This study analyzed speech outcomes in 20 patients who underwent hemiglossectomy for tongue cancer and reconstruction using a radial forearm free flap. The study aimed to evaluate the feasibility of using telemedicine for clinical research during COVID-19 and to analyze factors influencing postoperative speech outcomes. Patients completed speech evaluations remotely with speech language pathologists, assessing range of motion, speech clarity, articulation rate, and a speech handicap questionnaire. Early tumor stage, no radiation therapy, and base of tongue cancer were associated with better speech outcomes, particularly range of motion and clarity. Telemedicine was found to be an effective platform for conducting this clinical research during the pandemic.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract this deficit and provide topic-related researchers with a better basis for decision-making, we present, based on a literature review, favourable speech characteristics for the appliance toward AD detection via ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and points out that the combined use of acoustic, linguistic, and demographic features positively influences recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic features.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart
from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the
disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD
manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a
promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract
this deficit and provide topic-related researchers with a better basis for decision-making, we present,
based on a literature review, favourable speech characteristics for the appliance toward AD detection via
ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and
points out that the combined use of acoustic, linguistic, and demographic features positively influences
recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic
features.
Deaf Speech Assessment Using Digital Processing Techniquessipij
This paper mainly deals with analysis on acoustical characteristics of speeches of deaf people for the purpose of increasing the speech recognition rate. Since speech to text or sound system for a normal
speaker is available, by designing a speech to text or sound system for deaf, they can make use of all computer aided devices and normal speakers can also communicate with them freely. Fundamental frequency or the pitch frequency of the vocal fold and resonant frequency of the vocal tract or formants are considered for analysis which are the foremost characteristics of speech. Compared to normal speech, there is a high variability in deaf speech and by hearing once we couldn’t understand it. Deaf speech is taken from children in the age group of 5-10 years from Maharishi vidya mandir centre for hearing impaired. Another set of speech were taken from normal speakers for comparison. Initially the input is sampled, filtered, windowed and Pitch frequency is determined for each frame. Similarly first six formants are determined for each frame. The fundamental frequency contour of deaf children exhibit unusual characteristics, and the formants are also very closed. This shows that, pitch and formants cannot be used as features for deaf speech recognition. At the same time, variation in the pitch and formants for deaf is larger than normal speakers it can be used for speaker classification purpose.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract this deficit and provide topic-related researchers with a better basis for decision-making, we present, based on a literature review, favourable speech characteristics for the appliance toward AD detection via ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and points out that the combined use of acoustic, linguistic, and demographic features positively influences recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic features.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart
from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the
disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD
manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a
promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract
this deficit and provide topic-related researchers with a better basis for decision-making, we present,
based on a literature review, favourable speech characteristics for the appliance toward AD detection via
ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and
points out that the combined use of acoustic, linguistic, and demographic features positively influences
recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic
features.
Deaf Speech Assessment Using Digital Processing Techniquessipij
This paper mainly deals with analysis on acoustical characteristics of speeches of deaf people for the purpose of increasing the speech recognition rate. Since speech to text or sound system for a normal
speaker is available, by designing a speech to text or sound system for deaf, they can make use of all computer aided devices and normal speakers can also communicate with them freely. Fundamental frequency or the pitch frequency of the vocal fold and resonant frequency of the vocal tract or formants are considered for analysis which are the foremost characteristics of speech. Compared to normal speech, there is a high variability in deaf speech and by hearing once we couldn’t understand it. Deaf speech is taken from children in the age group of 5-10 years from Maharishi vidya mandir centre for hearing impaired. Another set of speech were taken from normal speakers for comparison. Initially the input is sampled, filtered, windowed and Pitch frequency is determined for each frame. Similarly first six formants are determined for each frame. The fundamental frequency contour of deaf children exhibit unusual characteristics, and the formants are also very closed. This shows that, pitch and formants cannot be used as features for deaf speech recognition. At the same time, variation in the pitch and formants for deaf is larger than normal speakers it can be used for speaker classification purpose.
