation during one episode, and a failure to perceive melody during another. The perceptual losses during these TIA's are consistent with experimental results which suggest that the non-dominant hemisphere is specialized for complex-pitch processing. In some instances, amusia, dysprosody, and aprosodia reflect a common functional deficit.

Prosodic features in the speech production of 21 patients with idiopathic Parkinson's disease were tested. The appreciation of vocal and facial expression was also examined in the same patients. Significant intergroup differences were found in the prosody production tasks but, in contrast to previous results, not in the receptive tasks on the recognition and appreciation of prosody and of facial expression. The discrepancy between the production and recognition of prosodic features does not support the suggestion that dysprosody in Parkinson's disease is necessarily a disorder of processing emotional information that could be misinterpreted as a dysarthria.

Summary The obvious differences in verbal output of individual aphasics has been noted and an attempt made to evaluate these differences. In order to accomplish this a set of variable characteristics of aphasic speech was described. There were ten such features; rate of speaking, prosody, pronunciation, phrase length, effort, pauses, press of speech, perseveration, word use and paraphasia. It was noted that certain of these characteristics occurred together naturally so that two distinct clusters of clinical features were outlined. 100 aphasic patients were then studied, each of the characteristics being rated separately and it was found that the majority of patients (64%) readily fell into one of the two groups. Correlation of these two clinical groups with the underlying anatomical lesion was obtained through use of radioisotope brain scan results. Almost without exception the lesion producing one cluster of characteristics was located anterior to the Fissure of Rolando while the other cluster had a posterior lesion. The cluster with the anterior lesion had speech characterized by low verbal output, dysprosody, dysarthria, considerable effort and predominant use of substantive words while the posterior group were normal or near normal in all these features but often had paraphasia, press of speech and a distinct lack of substantive words. Thus it was felt that an anterior or posterior localization could be realiably diagnosed in many cases of aphasia based solely on the characteristics of verbal output. Several significant exceptions to this simple clinical observation were noted.