Correlation of Patient Report of Speech and Swallowing Difficulty with Diadochokinetic Rate

Background:

Persons managing Multiple Sclerosis (pmMs) report difficulty with swallow function and consistent clear articulation.  However, on the day of the assessment, the symptoms of difficulty speaking (slurring, breathlessness, slowed rate of production) and  / or difficulty swallowing (coughing, wet vocal quality, residue after swallow) may not be apparent.  A potential screening tool correlating with patient report of deficit is sought that would trigger a referral for skilled speech or swallowing treatment.

Objectives:

To determine if serial and repetitive motor speech tasks (each component of the diadochokinetic rate individually and then in series) correlates with pmMS report of speech or swallowing difficulty.

Methods:

In one year medical record review of 233 evaluations completed by a SLP at a Comprehensive MS Center was completed between 11.01.2013 and 10.31.2014.  Five speech production scores needed to be present in the evaluation to be included in the data analysis.  Bilingual patients and those patients currently applying for social security disability were excluded.  From that time period, 146 evaluations met these criteria.

The speech production measurements were obtained utilizing the KayPENTAX VisiPitch IV3950B with a Shure SM48 – LC Unidirectional Vocal Microphone.  The measurements were /p/,/t/, /k/, /ptk/ and productions of /ptk/ in 10 seconds. Analyses were completed to determine if these five speech production scores correlated with patient report. Secondary analyses were completed to determine if current age, age at onset or time since onset had an impact on results.

Results:

Of the pmMS with complaints of difficulty with speech production (53), repetitive production of each phoneme correlated with patient complaint (/p/ - p=<.0001; /t/- p=0.0018 and /k/ - p=0.0003). Serial production also correlated with patient complaint (/ptk/ - p<.0001 and /ptk/per 10 seconds – p=<.0001).

Of the pmMS with complaints of difficulty swallowing (51) repetitive production of each phoneme correlated with patient complaint (/p/- p=0.0063; /k/ - p=0.0094) with /t/ being not quite significant (p=0.0566).  Serial production also correlated with patient complaint (/ptk/ - p=0.0006 and /ptk/per 10 seconds – p=0.0006).

Of the pmMS with complaints of difficulty with both speaking and swallowing (25), repetitive production of each phoneme correlated with patient complaint (/p/ - p=0.0015; /t/ - p=0.0021 and /k/ - p=0.0033). Serial production also correlated with patient complaint (/ptk/ - p=0.0002 and /ptk/ per 10 seconds – p=0.0014)

Analysis of age at onset, time since onset and current age were not related to complaints of difficulty with speech or swallow for any group.

Conclusions:

1. Diadochokinetic rate, both repetitive sounds and serial sounds, correlate with patient report of difficulty with speaking and swallowing.
2. Current age, age at onset or time since onset are not factors in the ability of the pmMS to speak or swallow.