The current study was conducted for children with CP who are Hindi speakers, to analyze voice onset time (VOT) patterns associated with stop consonants. The purpose was to gain more detailed insights into how the coordination and timing needed for these articulations may be affected by the neurodevelopmental disorder ultimately opening up avenues for improved treatment solutions. Total 20 children in the age group of 6 - 8 years were taken for the study which was divided into two groups: 10 children diagnosed with spastic CP and 10 typical children speaking Hindi. Measuring VOT through voice analysis helped us gauge the interval lapsing between releasing a stop closure and voicing onset. The outcomes exhibited considerable variation in VOT values when comparing groups of children with cerebral palsy (CP) against typical children speaking Hindi. Specifically, CP children showed longer VOT durations indicating delayed voicing onset compared to controls. These findings point out that children who have cerebral palsy exhibit different timing and coordination patterns upon pronouncing stop consonants. It is essential to grasp the VOT traits in children with cerebral palsy. This will aid in creating suitable intervention techniques that enhance their speech comprehensibility and communication skills.
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The current study was conducted for children with CP who are Hindi speakers, to analyze voice onset time (VOT) patterns associated with stop consonants. The purpose was to gain more detailed insights into how the coordination and timing needed for these articulations may be affected by the neurodevelopmental disorder ultimately opening up avenues for improved treatment solutions. Total 20 children in the age group of 6 - 8 years were taken for the study which was divided into two groups: 10 children diagnosed with spastic CP and 10 typical children speaking Hindi. Measuring VOT through voice analysis helped us gauge the interval lapsing between releasing a stop closure and voicing onset. The outcomes exhibited considerable variation in VOT values when comparing groups of children with cerebral palsy (CP) against typical children speaking Hindi. Specifically, CP children showed longer VOT durations indicating delayed voicing onset compared to controls. These findings point out that children who have cerebral palsy exhibit different timing and coordination patterns upon pronouncing stop consonants. It is essential to grasp the VOT traits in children with cerebral palsy. This will aid in creating suitable intervention techniques that enhance their speech comprehensibility and communication skills.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. yngology specifically, certain telehealth assessments have been
shown to allow for quicker examinations without compromising
the communication of crucial information from the patient to the
physician, or vice versa [4]. Otolaryngologists and speech-lan-
guage pathologists have rapidly adopted telemedicine to provide
adequate care to their patients.
Patients with advanced tongue cancer undergo glossectomy with
free flap reconstruction, with or without post-operative radiation
therapy [5-8]. One of the most common postoperative sequelae of
treatment of tongue cancer is dysarthria. Though reduced post-sur-
gical speech intelligibility has long been observed using clinical
assessments relying on impressionistic phonetic transcription and
acoustic measures, no study has systematically identified the ana-
tomical and physiological patterns that underlie the impairment of
lingual function that reduces speech intelligibility due to anatomic
disruption of the tongue [6, 9]. Because such patterns have not
been identified, the anatomical and physiological changes that give
rise to improved speech intelligibility over the course of rehabil-
itation also remain unknown. Speech plays a primary role in dai-
ly communication, and dysarthria greatly impacts Quality of Life
(QOL). Despite the prevalence of dysarthria in this patient popu-
lation, there are limited studies that evaluate their postoperative
speech outcomes using both objective and subjective measures
[10, 11]. Conducting such clinical research is more challenging
during the COVID pandemic due to limited in-person visits. The
goals of the current study are 1) to determine the feasibility of
conducting clinical research using telecare platform; 2) to analyze
speech outcomes in hemiglossectomy patients who underwent Ra-
dial Forearm Free Flap (RFFF) tongue reconstruction.
3. Materials and Methods
This is a prospective cohort study, with a total of 20 patients who
all underwent hemiglossectomy with primary tongue reconstruc-
tion using Radial Forearm Free Flap (RFFF). We implemented
this careful method of patient selection in order to minimize the
variability in speech outcomes that may be introduced with dif-
ferent types of glossectomy and/or flaps. Surgery was the primary
method of treatment for all participants, and each patient received
postoperative Speech-Language Pathologist (SLP) evaluation. All
participants, as well as respective family members (except one),
completed the Speech Handicap Index (SHI). Cohorts were based
on site of tongue resection (oral tongue, base of tongue, overlap-
ping sites), early versus late tumor stage (T1/2 vs T3/4), and pres-
ence of nodal spread (N0 or N+). All participants interacted with
two experienced speech-language pathologists (BV, MO). This
study was approved by the University of Southern California In-
stitutional Review Board.
