The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS
The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS
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DOI：
10.1080/21678421.2017.1303515
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发表时间：
2017-01-01
影响因子：
2.8
通讯作者：
Green, Jordan R.
中科院分区：
文献类型：
--
作者：
Allison, Kristen M.;Yunusova, Yana;Green, Jordan R.
目的：本研究旨在确定临床医生语音评分和患者自我报告在检测与肌萎缩侧索硬化症(ALS)相关的早期球部改变方面的诊断价值，并与基于仪器的语音测量进行比较。方法：36例ALS患者和17例健康对照受试者。使用肌萎缩侧索硬化症功能评定量表修订版(ALSFRS-R)的自我报告评分来评估患者对早期球运动受累的认识。临床医生通过两位经验丰富的语音-语言病理学家的知觉语音评分来评估早期延髓运动受累的检测。根据自我报告和临床医生的评分，ALS患者被分成“有症状的延髓”或“有延髓症状的”，并在六项基于仪器的语音测量上与健康对照组进行比较。ROC分析被用来比较感知和基于仪器的测量方法在检测症状前期个体的球部变化方面的敏感性和特异性。结果：患者和临床医生均未发现使用基于器械的测量方法记录的早期球部改变。ROC分析表明，基于仪器的措施优于临床医生衡量的严重程度评级，而百分比停顿时间是区分健康对照组和患有ALS的球部症状前患者的最佳指标。结论：研究结果表明，基于仪器的语音测量对于早期发现ALS所致的球部改变可能是必要的。
Objective: 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. Methods: 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. Results: 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. Conclusions: Findings suggested that instrumentation-based measures of speech may be necessary for early detection of bulbar changes due to ALS.