Subcortical Effects on Voice and Fluency in Dysarthria: Observations from Subthalamic Nucleus Stimulation

Diana Sidtis, John J Sidtis, Diana Sidtis, John J Sidtis

Abstract

Objective: Parkinson's disease (PD), caused by basal ganglia dysfunction, is associated with motor disturbances including dysarthria. Stimulation of the subthalamic nucleus, a preferred treatment targeting basal ganglia function, improves features of the motor disorder, but has uncertain effects on speech.We studied speech during contrasting stimulation states to reveal subcortical effects on voice and articulation. Measures were made on selected samples of spontaneous and repeated speech.

Methods: Persons with Parkinson's disease (PWP) who had undergone bilateral deep brain stimulation of the subthalamic nucleus (DBS-STN) provided spontaneous speech samples and then repeated portions of their monologue both on and off stimulation. Excerpts were presented in a listening protocol probing intelligibility. Also analysed were a continuous phrase repetition task and a second spontaneous speech sample. Fundamental frequency (F0), harmonic-to-noise ratio (HNR), jitter, shimmer and fluency were measured in these three speech samples performed with DBS stimulation on and off.

Results: During subcortical stimulation, spontaneous excerpts were less intelligible than repeated excerpts. F0 and HNR were higher and shimmer was decreased in repetition and stimulation. Articulatory dysfluencies were increased for spontaneous speech and during stimulation in all three speech samples.

Conclusion: Deep brain stimulation disrupts fluency and improves voice in spontaneous speech, reflecting an inverse influence of subcortical systems on articulatory posturing and laryngeal mechanisms. Better voice and less dysfluency in repetition may occur because an external model reduces the speech planning burden, as seen for gait and arm reach. These orthogonal results for fluency versus phonatory competence may account for ambivalent reports from dysarthric speakers and reveal the complexity of subcortical control of motor speech.

Keywords: Acoustic measures; Basal ganglia; Deep brain stimulation; External vs. internal models for motor behaviors; Parkinsonian dysarthria; Speech intelligibility; Speech task.

Figures

Figure 1
Figure 1
Percentage of words correctly transcribed by listeners for both stimulation states, on and off, in conversation and repetition modes in the first speech sample.
Figure 2
Figure 2
Harmonic to noise ratios in deep brain stimulation on and off for two tasks, conversation and repetition, for both stimulation states, on and off, in conversation and repetition modes in the first speech sample.
Figure 3
Figure 3
Shimmer measures in deep brain stimulation on and off for two tasks, conversation and repetition, in the first speech sample.
Figure 4
Figure 4
Mean F0 in two stimulation states, on and off, in continuous phrase repetition and the second conversational sample.
Figure 5
Figure 5
The number of motor speech errors in three categories during the continuous repetition of the sentence /pop the top cop/. The categories were dysfluency (e.g. repetition of a phone or word), sound omission and word omission.
Figure 6
Figure 6
Shimmer values during two stimulation states, on and off, for continuous phrase repetition task and the second conversational sample.

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