Amyotrophic lateral sclerosis (ALS; or motor neurone disease) is characterised by gradual loss of function in the speech muscles resulting in a progressive deterioration in a person’s ability to communicate. The aim of this study was to investigate the use of measurement of articulatory movements as a diagnostic marker for bulbar involvement in ALS. Changes in lip movement have been shown to precede detectable changes in intelligibility of speech, thus this study focused on using alternating motion rates (AMR) as a marker of future change. Fifty seven participants with probable ALS or definite ALS (33:24, male:female) and 22 healthy participants (10:12, male:female) took part in the study. Amongst participants with ALS, eight presented with bulbar onset, four mixed bulbar and 45 spinal/other onset sites. Upper and lower lip movements were recorded in 3D using an electromagnetic or optical tracking system as participants repeated /b/ as fast as they could on one breath. An algorithm was developed to automatically extract lip movement features for analysis. Results demonstrated that overall lip AMR performance declined early and before any detectable change in speech intelligibility or rate and predicted the timing of this anticipated progression. Increased temporal variability across the AMR tasks was found to be the most sensitive indicator of these changes. Improving early diagnosis of bulbar changes can provide prognostic information on speech changes and identify targets for treatment and compensation as early as possible, thus enabling people with ALS to live as independently as possible for as long as possible.
Monitoring the mouth in ALS
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