Name: ultrasound images of the tongue: a tutorial for assessment and remediation of speech sound errors
Uploaded: 2017-01-03T15:00:00.000+00:00
Duration: 8 min 32 s
Description: Watch this Scientific Journal Video about Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors at JoVE.com

由美国国立卫生研究院支持的工作给予R01DC013668（D.惠伦，PI）和R03DC013152（J.普雷斯顿，PI）。

道德守则。当儿童在研究，知情同意和/或同意使用采集超声图像之前，总是需要的。在临床上使用，客户应告知的超声成像的目的。虽然诊断超声成像被认为是"风险极小"30，用户应使用超声波时，这意味着暴露于超声波应尽可能始终遵循ALARA原则"作为合理抑低"31。这涉及到在成像期间限制声功率并且还限制曝光时间。例如，如果使用超声波视觉反馈，但参加者不参加的视觉反馈，这将是审慎的做法是停止成像。 1.收集舌的超声图像注: 技术考虑 。诊断超声波探头被用于图像的舌头。 8 MHz的W - 约3之间的频率范围第i每秒约30帧的帧速率被推荐用于临床成像舌32。 注:下面的说明适用于超声诊断系统（见材料表 ）与C6-2换能器，这是基于从可用于该系统的多个传感器采集的超声图像的视觉比较选择。这些指令从该设备的诊断超声系统参考手册适于并意在用于一个超声的说明性实例。许多其他的超声系统都在使用，并且用户应咨询自己的特定设备的操作手册。 <ol><li>开启机器。接通电源后，观察屏幕上会自动显示2D成像模式。 <ol><li>等待系统完成的自诊断和校准测试。 注:自动显示的图像可以调整通过改变插件的设置，优化临床医生的看法trument。因为用于言语治疗使用超声波是新的，适合于语音期间成像舌头表面设置未通常预先安装，并且必须由从制造商（优选方法）的代表进行安装，或由临床医生。有为了正确的设置是很重要的安全，准确的图像为言语治疗目的的舌头。 注:用户应该熟悉他们的超声设备的基本操作是确保他们了解如何使包括深度，强度和对比度他们的设备，以获得最佳的图像所有控件的调整。电源应设置为低，为了安全起见合理可行，具有增益调整，以补偿低功率设置。 </li><li>要使用系统预设功能，按键盘上的预置密钥。 </li><li>观察预设画面。观察在屏幕的右侧上的左侧和选择的菜单项。 </li><li>第卷Ë轨迹球在屏幕左侧的菜单项，并按下控制面板上的SET键。请遵守选择的菜单项更多的选择。 </li><li>要保存更改并退出系统预置，在屏幕的底部点击保存按钮。 注: 表1示出了用于在视频图像的设置。注意，深度是换能器相关的。设置是在与西门子公司协商制定。 </li></ol></li><li>放置超声凝胶少量的超声换能器。 </li><li>参与者用双脚在地板上，背部挺直，下巴微微前倾椅子舒服的位置。 </li><li>为了收集矢状图像和尖端可视化的舌头根部，换能器垂直定位，使得与下巴下面的皮肤紧密接触并施加压力的坚定但不舒服的程度。定向换能器沿下颌骨的心理脊椎和舌骨B之间的中线一。 </li><li>开始与超声扫描。 </li><li>查看屏幕，以验证该换能器被适当地定向。在这些矢状图像，舌头的前面是在屏幕的右和舌头的背面是在左侧。角度的超声换能器稍微向前或向后稍微取决于什么舌头部分是利息。 注:在某些设备上，缺省设置将显示超声图像是上下颠倒。用户应检查其设备的默认设置，并进行必要的调整。 </li><li>指示参与者吞定向用户相对于腭舌的位置。 </li><li>得到冠状视图图像舌从左到右两侧。为了收集冠状，旋转超声换能器90度。指示参与者以维持要求舌中线开槽诸如/ R，S，Z，ʃ声音/。它可能有必要调整振子稍有毛皮疗法向前或向后想象舌头插削不同的声音。 </li><li>一旦成像完成后，擦去多余的胶和清洁超声批准的消毒湿巾或超声批准清洗喷雾传感器。 </li></ol> 2.舌口译超声图像<ol><li> 矢状面图像的基本解释 <ol><li>在矢状图，观察骨，这是不透明的超声波产生两大阴影之间的舌头下颌骨（前）的阴影和舌骨（后）的影子。的至少一个，并优选两个，这些标志是舌成像期间可见。 注:如果在舌尖低于空气（如通常是当舌尖延伸的情况下），舌尖的末端不会在超声图像上可见。 </li><li>指导参与者产生肺泡及软腭的声音，如/ TDN /然后/公斤/。这将有助于这两个东方参与者和临床医生对图像的哪一侧是前部/舌头尖和哪一侧是后部/舌背部。 </li></ol></li><li> 正确/ R /生产 <ol><li>指导参与者产生和维持/ R /。