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Biomedical subjects

J A Logemann

Publications and source records attributed to J A Logemann.

At least 127 records · Page 7Linked to original sources
PubMed1986

Swallowing and speech production in Parkinson's disease.

Videofluoroscopy was used to examine movement patterns during swallowing and speech production in 6 parkinsonian subjects and 6 age-matched controls. Motility patterns for liquid and semisolid swallows were documented. We performed temporospatial analyses of oropharyngeal structures, particularly the velum, which is prominently involved in both motor speech production and swallowing. Differences were found between groups and conditions. All of the parkinsonian subjects exhibited abnormal oropharyngeal movement patterns and timing during the volitional oral as well as the pharyngeal stage of swallowing; only 50% of these subjects admitted to any swallowing difficulty upon questioning. Two of the subjects with Parkinson's disease aspirated liquids. Duration of velar movement during speech production significantly differentiated the groups (p less than 0.01), reflecting reduced range of velar motion. Our findings suggest that rigidity and bradykinesia underlie the volitional speech abnormality as well as the disordered oral and pharyngeal stages of swallowing. Findings indicate that parkinsonian patients may be "silent aspirators" with decreased cough reflexes and lack of awareness of aspiration. The clinical value of videofluoroscopic monitoring of swallowing is that aspiration may be detected and managed early.

Adult↗
PubMed1985

Swallowing disorders in persons with cerebrovascular accident.

Thirty-eight CVA patients with swallowing disorders were studied videofluorographically (VFG) to determine: (1) the nature of their swallowing disorders, (2) the relationship between the site of the cerebrovascular accident and the nature of the swallowing disorder(s) exhibited and (3) the frequency and etiology of any aspiration present. The 38 CVA patients exhibited a variety of physiologic disturbances in swallowing, usually occurring in combination rather than as isolated disorders. A delayed swallowing reflex was the most frequent disorder seen in all patient groups. Reduced pharyngeal peristalsis was the next most frequent disorder, followed by reduced tongue control. Only brainstem CVA patients exhibited reduced laryngeal closure. Two patients (no right CVAs) experienced cricopharyngeal dysfunction. Few differences in nature of swallowing disorders were seen according to lesion location. Approximately one third of the patients aspirated, most frequently because of delayed triggering of the swallowing reflex. All aspiration occurred because of disorders in the pharyngeal stage of the swallow, emphasizing the importance of VFG evaluation of dysphagia in CVA patients.

Adult↗
PubMed1982

Acoustic characteristics of voice production after Staffieri's surgical reconstructive procedure.

Selected phonatory variables for two laryngeal cancer patients were studied before and after total laryngectomy with reconstruction designed to restore phonation. Each subject performed five speaking tasks while simultaneous pneumographic and voice recordings were obtained. Measures of sound pressure level, fundamental frequency, vowel formant structure, frequency range, words per minute, maximum phonation time, and syllables per breath were compared pre- and post-operatively. Results indicate that for the post-surgical condition there was a reduction in intensity, frequency, and temporal measures for the two subjects studied. Results are analyzed and discussed in relation to variation within subjects and between subjects, and by comparison with the acoustic parameters of normal and esophageal talkers.

Aged↗
PubMed1982

Compensatory articulation patterns of a surgically treated oral cancer patient.

Acoustic, physiologic, and perceptual data on articulation of bilabial and alveolar stop consonants in CVC words spoken by a subject with a 20% glossectomy, 2/3-mandibulectomy and radical neck dissection, whose surgical closure was accomplished by suturing the tongue to the floor of the mouth and buccal mucosa are provided. Compensatory articulation patterns were identified from tracings of vocal tract shapes obtained by videofluoroscopy. Acoustic analysis was accomplished by means of computer-aided examination of the speech waveform. Compensatory postures for articulation of the stop consonants were characterized by varying degrees of labial protrusion and retraction, dependent on the vowel context. Distinction between the bilabial and tip-alveolar consonants was evidenced in lingual-velar closure vs. lingual-velar-palatal closure. These compensatory patterns are discussed in relation to the acoustic properties of the corresponding speech sounds obtained from synthetic speech samples and in relation to perceptual data obtained from trained listeners.

Glossectomy↗
PubMed1981

Vocal tract control in Parkinson's disease: phonetic feature analysis of misarticulations.