3.1. Telemedicine SLP Evaluations
All patients received formal Speech-Language Pathologist (SLP)
evaluation through telemedicine appointments via the video-call
application Zoom, because in-person evaluations have been se-
verely limited during the COVID-19 pandemic. These SLP evalu-
ations consisted of objective measures of speech, including tongue
range of motion, speech clarity, and diadochokinetic rate, as de-
tailed below.
3.2. Tongue Range of Motion (ROM) Assessment Scale
Tongue ROM was assessed using the Tongue ROM Severity Rat-
ing Scale by Lazarus et al [12]. There are four sub-categories for
ROM: protrusion, left lateralization, right lateralization, and ele-
vation. The scores for protrusion and lateralization (left and right)
are as follows: 100 - normal, 50 - mild to moderately impaired, 25
- severely impaired, and 0 - totally impaired. The scores for eleva-
tion are: 100 - normal, 50 - moderately impaired, and 0 - severely
impaired. Total tongue ROM score was subsequently obtained by
calculating the mean of the four sub-category scores. Possible total
tongue ROM scores ranged from 0 to 100, with lower scores indi-
cating a greater degree of impairment to tongue range of motion.
3.3. Speech Clarity
Level of speech clarity was evaluated, both during conversation
and reading, based on ASHA National Outcomes Measurement
System (NOMS) guidelines for Spoken Language Expression and
for Reading, respectively [13]. Reading and conversation clarity
were graded from level 1 to 7, with increasing clarity. Please refer
to Supplementary Table S1 for detailed descriptions of each level.
Supplementary Table S1: ASHA National Outcomes Measurement System (NOMS) guidelines for Reading and for Spoken Language Expression
[13].
Level Reading Clarity
1 Attends to printed material, but does not recognize even single letters or common words
2 Reads single letters and common words with consistent maximal cueing
3
Reads single letters and common words, with consistent moderate cueing, and can read some words that are less familiar, longer, and more
complex
4
Reads words and phrases related to routine daily activities, and words that are less familiar, longer, and more complex; requires moderate
cueing to read sentences of approximately 5-7 words
5
Reads sentence-level material containing some complex words; occasionally requires minimal cueing to read more complex sentences and
paragraph-level material; occasionally uses compensatory strategies
6
Successfully able to read most material but some limitations are apparent in vocational, avocational, and social activities; rarely requires
minimal cueing to read complex material; reading is successful, but may take longer to read the material; usually uses compensatory
strategies when encountering difficulty
clinicsofoncology.com 2
Volume 4 Issue 3 -2021 Research Article
3. 7
Successfully and independently participates in vocational, avocational, and social activities and is not limited by reading skills;
independent functioning may occasionally include compensatory strategies
Level Conversation Clarity
1 Attempts to speak, but verbalizations are not meaningful to familiar or unfamiliar communication partners at any time
2
Attempts to speak, although few attempts are accurate or appropriate; partner must assume responsibility for structuring communication
exchange; with consistent and maximal cueing, the individual can only occasionally produce automatic and/or imitative words and phrases
that are rarely meaningful in context
3
Communication partner must assume responsibility for structuring communication exchange; with consistent and moderate cueing,
individual can produce words and phrases that are appropriate and meaningful in context
4
Successfully able to initiate communication using spoken language in simple, structured conversations in routine daily activities with
familiar partners; usually requires moderate cueing, but able to demonstrate simple sentences and rarely uses complex sentences/messages
5
Successfully able to initiate communication using spoken language in structured conversations with both familiar and unfamiliar partners;
occasionally requires minimal cueing to frame more complex sentences; occasionally self-cues when encountering difficulty;
6
Successfully able to communicate in most activities, but some limitations in spoken language are apparent in vocational, avocational, and
social activities; rarely requires minimal cueing to frame complex sentences; usually self-cues when encountering difficulty;
7
Successfully and independently participate in vocational, avocational, and social activities; not limited by spoken language skills;
independent functioning may occasionally include use of self-cueing
3.4. Diadochokinetic Rate
Diadochokinetic (DDK) rate measures the repetition rate of a set
of syllables. In our study, it was calculated by counting the number
of times the participant was able to repeat the syllables “/p/ /t/ /k/”
within a 15 second interval. DDK rate is considered a stable mea-
surement of maximum performance in speech evaluations [14].
