title: The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS.
abstract: This study aimed to determine the diagnostic utility of clinician speech ratings and patient self-report for detecting early bulbar changes associated with amyotrophic lateral sclerosis (ALS), compared to instrumentation-based speech measures.
  
  
  
  Thirty-six individuals with ALS and 17 healthy control participants were included. Patients' awareness of early bulbar motor involvement was assessed using self-reported scores on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Clinicians' detection of early bulbar motor involvement was assessed through perceptual speech ratings by two experienced speech-language pathologists. Participants with ALS were grouped as 'bulbar pre-symptomatic' or 'bulbar symptomatic' based on self-report and clinician ratings, and compared to healthy controls on six instrumentation-based speech measures. ROC analysis was used to compare the sensitivity and specificity of perceptual and instrumentation-based measures for detecting bulbar changes in pre-symptomatic individuals.
  
  
  
  Early bulbar changes that were documented using instrumentation-based measures were undetected by both patients and clinicians. ROC analyses indicated that instrumentation-based measures outperformed clinicians' scaled severity ratings, and that percent pause time was the best measure for differentiating healthy controls from bulbar pre-symptomatic individuals with ALS.
  
  
  
  Findings suggested that instrumentation-based measures of speech may be necessary for early detection of bulbar changes due to ALS.
authors.affiliation: a Department of Communication Sciences and Disorders , MGH Institute of Health Professions , Boston , MA , USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Allison
authors.affiliation: b Department of Speech-Language Pathology , University of Toronto , Toronto , Canada.
authors.forename: Yana
authors.initials: Y
authors.lastname: Yunusova
authors.affiliation: c Callier Center for Communication Disorders , University of Texas at Dallas , Dallas , TX , USA , and.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Campbell
authors.affiliation: c Callier Center for Communication Disorders , University of Texas at Dallas , Dallas , TX , USA , and.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: d MDA ALS Clinic, Massachusetts General Hospital , Boston , MA , USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Berry
authors.affiliation: a Department of Communication Sciences and Disorders , MGH Institute of Health Professions , Boston , MA , USA.
authors.forename: Jordan R
authors.initials: JR
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report / Q000592:standards*; D013064:Speech Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D013070:Speech Therapy / Q000379:methods / Q000592:standards; D013066:Speech-Language Pathology / Q000379:methods / Q000592:standards*
keywords: Bulbar; early detection; speech motor impairment