Consonant articulation patterns of 200 Parkinson patients were defined by two expert listeners from high fidelity tape recordings of the sentence version of the Fisher-Logemann Test of Articulation Competence (1971). Phonetic transcription and phonetic feature analysis were the methodologies used. Of the 200 patients, 90 (45%) exhibited some misarticulations. Phonetic data on these 90 dysarthric Parkinson patients revealed articulatory errors highly consistent in detailed production characteristics. Manner changes predominated. Phoneme classes that were most affected were the stop-plosives, affricates, and fricatives. In terms of perception features (Chomsky & Halle, 1968), the stop-plosives and affricates, which are normally [-continuant] were produced as [+continuant] fricatives; fricatives that are [+strident] were produced as [-strident]. There is no implication, however, that Parkinsonism involves a perception deficit. Analysis of the articulatory deficit reveals inadequate tongue elevation to achieve complete closure on stop-plosives and affricates, which can be expressed in production features as a change from [+stop] to [+fricative]. There was also inadequate close constriction of the airway in lingual fricatives, which in articulatory features can be expressed as a change from [+fricative] to [-fricative]. Both the incomplete contact for stops and the partial constriction for fricatives represent an inadequate narrowing of the vocal tract at the point of articulation. These results are discussed in relation to recent EMG studies and other physiologic examinations of Parkinsonian dysarthria.

Electromyography↗
PubMed1979

Swallowing disorders in three types of head and neck surgical patients.

This study examined swallowing transit times and motility problems in three groups of patients following ablative surgery for oropharyngeal carcinoma and in a control group of 10 normal subjects. A total of 30 patients was studied: 10 after anterior floor of mouth resection, 12 after tonsil/base of tongue resection, and 8 after supraglottic laryngectomy. Videofluoroscopic studies of liquid, thin paste, thick paste, and thick paste plus liquid swallows were completed 1 week post-initiation of oral feeding following surgery. From the videotapes, oral and pharyngeal transit times were measured, and motility disturbances were defined during each stage of the swallow. All three types of patients in this study showed severe problems with swallowing. The anterior floor of mouth resection patients had problems with preparation for the swallow and oral transit. Tonsil/base of tongue resection patients had slowing in the preparation for the swallow and in the oral and pharyngeal stages. After supraglottic laryngectomy, patients showed only slight slowing in oral transit and pharyngeal transit as compared to other types of surgical patients.

Adult↗
PubMed1978

Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients.

In this study, the frequency of occurrence of speech and voice symptoms in 200 Parkinson patients was defined by two expert listeners from high-fidelity tape recordings of conversational speech samples and readings of the sentence version of the Fisher-Logemann Test of Articulation Competence. Specific phonemes that were misarticulated were catalogued. Other vocal-tract dysfunctions, including laryngeal disorders, rate disorders, and hypernasality, were also recorded. Cooccurrence of symptoms in each patient was tabulated. Examination of the patterns of cooccurring dysfunctions permitted classifying the 200 patients into five groups: Group 1 (45% of the patients) with laryngeal dysfunction as their only vocal-tract symptom; Group 2 (13.5% of the patients) with laryngeal and back-tongue involvement; Group 3 (17% of the patients) with laryngeal, back-tongue, and tongue-blade dysfunction; Group 4 (5.5% of the patients) with laryngeal dysfunction, back-tongue involvement, tongue-blade dysfunction, and labial misarticulations; and Group 5 (9% of the patients) with laryngeal dysfunction and misarticulations of the back tongue, tongue blade, lips, and tongue tip. Disfluencies and hypernasality did not follow a systematic pattern of cooccurrence with other vocal-tract dysfunctions.

Humans↗
PubMed1977

Speech and swallowing evaluation in the differential diagnosis of neurologic disease.

Examination of the speech mechanism (the vocal tract) frequently provides information about certain neurologic lesions. The speech, swallowing and respiratory patterns of patients with cerebellar, upper motor neuron, lower motor neuron and extra-pyramidal lesions (parkinsonism) were studied, 10 of each category. The patient's lingual, labial and velar movement was examined cineradiographically during production of four short speech samples and the oral, through esophageal structures, during chewing and swallowing. Videotape, with simultaneous voice recording, and 16 mm. film were used. Oral, pharyngeal and esophageal transit times during swallowing were determined. These quantified tests reveal distinctive differences in vocal tract physiology between patient groups. The specific physiologic patterns characteristic of each neurological lesion were discussed and illustrated with films. Each patient group in this study exhibited a distinctive profile distinguishing it from every other. The results also indicate that if only a portion of these studies was completed, the disorder might be erroneously classified. The findings emphasize the need for complete and detailed physiologic studies of the speech and swallowing of patients with neurologic lesions, as an aid to accurate diagnosis.