在一个正确的生产/ R /的矢状图，舌的前部将升高。舌背部的背部向后倾斜的正确/ R /生产。观察，如果探针是关闭中线或已转动时，图像将改变并且可能无法解释。 注意:如果该生产是一个"舌"/ R /，则舌尖升高朝向硬腭和舌尖的图像可能会丢失，或者可以被表示为伪影（ 例如 ，舌尖似乎提出通过腭）。在一个经典"聚束"/ R /，舌尖和/或刀片要么水平或成角度向下朝向口腔的地板上，但舌鼻背的将前部得到提升。在这两种情况下，舌片的升高部分被缩小舌和之间的空域腭，也就是说，它是使一个声道收缩。这个收缩的位置，让英语/ R /它的主要腭发音部位。 </li><li>虽然参与者维持/ R /，可视化的舌根。 注意:根据特定类型的超声波探头的被使用，这可能需要钓鱼探头向后朝着舌骨。感知准确英语/ R /需要引起舌根向后咽壁的缩回声道的二次收缩。后咽壁通常不能用超声波来可视化，但是回缩可以推断:如果舌根缩回时，前缩颈后面舌头表面的斜率将变浅。 </li><li>旋转探头90度，以获得冠状图。探针在最高点的粗糙附近位置舌大约下巴和在矢状面喉部之间的距离的1/3。 注意:当参与者被维持/ R /，舌头的横向边缘的一些海拔一般是可见的。虽然齿是不可见的，这是很常见的个体制备成束类型的/转/感觉与背臼齿一些接触。 </li></ol></li><li> 评估扭曲/ R /生产超声 <ol><li>指导参与者模仿和维持/ R /。 注意:在一个扭曲的生产/ R /的矢状图，舌的前方面通常较低，舌鼻背通常拉高和背部。舌根回缩往往是不存在，这往往是由前收缩后面舌形状的陡峭或几乎垂直的斜率表示。 </li><li>指导参与者模仿/ R /在一些音节，如/ɝ，ɑr，ɪr，rɑ，RI，RU /的。请注意，有PE背景的任何rceptually正确识别与正确不正确对相关生产舌头的形状。 注:方言的差异会影响清晰度;这些例子都是美式英语。 </li><li>旋转探头90度，以获得冠状视图，观察舌的横向边缘。音节，如/ɝ，ɑr，ɪr，rɑ，RI，RU /重复生产。而参与者维持一个扭曲/ R /，舌头的横向边缘经常一面或两面仍然很低。 </li></ol></li></ol> 3.使用实时超声图像进行反馈补救声音讲话的错误<ol><li>指示在超声波的适当定位的参与者。允许参与者持有超声波振子，如果他们能够。另外，有临床研究员握住换能器，或钳换能器的麦克风站在保持稳定，而参与者前倾和休息下巴它，保持公司的压力。 注意:有可能使探头周围滑动的倾向。临床医师应警惕校正测头的移动的正中矢状平面的两侧，随着图像变得不太一致，更难理解。 </li><li>定向参与者通过教他们的舌头部位超声矢状切面图像。参与者应能够跟踪一个矢状超声图像上采样舌轮廓。指示该/ R /需要在前面两个口服收缩和在后面咽缩颈的参与者。 注意:它常常是有帮助，以指示参加者分开识别的尖端，叶片，背部和根，因为这些对应于舌头的独立地可移动的区域。 </li><li>要求参与者点到表示与"舌前面的"前，后，或实时超声波图像的侧"舌背面"。 </li><li>引入参与者/不同舌形状为/ R使用附图，超声图像或磁共振图像33。要清楚当口腔及咽部收缩的，但也承认，每一个舌形略有不同。 注:解释从正确/ R /生产图像见2.2.1和2.2.2 </li><li>要求参与者描述/ R /是在矢状切面可见2大收缩。如果参与者无法确定刚刚描述的口腔和咽部收缩，继续指导。 注:参与者应能够报告什么描述于3.4，表明该舌的前部的一些部竖起，并且该舌根向后移动（如在2.2.1和2.2.2中所述） </li><li>定向参与者冠状切面超声图像。指示在期望的舌形参与者从左到右。要求参与者跟踪舌的形状，确定左和右边缘，并且中心线槽。要求参与者解释的所需形状。 </li><li>试图通过提供语音提示来复制不同形状的舌头，征求正确的/ R /隔离或音节。 注:可以帮助提供屏幕上的"目标"，为参加者/ R /生产过程相匹配。目标可以使用光标或通过在放置在画面的透明度绘图生成。提供明确的指令，如"如果舌头行不匹配的红色目标，尝试不同的做一些事情。改变人说声音的方式。应把重点放在背部走下来，" 等见附录1的发音器官的例子放置线索。 </li><li>有与会者提供他们后他们的一些尝试，做了什么正确或不正确的解释。 </li><li>如有必要，使用标准的整形策略，如整形/ L /到/ R /或/ɑ/到/ R /同时观看可见UAL反馈。 </li><li>实现正确的制作后，按下暂停按钮以冻结图像。讨论正确的图像看起来如何从以前的不正确制作不同。 </li><li>整个无超声会话练习，以提供休息，并提供推广机会讲话时，视觉反馈不可用。 注:由于参与者达到更精确的生产，增加语言复杂的音节单词，短语和句子，并减少反馈量，以方便概括。 注:语音目标精度应定期监测。这可以通过感知打分谁正在与超声训练有素的声音录音个人（最好谁是盲目的治疗状态）来完成。 </li></ol>