3.5. Speech Handicap Index (SHI)
The SHI is a survey specifically designed to analyze speech in pa-
tients with oral or oropharyngeal cancer [15]. It is composed of
thirty questions that address patient speech function and how their
speech is perceived. Each question may be answered as never (0),
almost never (1), sometimes (2), almost always (3), and always
(4). The responses are added for a total score that ranges from 0
to 120. Total scores are categorized as follows: 0-29 excellent, 30-
69 good, 70-99 average, and 100-120 bad [10]. There are also 2
SHI subcategories: speech domain and psychosocial domain [10].
14 statements focused on the patients’ speech itself, and 14 oth-
er statements primarily assessed psychosocial problems related to
speech impairments.
Participants were asked to personally complete the SHI, sent to
them via email. They were also asked to distribute a separate SHI
to a close family member or friend in order to assess how others
perceive the participant’s speech function.
3.6. Statistical Analysis
Data analysis was performed using statistical software R v.3.6.3.
Because the data did not follow a normal distribution, non-para-
metric tests were used to compare patient subgroups as well as
patient and family SHI scores. Patient data on tongue range of
motion and speech clarity were analyzed using the Mann-Whit-
ney U-test (for comparison between two patient subgroups) and
the Kruskall-Wallis test (for comparing three or more subgroups).
In addition, the correlation between patients’ SHI speech domain
and psychosocial domain, and the correlation between patient total
SHI score and family total SHI score were assessed using Spear-
man’s rank correlation coefficient.
4. Results
4.1. Patient Population
There was a total of 20 participants included in this study, with a
mean (SD) age of 60 (+14) years (Table 1). The male to female
ratio was 1.5:1 and a majority was Caucasian (55%). The rest of
the patients were Hispanic (10%), Asian (5%), or Other (30%).
All patients grew up in Southern California and spoke English as
their primary language. Though all patients underwent hemiglos-
sectomy, varying anatomical sites of tongue were resected: 20%
of participants had only their Oral Tongue Cancer (OTC) resected,
30% had their Base of Tongue (BOT) resected, and 50% had Over-
lapping Sites (OLS) resected. More than half (55%) had radiation
therapy in the past and/or as part of their current cancer treatment.
A majority (65%) had T1/T2 disease, and the remainder (35%) had
T3/T4 disease. Most participants (60%) had no nodal spread. All
patients completed their cancer treatment 1-5 years ago.
Table 1: Patient Characteristics
Category No. (%)
Ethnicity
Caucasian 11 (55%)
African-American 0 (0%)
Hispanic/Latino 2 (10%)
Asian 1 (5%)
Other 6 (30%)
Age
Mean (SD) 60 (14) years
T stage
T1 8 (40%)
T2 5 (25%)
T3 6 (30%)
T4 1 (5%)
N stage
N0 12 (60%)
N1 3 (15%)
N2 4 (20%)
N3 1 (5%)
Site of Tongue Resection
Oral tongue 4 (20%)
Base of tongue 6 (30%)
Overlapping sites 10 (50%)
Radiation therapy (XRT)
Yes 11 (55%)
No 9 (45%)
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4. 4.2. Participation in Telecare Platform
All patients used the Zoom platform to communicate and be eval-
uated by SLPs.
4.3. Range of Motion
All 20 patients scored between 25 and 100 for each subcategory of
tongue range of motion (Table 2). Each subcategory had a varied
distribution of scores, except for tongue elevation, for which all 20
patients were able to elevate their tongue tip but without contact
with the upper alveolar ridge.
When analyzing ROM based on site of resection, OTC patients
experienced the most difficulty. When protruding the tongue, a
higher percentage of OTC patients (25%) could not reach past the
upper lip margin, compared to BOT (15%) and OLS (20%) pa-
tients. When lateralizing the tongue, half of the OTC and BOT
participants had >50% reduction; but there was one BOT patent
who was able to reach the corner of the mouth, a task that none of
the OTC participants were able to achieve.
