title: Predicting Early Bulbar Decline in Amyotrophic Lateral Sclerosis: A Speech Subsystem Approach.
abstract: OBJECTIVE
  To develop a predictive model of speech loss in persons with amyotrophic lateral sclerosis (ALS) based on measures of respiratory, phonatory, articulatory, and resonatory functions that were selected using a data-mining approach.
  
  
  METHODS
  Physiologic speech subsystem (respiratory, phonatory, articulatory, and resonatory) functions were evaluated longitudinally in 66 individuals with ALS using multiple instrumentation approaches including acoustic, aerodynamic, nasometeric, and kinematic. The instrumental measures of the subsystem functions were subjected to a principal component analysis and linear mixed effects models to derive a set of comprehensive predictors of bulbar dysfunction. These subsystem predictors were subjected to a Kaplan-Meier analysis to estimate the time until speech loss.
  
  
  RESULTS
  For a majority of participants, speech subsystem decline was detectible prior to declines in speech intelligibility and speaking rate. Among all subsystems, the articulatory and phonatory predictors were most responsive to early bulbar deterioration; and the resonatory and respiratory predictors were as responsive to bulbar decline as was speaking rate.
  
  
  CONCLUSIONS
  The articulatory and phonatory predictors are sensitive indicators of early bulbar decline due to ALS, which has implications for predicting disease onset and progression and clinical management of ALS.
authors.affiliation: Department of Communication Sciences and Disorders, MGH Institute of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
authors.forename: Panying
authors.identifier: 0000-0001-7067-0083
authors.initials: P
authors.lastname: Rong
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7.
authors.forename: Yana
authors.identifier: 0000-0002-2353-2275
authors.initials: Y
authors.lastname: Yunusova
authors.affiliation: Department of Bioengineering, University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA ; Callier Center for Communication Disorders, University of Texas at Dallas, 1966 Inwood Road, Dallas, TX 75235, USA.
authors.forename: Jun
authors.identifier: 0000-0001-7265-217X
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Communication Sciences and Disorders, MGH Institute of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
authors.forename: Jordan R
authors.identifier: 0000-0002-1464-1373
authors.initials: JR
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D004401:Dysarthria / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013065:Speech Intelligibility