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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+multi-modal+approach+to+intervention+for+one+adolescent's+frontal+lisp.">A multi-modal approach to intervention for one adolescent's frontal lisp.</a> Clin Linguist Phon. 27 (1), 1-17 (2013).</li><li>Gick, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+imaging+applications+in+second+language+acquisition.">Ultrasound imaging applications in second language acquisition.</a> Phonology and second language acquisition. 36, 315-328 (2008).</li><li>Gick, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+motor+differentiation+model+for+liquid+substitutions+in+children's+speech.">A motor differentiation model for liquid substitutions in children's speech.</a> Proceedings of Meetings on Acoustics. 1 (1), (2007).</li><li>Klein, H. B., McAllister Byun, T., Davidson, L., Grigos, M. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Multidimensional+Investigation+of+Children's+/r/+Productions:+Perceptual,+Ultrasound,+and+Acoustic+Measures.">A Multidimensional Investigation of Children's /r/ Productions: Perceptual, Ultrasound, and Acoustic Measures.</a> Am J Speech Lang Pathol. 22 (3), 540-553 (2013).</li><li>Zharkova, N., Gibbon, F. E., Lee, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+ultrasound+tongue+imaging+to+identify+covert+contrasts+in+children's+speech.">Using ultrasound tongue imaging to identify covert contrasts in children's speech.</a> Clin Linguist Phon. , 1-14 (2016).</li><li>McAllister Byun, T., Buchwald, A., Mizoguchi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Covert+contrast+in+velar+fronting:+An+acoustic+and+ultrasound+study.">Covert contrast in velar fronting: An acoustic and ultrasound study.</a> Clin Linguist Phon. 30 (3-5), 249-276 (2016).</li><li>Epstein, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+and+the+IRB.">Ultrasound and the IRB.</a> Clin Linguist Phon. 19 (6-7), 567-572 (2005).</li><li>Barnett, S. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+recommendations+and+guidelines+for+the+safe+use+of+diagnostic+ultrasound+in+medicine.">International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine.</a> Ultrasound Med Biol. 26 (3), 355-366 (2000).</li><li>Lee, S. A. S., Wrench, A., Sancibrian, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+To+Get+Started+With+Ultrasound+Technology+for+Treatment+of+Speech+Sound+Disorders.">How To Get Started With Ultrasound Technology for Treatment of Speech Sound Disorders.</a> SIG 5 Perspectives on Speech Science and Orofacial Disorders. 25 (2), 66-80 (2015).</li><li>Boyce, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+articulatory+phonetics+of+/r/+for+residual+speech+errors.">The articulatory phonetics of /r/ for residual speech errors.</a> Seminars in Speech and Language. 36 (4), 257-270 (2015).</li><li>Preston, J. L., Leece, M. C., Maas, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor-based+treatment+with+and+without+ultrasound+feedback+for+residual+speech-sound+errors.">Motor-based treatment with and without ultrasound feedback for residual speech-sound errors.</a> International Journal of Language &amp; Communication Disorders. , (2016).</li><li>Cleland, J., Mccron, C., Scobbie, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tongue+reading:+Comparing+the+interpretation+of+visual+information+from+inside+the+mouth,+from+electropalatographic+and+ultrasound+displays+of+speech+sounds.">Tongue reading: Comparing the interpretation of visual information from inside the mouth, from electropalatographic and ultrasound displays of speech sounds.</a> Clin Linguist Phon. 27 (4), 299-311 (2013).</li><li>Zharkova, N., Gibbon, F. E., Hardcastle, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantifying+lingual+coarticulation+using+ultrasound+imaging+data+collected+with+and+without+head+stabilisation.">Quantifying lingual coarticulation using ultrasound imaging data collected with and without head stabilisation.</a> Clin Linguist Phon. 29 (4), 249-265 (2015).</li></ol>

Siemens Corporation provided a temporary loan of three Acuson X300 ultrasounds for research purposes at no cost to the authors.

<html>该议定书中的关键步骤如在步骤1.3和1.6中所述，必须获得清晰，可解释的图像。可怜的画质呈现的过程毫无意义。此外，参与者必须充分意识到他们看到在屏幕上什么。因此，定向参与者在3.2描述的图像是应该先提供视觉反馈训练强调的一个步骤。此外，步骤3.10，其中涉及参与者的感知准确和不准确的舌形状之间在舌形清楚描述的差异，是增加目标舌形状的认识为特定扬?...