Table 2: Results of Objective and Subjective Speech Outcome Measures
*statistically significant relationship
Speech Measure Patient Characteristic
Oral Tongue Base of Tongue Overlapping Sites of Tongue
Range of Motion
Protrusion 43.8 (12.5) 45.8 (10.2) 45.0 (10.5)
Lateralization 37.5 (14.4) 45.8 (29.2) 42.5 (12.1)
Elevation 50.0 (0.0) 50.0 (0.0) 50 (0.0)
Total 42.2 (9.4) 46.9 (15.7) 45.0 (8.2)
Clarity
Reading 6.5 (0.6) 6.2 (0.8) 5.9 (1.1)
Conversation 6.5 (0.6) 5.8 (1.0) 6.0 (1.1)
Diadochokinetic
Rate 26.8 (8.5) 24.2 (5.5) 22.9 (6.4)
Speech Handicap Index
Total 20.0 (8.04) 24.8 (20.9) 28.5 (19.7)
Speech Domain 11.8 (17.0) 13.0 (10.1) 15.3 (8.8)
Psychosocial Domain 7.0 (6.1) 9.1 (9.2) 11.2 (9.8)
T1/T2 T3/T4
Range of Motion
Protrusion 46.2 (9.4) 42.9 (12.2)
Lateralization* 48.1 (19.0) 32.1 (12.2)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 48.1 (10.9) 39.3 (7.8)
Clarity
Reading 6.2 (1.0) 6.0 (0.8)
Conversation 6.2 (0.9) 5.9 (1.1)
Diadochokinetic
Rate 24.8 (6.4) 22.7 (6.7)
Speech Handicap Index
Total* 20.9 (18.1) 34.5 (14.7)
Speech Domain 11.7 (8.3) 18.0 (6.5)
Psychosocial Domain 7.8 (8.9) 13.2 (8.0)
N0 N-positive
Range of Motion
Protrusion 43.8 (11.3) 46.9 (8.8)
Lateralization 45.8 (20.9) 37.5 (13.4)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 46.4 (12.3) 43.0 (7.8)
Clarity
Reading 5.9 (1.0) 6.4 (0.7)
Conversation 5.9 (0.9) 6.3 (1.0)
Diadochokinetic
Rate 24.4 (6.2) 23.5 (7.0)
Speech Handicap Index
Total 25.2 (20.4) 26.4 (14.6)
Speech Domain 13.6 (9.5) 14.3 (6.2)
Psychosocial Domain 7.8 (8.9) 13.2 (8.0)
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5. No XRT XRT
Range of Motion
Protrusion 44.4 (11.0) 45.5 (10.1)
Lateralization 50.0 (21.7) 36.4 (13.1)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 48.6 (12.8) 42.0 (8.0)
Clarity
Reading 6.3 (0.9) 5.9 (0.9)
Conversation 6.4 (0.7) 5.7 (1.0)
Diadochokinetic
Rate* 26.9 (5.9) 21.7 (6.0)
Speech Handicap Index
Total 23.2 (20.5) 27.7 (16.3)
Speech Domain 12.8 (9.3) 14.7 (7.4)
Psychosocial Domain 8.4 (9.7) 10.8 (8.2)
Patients with early T stage performed better than those with late T
stage across all range of motion subcategories, particularly during
tongue lateralization. Most (77%) early T stage participants were
able to lateralize their tongue to the corner of their mouths or had
<50% reduction in movement, whereas most (71%) late T stage
participants had >50% reduction in movement (p=0.03). Further-
more, those with no nodal spread performed better than those with
nodal spread during lateralization, though the association was not
as strong.
Patients who did not undergo XRT generally performed better than
those who received XRT. A larger percentage (55%) of patients
who received XRT had >50% reduction in lateralization, com-
pared to those who did not undergo XRT (22%).
4.4. Total ROM
OTC patients had the lowest mean total ROM score (42.2) com-
pared to BOT (46.9) and OLS patients (45.0) (p=0.87). Early T
stage and lack of nodal spread had a higher mean total ROM score
than those with late T stage (p=0.06) and nodal spread (p=0.6),
respectively. Additionally, participants who underwent XRT had a
lower mean total tongue ROM score (42.0) than those who did not
receive XRT (48.6) (p=0.22).
4.5. Diadochokinetic (DDK) Rate
OTC patients had slightly higher mean DDK rates (26.8) than
BOT (24.2) and OLS (22.9) patients (p=0.7). Those with early T
stage and no nodal invasion had higher DDK rates than those with
late T stage (p=0.5) and nodal invasion (p=0.6), respectively. XRT
had a significantly negative relationship with DDK rate, with XRT
patients having a mean rate of 21.7 and non-XRT patients a mean
rate of 26.9 (p=0.04).
4.6. Speech Clarity
All 20 patients scored between 4 and 7 in reading clarity, meaning
they were able to read without consistent cueing. They also scored
between 4 and 7 in conversation clarity, with all patients being able
to at least successfully initiate communication (Figure 1 and 2).