Brain Diseases↗
PubMed1975

Voice rehabilitation after laryngectomy. Results with the use of a hypopharyngeal prosthesis.

The Northwestern voice prosthesis for laryngectomees is described. The prosthesis contains no vibrator but activates vibration of the patient's pharyngeal or upper esophageal tissue by transporting air from the tracheostoma to a fistula in the upper neck, well away from major blood vessels. The prosthesis fits directly onto the laryngectomy tube and allows the patient to breathe, speak, and cough without any manual adjustments. The important advantage of this prosthesis is the fistula location. It can be placed at the time of original surgery and is also workable in patients who have had radiation and extensive radical surgery with total reconstruction of their gullet. The prosthesis can be used by primary total laryngectomees while learning esophageal speech or installed in those who are unable to use the electronic larynx or to learn esophageal speech. Four case studies are presented.

Adult↗
PubMed1975

Comparison of speech and swallowing function in patients with tremor disorders and in normal geriatric patients: a cinefluorographic study.

In a study of vocal tract and esophageal function during speech and swallowing, unmedicated Parkinson patients were found to have specific disorders in oral and esophageal stages of deglutition and a predictable sequence of deterioration in speech. To determine whether these disorders are exclusive to parkinsonism or are typical of all patients with tremor or of geriatric patients in general, a cinefluoroscopic study was initiated to examine the physiology of speech and swallowing in these other patients. Subjects were 10 normal geriatric patients and 10 patients with essential tremor. Results of the studies for these two groups were compared with data from earlier studies on unmedicated Parkinson patients. Parkinson patients showed most severely disordered swallowing and speech function. Patients with essential tremor showed only slight slowing in esophageal transit during swallowing and vocal tremor during speech, but no progressive deterioration. Normal geriatric patients revealed no swallowing or speech disturbances.

Age Factors↗
PubMed1975

Rehabilitation after laryngectomy with a hypopharyngeal voice prosthesis.

The northwestern laryngeal voice prosthesis contains no vibrator, but produces good voice by means of a properly placed pharyngostomy. The quality of voice production is such that patients have been able to resume former occupations, i.e., teaching and coaching football. The significant difference and advantage of this prosthesis when compared with similar ones to the fistula location. The location in the hypopharynx is in a surgically safe area distant from major vessels. It can be placed at the time of original surgery and is also workable in patients who have had radiation and extensive radical surgery with total reconstruction of their gullet. The prosthesis can be used by primary total laryngectomees while learning esophageal speech or installed in those who are unable to use the electronic larynx or esophageal speech.

Aged↗
PubMedDate not supplied

Longitudinal assessment of quality of life in laryngeal cancer patients.

BACKGROUND: Although quality of life (QL) and performance status are important outcomes in head and neck (HN) cancer, there is little systematic inclusion of these parameters in treatment trials. METHODS: Rate and recovery of function were evaluated over a 6-month period in 21 laryngeal cancer patients, 7 in each of 3 treatment groups: total laryngectomy (group 1), hemilaryngectomy (group 2), and radiotherapy only (group 3). Assessment included Performance Status Scale for Head and Neck Cancer Patients (PSS-HN: Diet, Speech, and Eating in Public subscales) and the FACT-HN, a multidimensional QL measure. RESULTS: Groups differed in patterns of performance recovery over time in expected directions. Group 1 recovered most slowly, without achieving normal functioning by 6 months; most of group 2 returned to normal functioning by 3 months; group 3 showed little overall dysfunction. There was no difference in overall QL between groups or over time. Performance status was significantly correlated with the FACT head and neck subscale and somewhat with the Physical subscale. In contrast, ability to eat and/or speak was not associated with overall QL nor with any other specific QL dimension (eg, emotional or social well-being). CONCLUSIONS: Results support the sensitivity and applicability of two site-specific performance/QL measures: PSS-HN and FACT-HN. Findings also emphasize the need to employ multidimensional tools to adequately evaluate the nonmedical outcomes in head and neck patients.

Aged↗