临床和研究环境已经看到在使用超声成像的增加提供视觉生物反馈干预个人有语言障碍。超声成像的语音语言病理学家的一个重要的用途是作为干预有语言障碍的个体中的可视化的生物反馈工具。随着语言病理学家的指导下，学习者可以观察到的形状和舌头的动作实时视频，并讨论如何这些图像可以从正确表达的语言声音所需要的舌头运动不同。进行这样的干预，为用户在超声图像的解释主管作为舌实时移动是很重要的。正确的关节形态典型的人士使用的范围的知识基础，以承认错误的舌头形状。 本文描述的方法处理（a）收集所述夹钳的超声图像UE，（二）解释与语音的正确和不正确制作的声音，并使用实时超声成像视觉生物反馈的一个源，以方便与语音声音错误个人语音产生的变化（c）进行相关的超声图像。虽然超声可以用于可视化的各种语言的音素，在这里实施例将集中于舌的/ R /声音的超声波图像（如在红色汽车 ），其孩子取得美国英语中描述为最常见的残余误差1。也已在迄今为止超声临床应用最广泛研究的声音。 2-14 在语音（重新）康复的一个重要目标是通过教导导致目标声音或序列的感知适当的制作程序关节，以促进更清晰的语音。因此，关键是要理解正常讲话和杜里在舌头的动作纳克生产言论错误。舌实时可视化可以在鼓励扬声器修改关节运动起到非常有益的作用，因为它提供了临床医生和客户端的什么讲话期间实际发生的共享表示。未经舌实时可视化，仅静态图片或目标舌配置的语言描述的可用于促进所期望的关节的行为的理解。在运动学习的基于模式的模型，对舌头的演讲中的运动视觉信息被认为是"知识表现"反馈的形式（ 即它提供了有关发生的具体动作的定性信息）15。以往的研究已经表明，绩效反馈详细知识，可以方便获取一个新的电机程序16。 超声较其他TECHNOLOGI几个优势ES用于可视化语音。随着超声，舌头的整个外形可直观迅速地从尖端到根部。对于超声成像准备通常需要不到一分钟。 相比之下，electropalatography（EPG），需要牙齿印模和定制pseudopalate创建（这可能需要数周），它可能需要一段时间来适应与讲伪腭17。 EPG还使舌腭接触的可视化只在由pseudopalate覆盖的区域和不能显示舌根或舌的整体形状。这限制了什么关节运动的各方面可以与EPG被有效靶向的性质。 另一种选择是电磁articulography（EMA），它可以提供关于舌形状和运动18的一般信息。然而，EMA需要传感器来粘在舌头和其它结构;从而，在设置这种类型的舌成像可以采取20 - 30分钟，并可能不经常使用的可行方法。由此，超声波可以被视为更实用。 在评估和治疗/ R /错误的临床研究的具体情况下，使用超声波已报道在几个研究为特发性的语音病症2,10,11,13,19个体，听力障碍20，童年演讲12,21的失用，并遵循脑血管意外22讲话收购失用。研究还报道了用超声波对其他语言音素，如/ skglʃʧ/ 23,24对待错误。附加种群可能的候选人包括有语言障碍的学习声音发音以非母语25个人有关腭裂，或个人。 超声成像也可以是有用的诊断， 例如 ，到在舌形表征错误，26,27，或无序的讲话28,29识别子可察觉的或隐蔽的反差。如果正在得到和比较精确关节的测量，它是必不可少的超声波被稳定，以便用于测量的坐标空间保持相当稳定。然而，一般认为，未稳定的探针产生的足够的质量为临床诊断和治疗应用，这是本文件的重点信息。

<table><tbody><tr><td>ACUSON X300&amp;nbsp; ultrasound with C6-2 probe</td><td>Siemens</td><td>Acuson X300</td><td></td></tr><tr><td>Trasceptic Spray</td><td>Parker labs</td><td>PLI 09-25</td><td></td></tr><tr><td>Acquasonic 100 ultrasound gel</td><td>Parker labs</td><td>01-08</td><td></td></tr></tbody></table>

ultrasound images of the tongue: a tutorial for assessment and remediation of speech sound errors