OTC patients performed best and were able to read and converse
at the highest level (7), when compared to BOT and OLS patients,
though the differences in mean levels were minimal. Similarly, a
higher percentage of participants with early T stage and no nod-
al spread were able to achieve the level 7 clarity during reading
and conversation, compared to those with late T stage and nodal
spread, respectively. Additionally, more XRT patients had lower
clarity levels than patients who did not receive XRT.
4.7. Speech Handicap Index (SHI)
4.7.1. Patient SHI: Those with early T stage had a mean (SD) total
SHI score of 20.9 (18.12) whereas late T stage patients had a mean
score of 34.5 (14.7), indicating better subjective outcomes for the
former. Even when speech (p=0.05) and psychosocial (p=0.06)
SHI domains were evaluated separately, the early T stage cohort
had better scores than the late T stage cohort. Site of resection,
nodal stage, and exposure to radiation did not show similar as-
sociations with total, speech, or psychosocial SHI scores [Table
2]. Overall, patients’ respective speech domain and psychosocial
domain scores were highly correlated with each other (p<0.001)
(Figure 3).
4.7.2. Patient vs Family SHI: All 20 patients submitted a com-
plete SHI, but one patient was unable to have a family member
or close friend complete an SHI. On average, patients gave them-
selves higher SHI scores (25.7) than their family counterparts (21),
with higher scores indicating greater impairment (p=0.39). There
is a similar trend when analyzing the speech domain (p=0.53) and
psychosocial domain (p=0.64) SHI scores separately. There ap-
pears to be greater agreement between patient and family when
patient SHI scores are low, with larger discrepancies between the
two respective parties as patient SHI scores increase (Figure 4).
5. Discussion
5.1. Anatomic Site of Tongue Resection
Our results showed identifiable patterns in postoperative tongue
range of motion based on site of tongue resection. Oral tongue
participants had larger impairments in each tongue ROM sub-cat-
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Volume 4 Issue 3 -2021 Research Article
6. egory (except elevation) (Table 2). These trends are in line with
other findings in existing literature. Studies have shown that those
with oral cavity tumors have worse speech intelligibility than
those with oropharyngeal tumors [11, 16]. The greater severity
of dysarthria in oral glossectomy patients is likely due to the al-
teration of oral cavity articulators that work to produce intelligible
speech, including the anterior tongue and its direct role in conso-
nant articulation (i.e. plosives, fricatives) [10, 17]. The pliability
and complex mobility of the anterior tongue are difficult to restore,
even with flap reconstruction, so oral tongue resection often leads
to greater speech impairment [17]. Resection of base of tongue
(oropharyngeal) can lead to altered resonance, but reconstruction
can restore adequate function [17].
5.2. Tumor Stage
In our study, late T stage was significantly correlated with de-
creased tongue lateralization (Table 2). This is likely explained
by the fact that treatment of advanced disease requires larger area
of resection and reconstruction, though the heavier tumor burden
may be affecting adjacent sites and not primarily the tongue [18].
The resulting decrease in range of motion may lead to greater dif-
ficulty producing intelligible speech. Additionally, the discrepancy
in tongue range of motion may have been more prominent during
lateralization, due to the multidimensional (anterior and lateral)
movements required to successfully lateralize the tongue. Partic-
ipants with advanced T stage did not have notably lower speech
clarity ratings during SLP evaluation, but their significantly worse
SHI scores suggest dysarthria that is severe enough to be detected
in their daily lives. Our findings align with previous studies that
have also emphasized the relationship between tumor stage and
speech outcomes [10, 11, 16, 18].
Figure 1: The distribution of reading clarity levels based on site of tongue resection (top left), tumor stage (top right), nodal stage (bottom left), and
radiation therapy (bottom right).