诊断超声成像已经在医疗实践中的常用工具几十年。它提供了用于成像的结构内部的主体上的安全有效的方法。出现了在使用超声波技术来可视化语音期间的形状和舌头的运动，无论是在典型的扬声器，并在临床人群最近增加。演讲的超声成像，极大地扩展了我们的声音如何与舌（舌声音）产生铰接理解。这些信息可以是言语语言病理学家特别有价值。在其它优点中，超声图像可以言语治疗过程中使用，以提供（1）典型的（ 即 "正确"）舌配置的说明性模型讲话的声音，和（2）的见解的源极到异常制作的关节性质。的图像也可以被用作反馈临床人群学习DIS附加源从他们的作品不正确的tinguish更好的制作，途中建立更有效的关节习惯。 超声反馈越来越多的科学家和临床医生的用户的增加专门知识和作为设备下降为代价使用。在本教程中，过程提出了在临床方面收集舌头的超声图像。我们说明了一个扩展的例子具有一个共同的错误的声音，美国英语/ R /这些过程。正确和扭曲/ R的图像/用于演示（1）如何解释超声图像，（2）生产的语音声音，（3），如何分类舌形状误差的过程中如何评估舌的形状，和（4） ，如何提供视觉反馈以引发一个更合适的和功能性的舌头的形状。我们提出了使用舌的实时超声图像，视觉反馈补救语音声音差错的样品协议。此外，Example数据示来说明程序的结果。

图1给出/正确/ R样品矢状图像在一个9岁的女性。超声图像被配对与磁共振图像从相同的扬声器，以证明可以用两种技术要观看的相似舌形状。 <img alt="图2" src="/files/ftp_upload/55123/55123fig1.jpg" /> 图1:正确制作的美式英语/ R /用舌头的超声图像来自同一个参与者（右下）在磁共振图像的矢状位。中的所?...

Watch this Scientific Journal Video about Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors at JoVE.com

Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors

Ultrasound imaging can be used to display the shape and movements of the tongue in real time during speech. The images can be used to determine the nature of speech sound errors. Visual feedback of the tongue can be used to facilitate improvements in speech sound production in clinical populations.

舌的超声图像:一个教程评估和修复声音讲话的错误

Diagnostic ultrasound imaging has been a common tool in medical practice for several decades. It provides a safe and effective method for imaging ...

ultrasound-images-tongue-tutorial-for-assessment-remediation-speech

Research

Education

JoVE Core

JoVE Journal

Anatomy and Physiology

Behavior

Unit 1

Diagnostic Imaging Techniques

SCIENTISTS IN ACTION

21.6K 次观看.  Syracuse University. Ultrasound imaging can be used to display the shape and movements of the tongue in real time during speech. The images can be used to determine the nature of speech sound errors. Visual feedback of the tongue can be used to facilitate improvements in speech sound production in clinical populations. 

视频: Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression across speech subsystems, and for addressing the critical need for sensitive outcome measures for ongoing experimental treatment trials. To address this need, we are obtaining longitudinal profiles of bulbar impairment in 100 individuals based on a comprehensive instrumentation-based assessment that yield objective measures. Using instrumental approaches to quantify speech-related behaviors is very important in a field that has primarily relied on subjective, auditory-perceptual forms of speech assessment1. Our assessment protocol measures performance across all of the speech subsystems, which include respiratory, phonatory (laryngeal), resonatory (velopharyngeal), and articulatory. The articulatory subsystem is divided into the facial components (jaw and lip), and the tongue. Prior research has suggested that each speech subsystem responds differently to neurological diseases such as ALS. The current protocol is designed to test the performance of each speech subsystem as independently from other subsystems as possible. The speech subsystems are evaluated in the context of more global changes to speech performance. These speech system level variables include speaking rate and intelligibility of speech.
The protocol requires specialized instrumentation, and commercial and custom software. The respiratory, phonatory, and resonatory subsystems are evaluated using pressure-flow (aerodynamic) and acoustic methods. The articulatory subsystem is assessed using 3D motion tracking techniques. The objective measures that are used to quantify bulbar impairment have been well established in the speech literature and show sensitivity to changes in bulbar function with disease progression. The result of the assessment is a comprehensive, across-subsystem performance profile for each participant. The profile, when compared to the same measures obtained from healthy controls, is used for diagnostic purposes. Currently, we are testing the sensitivity and specificity of these measures for diagnosis of ALS and for predicting the rate of disease progression. In the long term, the more refined endophenotype of bulbar ALS derived from this work is expected to strengthen future efforts to identify the genetic loci of ALS and improve diagnostic and treatment specificity of the disease as a whole. The objective assessment that is demonstrated in this video may be used to assess a broad range of speech motor impairments, including those related to stroke, traumatic brain injury, multiple sclerosis, and Parkinson disease.

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

Objective assessments of the physiological mechanisms that support speech are needed to monitor disease onset and progression in persons with ALS and to quantify treatment effects in clinical trials. In this video, we present a comprehensive, instrumentation-based protocol for quantifying speech motor performance in clinical populations.

延髓功能障碍肌萎缩性脊髓侧索硬化症（ALS）的综合评估议定书

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression ...

科研

医学

Coordinate Mapping of Hyolaryngeal Mechanics in Swallowing

Characterizing hyolaryngeal movement is important to dysphagia research. Prior methods require multiple measurements to obtain one kinematic measurement whereas coordinate mapping of hyolaryngeal mechanics using Modified Barium Swallow (MBS) uses one set of coordinates to calculate multiple variables of interest. For demonstration purposes, ten kinematic measurements were generated from one set of coordinates to determine differences in swallowing two different bolus types. Calculations of hyoid excursion against the vertebrae and mandible are correlated to determine the importance of axes of reference.
To demonstrate coordinate mapping methodology, 40 MBS studies were randomly selected from a dataset of healthy normal subjects with no known swallowing impairment. A 5 ml thin-liquid bolus and a 5 ml pudding swallows were measured from each subject. Nine coordinates, mapping the cranial base, mandible, vertebrae and elements of the hyolaryngeal complex, were recorded at the frames of minimum and maximum hyolaryngeal excursion. Coordinates were mathematically converted into ten variables of hyolaryngeal mechanics.
Inter-rater reliability was evaluated by Intraclass correlation coefficients (ICC). Two-tailed t-tests were used to evaluate differences in kinematics by bolus viscosity. Hyoid excursion measurements against different axes of reference were correlated. Inter-rater reliability among six raters for the 18 coordinates ranged from ICC = 0.90 - 0.97. A slate of ten kinematic measurements was compared by subject between the six raters. One outlier was rejected, and the mean of the remaining reliability scores was ICC = 0.91, 0.84 - 0.96, 95% CI. Two-tailed t-tests with Bonferroni corrections comparing ten kinematic variables (5 ml thin-liquid vs. 5 ml pudding swallows) showed statistically significant differences in hyoid excursion, superior laryngeal movement, and pharyngeal shortening (p &#60; 0.005). Pearson correlations of hyoid excursion measurements from two different axes of reference were: r = 0.62, r2 = 0.38, (thin-liquid); r = 0.52, r2 = 0.27, (pudding).
Obtaining landmark coordinates is a reliable method to generate multiple kinematic variables from video fluoroscopic images useful in dysphagia research.

Coordinate mapping is a method of documenting salient features of hyolaryngeal biomechanics in the pharyngeal phase of swallowing. This methodology uses image analysis software to record coordinates of anatomical landmarks. These coordinates are imported into an excel macro and translated into kinematic variables of interest useful in dysphagia research.

协调Hyolaryngeal力学映射在吞咽

Characterizing hyolaryngeal movement is important to dysphagia research. Prior methods require multiple measurements to obtain one kinematic measurement ...

Measuring Oral Fatty Acid Thresholds, Fat Perception, Fatty Food Liking, and Papillae Density in Humans

Emerging evidence from a number of laboratories indicates that humans have the ability to identify fatty acids in the oral cavity, presumably via fatty acid receptors housed on taste cells. Previous research has shown that an individual&#39;s oral sensitivity to fatty acid, specifically oleic acid (C18:1) is associated with body mass index (BMI), dietary fat consumption, and the ability to identify fat in foods. We have developed a reliable and reproducible method to assess oral chemoreception of fatty acids, using a milk and C18:1 emulsion, together with an ascending forced choice triangle procedure. In parallel, a food matrix has been developed to assess an individual&#39;s ability to perceive fat, in addition to a simple method to assess fatty food liking. As an added measure tongue photography is used to assess papillae density, with higher density often being associated with increased taste sensitivity.

Oral chemoreception of fatty acids and the association with diet and fatty food preferences may enable the identification of mechanisms involved with the development of obesity and why dietary changes may be difficult for many individuals.

测量口腔脂肪酸阈值，感知脂肪，脂肪食物喜欢的，和乳头密度的人类

Emerging evidence from a number of laboratories indicates that humans have the ability to identify fatty acids in the oral cavity, presumably via fatty ...

神经科学

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include supporting mastication and deglutition, as well as taste-sensing and phonetics. Accordingly, the strength and volume of the tongue can impact the ability of vertebrates to accomplish basic activities such as feeding, communicating, and breathing. Human patients with sleep apnea have enlarged tongues, characterized by reduced muscle tone and increased intramuscular fat that can be visualized and quantified by magnetic resonance imaging (MRI). The abilities to measure force generation and viscoelastic properties of the tongue constitute important tools for obtaining functional information to correlate with imaging data. Here, we present techniques for measuring tongue force production in anesthetized Zucker rats via electrical stimulation of the hypoglossal nerves and for determining the viscoelastic properties of the tongue by applying passive Lissajous force/deformation curves.

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

We describe a surgical procedure in an anesthetized rat model for determining the muscle tone and viscoelastic properties of the tongue. The procedure involves specific stimulation of the hypoglossal nerves and application of passive Lissajous force/deformation curves to the muscle.

大鼠舌的机械和粘弹性的体内评估

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include ...

&#181;Tongue: A Microfluidics-Based Functional Imaging Platform for the Tongue In Vivo

Intravital fluorescence microscopy is a tool used widely to study multicellular dynamics in a live animal. However, it has not been successfully used in the taste sensory organ. By integrating microfluidics into the intravital tongue imaging window, the &#181;Tongue provides reliable functional images of taste cells in vivo under controlled exposure to multiple tastants. In this paper, a detailed step-by-step procedure to utilize the &#181;Tongue system is presented. There are five subsections: preparing of tastant solutions, setting up of a microfluidic module, sample mounting, acquiring functional image data, and data analysis. Some tips and techniques to solve the practical issues that may arise when using the &#181;Tongue are also presented.