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Volume 4 Issue 3 -2021 Research Article
7. Figure 2: The distribution of conversation clarity levels based on site of tongue resection (top left), tumor stage (top right), nodal stage (bottom left),
and radiation therapy (bottom right)
Figure 3: Comparison between patient speech and psychosocial domain
scores from the Speech Handicap Index (SHI) Figure 4: Comparisons between respective patient and family scores for
speech domain (left) and psychosocial domain (right) scores from the
Speech Handicap Index (SHI)
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8. 5.3. Radiation Therapy
Our results show that DDK rate is significantly lower for those
who underwent radiation therapy, though tongue range of motion
and clarity levels are not significantly related (Table 2). These
results suggest that XRT has a greater impact on tongue control
and coordination than on tongue ROM. This would lead to greater
speech impairments during rapid and repetitive tasks that require
high levels of tongue coordination (i.e. DDK), more so than during
slower tasks such as regular reading and conversation. Shin et al
also suggested a similar theory when they found that radiotherapy
patients had significantly higher DDK rates than those who only
underwent surgery, with no large differences in tongue mobility
[19]. The significantly diminished functional outcomes in XRT
therapy patients are likely due to greater tissue fibrosis induced by
radiation exposure [9, 19]. Thus, it is imperative to consider which
treatment modalities a patient will undergo when managing expec-
tations and planning for functional rehabilitation.
5.4. Speech vs Psychosocial SHI Domains
Our results show that there is a strong correlation between the
speech and psychosocial domains of SHI (p<0.001). Though it is
difficult to determine the direction of this relationship, it is appar-
ent that the two are closely intertwined. Patients who self-perceive
more dysarthria may feel a greater psychosocial burden as a result
of their impairments. Conversely, patients with less psychosocial
support may achieve lower levels of functional rehabilitation. Our
results are in line with other studies that have also emphasized
the importance of a biopsychosocial approach to rehabilitation of
patients with dysarthria and other speech impairments [20, 21].
Further research is required in order to better understand the rela-
tionship between speech and psychosocial outcomes, in order to
better guide the functional rehabilitation process of post-glossec-
tomy patients.
5.5. Patient Versus Family SHI
To our knowledge, this is the first study to compare patient and
family SHI scores in glossectomy patients. Overall, patient and
family scores are similar, but patients with greater impairments
(higher SHI) appear to have larger discrepancies between their
own scores and their families’ scores. Further research is required
in order to ascertain the reasons for this trend. It is important to
consider both the patient and family’s understanding of the pa-
tient’s dysarthria during speech rehabilitation, since family mem-
bers are often the primary communication partners and support
network [22]. Previous studies on rehabilitation of aphasia patients
have shown that SLPs are in favor of family involvement, and re-
sults support some degree of family participation [22, 23].
Future direction of telemedicine for speech therapy research
With the onset of the pandemic, the use of telemedicine in clini-
cal research has become a highly relevant topic. More specifically,
one of the concerns that have arisen is the practicality of conduct-
ing speech and swallow evaluations through telemedicine. There
are limited studies on the role of telemedicine in research, but our
study is the first to analyze the feasibility of conducting clinical re-
search entirely through video speech evaluation [24, 25]. It is also
the first to use telemedicine to analyze speech outcomes in hemi-
glossectomy patients who have undergone RFFF tongue recon-
struction. Our project design and results suggest that telemedicine
platforms can be used effectively for SLP evaluations and prospec-
tive studies. The authors who collected data stated that all twenty
patients were assessed to the same caliber as they would have been
through an in-person evaluation. Additionally, all our participants
endorsed feeling well-supported throughout the duration of these
evaluations. During a pandemic, when in-person assessments have
been severely limited, it is important to consider the future direc-
tions of clinical research via telecare platforms. There will likely
continue to be increased involvement of telemedicine in future
clinical and research settings.
5.6. Limitations
One of the limitations of our study was our small sample size. This
was largely due to the fact that we are conducting research during
a pandemic, and patients are less inclined to enroll in research
studies, whether or not they are performed through a virtual medi-
um. Additionally, it is possible that participants’ responses to the
Speech Handicap Index were influenced by the pandemic. COVID
precautions have led to fewer social interactions for many, so this
may have affected both the participant and family’s perceptions of
patient speech.
6. Conclusion
Dysarthria is a common sequela of glossectomy that can have
large impacts on patients’daily functioning and quality of life. Our
data has shown that the degree of speech impairment, as measured
by both objective and subjective speech measures, can be affected
by a variety of factors, particularly tumor stage and inclusion of
radiation therapy. Speech function is also closely correlated with
psychosocial factors, underlining the importance of a more biopsy-
chosocial approach to rehabilitation. Future projects with larger
sample sizes are required in order to further analyze the factors
that influence dysarthria in glossectomy patients, a population that
is frequently afflicted by speech dysfunction. Furthermore, our
study highlights the fact that telecare is an effective platform to
conduct such clinical research.
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