 &#181;Tongue: A Microfluidics-Based Functional Imaging Platform for the Tongue In Vivo

The article introduces the &#181;Tongue (microfluidics-on-a-tongue) device for functional taste cell imaging in vivo by integrating microfluidics into an intravital imaging window on the tongue.

μTongue:一个基于微流体的功能成像平台，用于在Viva的舌头

Intravital fluorescence microscopy is a tool used widely to study multicellular dynamics in a live animal. However, it has not been successfully used in ...

Endoscopic Approach for Studying Laryngeal Dysfunction in Rodents

Minimally Invasive Murine Laryngoscopy for Close&#45;Up Imaging of Laryngeal Motion During Breathing and Swallowing

The larynx is an essential organ in mammals with three primary functions - breathing, swallowing, and vocalizing. A wide range of disorders are known to impair laryngeal function, which results in difficulty&#160;breathing (dyspnea), swallowing impairment (dysphagia), and/or voice impairment (dysphonia). Dysphagia, in particular, can lead to aspiration pneumonia and associated morbidity, recurrent hospitalization, and early mortality. Despite these serious consequences, existing treatments for laryngeal dysfunction are largely aimed at surgical and behavioral interventions that unfortunately do not typically restore normal laryngeal function, thus highlighting the urgent need for innovative solutions.
To bridge this gap, we have been developing an experimental endoscopic approach to investigate laryngeal dysfunction in murine (i.e., mouse and rat) models. However, endoscopy in rodents is quite challenging due to their small size relative to current endoscope technology, anatomical differences in the upper airway, and the necessity for anesthesia to optimally access the larynx. Here, we describe a novel transoral laryngoscopy approach that permits close-up, unobstructed video imaging of laryngeal motion in mice and rats. Critical steps in the protocol include precise anesthesia management (to prevent overdosing that abolishes swallowing and/or risks respiratory distress-related mortality) and micromanipulator control of the endoscope (for stable video recording of laryngeal motion by a single researcher for subsequent quantification).
Importantly, the protocol can be performed over time in the same animals to study the impact of various pathological conditions specifically on laryngeal function. A novel advantage of this protocol is the ability to visualize airway protection during swallowing, which is not possible in humans due to epiglottic inversion over the laryngeal inlet that obstructs the glottis from view. Rodents therefore provide a unique opportunity to specifically investigate the mechanisms of normal versus pathological laryngeal airway protection for the ultimate purpose of discovering treatments to effectively restore normal laryngeal function.

This protocol describes a serial transoral laryngoscopy approach for mice and rats that permits close-up, unobstructed video imaging of the larynx during breathing and swallowing using an optimized anesthetic regimen and finely tuned endoscopic manipulation techniques.

The larynx is an essential organ in mammals with three primary functions - breathing, swallowing, and vocalizing. A wide range of disorders are known to ...

Image Acquisition using Portable Sonography for Emergency Airway Management

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of patients, but also to address the potential benefits of employing ultrasound in airway management. The benefits of point of care ultrasound (POCUS) include its portability, the speed at which it can be utilized, and its lack of invasiveness or exposure of the patient to radiation of other imaging modalities.
Two primary indications for airway POCUS include confirmation of endotracheal intubation and identification of the cricothyroid membrane in the event a surgical airway is required. In this article, the technique of using ultrasound to confirm endotracheal intubation and the relevant anatomy is described, along with the associated ultrasonographic images. In addition, identification of the anatomy of the cricothyroid membrane and the ultrasonographic acquisition of appropriate images to perform this procedure are reviewed.
Future advances include utilizing airway POCUS to identify patient characteristics that might indicate difficult airway management. Traditional bedside clinical exams have, at best, fair predictive values. The addition of ultrasonographic airway assessment has the potential to improve this predictive accuracy. This article describes the use of POCUS for airway management, and initial evidence suggests that this has improved the diagnostic accuracy of predicting a difficult airway. Given that one of the limitations of airway POCUS is that it requires a skilled sonographer, and image analysis can be operator dependent, this paper will provide recommendations to standardize the technical aspects of airway ultrasonography and promote further research utilizing sonography in airway management. The goal of this protocol is to educate researchers and medical health professionals and to advance the research in the field of airway POCUS.

Point of care ultrasound (POCUS) is increasingly being utilized in airway management. Presented here are some clinical utilities of POCUS, including differentiating endotracheal and esophageal intubation, identification of the cricothyroid membrane in the event a surgical airway is required, and measuring anterior neck soft tissue to predict difficult airway management.

使用便携式超声采集图像进行紧急气道管理

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON method, which looks for and evaluates the Mallampati classification, signs of obstruction, and neck mobility. Clinical findings help predict a higher likelihood of difficult tracheal intubation, but no clinical result reliably excludes difficult intubation. Ultrasound as an adjunct to clinical examination can provide the clinician with a dynamic anatomical airway assessment, which is impossible with clinical examination alone. In the hands of anesthesiologists, ultrasound is becoming more popular in the perioperative period. This method is particularly applicable for identifying proper endotracheal tube positioning in specific patient populations, such as those who are morbidly obese and patients with head and neck cancer or trauma. The focus is on identifying the normal anatomy, correctly positioning the endotracheal tube, and refining the parameters that predict difficult intubation. Several ultrasound measurements are clinical indicators of difficult direct laryngoscopy in the literature. A meta-analysis revealed that the distance from the skin to the epiglottis (DSE) is most associated with a difficult laryngoscopy. An ultrasound of the airway could be applied in routine practice as an adjunct to the clinical examination. A full stomach, rapid sequence intubation, gross visual anatomical abnormalities, and restricted neck flexibility prevent using ultrasound to assess the airway. The airway evaluation is performed with a linear array transducer of 12-4 MHz, with the patient in the supine position, with no pillow, and with the head and neck in a neutral position. The central axis of the neck is where the ultrasound parameters are measured. These image acquisitions guide the standard ultrasound examination of the airway.

A point-of-care ultrasound (POCUS) is a simple, non-invasive, and portable tool that enables dynamic airway assessment. Several studies have attempted to determine the role of ultrasound parameters as an adjunct to clinical examination in predicting difficult laryngoscopies.

床旁超声:预测困难气道的超声参数综述

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

Objectification of Tongue Diagnosis in Traditional Medicine, Data Analysis, and Study Application

Tongue diagnosis is an essential technique of traditional Chinese medicine (TCM) diagnosis, and the need for objectifying tongue images through image processing technology is growing. The present study provides an overview of the progress made in tongue objectification over the past decade and compares segmentation models. Various deep learning models are constructed to verify and compare algorithms using real tongue image sets. The strengths and weaknesses of each model are analyzed. The findings indicate that the U-Net algorithm outperforms other models regarding precision accuracy (PA), recall, and mean intersection over union (MIoU) metrics. However, despite the significant progress in tongue image acquisition and processing, a uniform standard for objectifying tongue diagnosis has yet to be established. To facilitate the widespread application of tongue images captured using mobile devices in tongue diagnosis objectification, further research could address the challenges posed by tongue images captured in complex environments.

The present study employed U-Net and other deep learning algorithms to segment a tongue image and compared the segmentation results to investigate the objectification of tongue diagnosis.

舌诊在传统医学中的客观化、数据分析与研究应用

Tongue diagnosis is an essential technique of traditional Chinese medicine (TCM) diagnosis, and the need for objectifying tongue images through image ...

干燥综合征的唾液腺超声检查技术

Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular manifestations including arthralgia, cytopenia, and lymphoma. The presence of autoantibodies against SSA/Ro, labial salivary gland biopsy, ocular staining, Schirmer's test, or salivary flow assessment are included in the current classification criteria of SS. However, the availability and invasiveness of these procedures limit their widespread use in clinical settings. Salivary gland ultrasonography (SGUS) is a non-invasive imaging modality for the evaluation of the salivary gland parenchyma and is increasingly utilized to aid diagnosis and monitoring in SS. 
This article presents the protocol of SGUS for image acquisition at the parotid and submandibular glands. The objective is to present a standardized, reproducible, and practical approach to diagnostic SGUS for SS in daily clinical settings. Major salivary glands are scanned in a stepwise approach, beginning at the angle of the mandible for the superficial lobe of the parotid gland, followed by the deep lobe below the ramus of the mandible. Submandibular areas are then scanned for the submandibular glands. The steps in obtaining salivary gland images at each anatomical site are explained in the accompanying video. The echogenicity and echotexture at the thyroid gland are taken as a reference. The homogeneity, the presence and distribution of hypoechoic areas within the glands, and the border of the salivary glands are examined. The sizes and features of intra-/peri-glandular lymph nodes are recorded. The most distinctive sonographic feature in SS is glandular heterogeneity with the presence of hypoechoic/hyperechoic areas within the glands. 
In summary, while SGUS cannot diagnose SS on its own, it can supplement the current classification criteria of SS and guide the clinical decision for salivary gland biopsy to support the diagnosis of SS in patients with sicca syndrome or suspicious systemic features, combined with autoantibody testing.

作者聚焦：结缔组织病研究中标准化唾液腺超声方案的重点

Salivary gland ultrasonography is a promising tool for the diagnosis and evaluation of disease activity and complications in Sjogren's syndrome (SS). The scanning technique for salivary gland ultrasound examination relevant to SS is described in the article.

干燥综合征唾液腺的超声评估：诊断和监测见解

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular ...