• Speech Sciences
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• v.12 no.3
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• pp.19-33
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• 2005

Tremor is a main factor of parkinsonism. Voice tremor may be the first, later or the only symptom of a neurological disease and its frequency, amplitude, and regularity may differ among the diseases of different neural subsystems. Differential diagnosis between idiopathic Parkinson's disease (IPD) and multiple system atrophy (MSA) has been difficult. This study included three groups: (1) 6 IPD patients; (2) 6 MSA patients; and (3) 20 ageand sex-matched normal controls. The MDVP (Multidimensional Voice Program) was used to analyze the sustained /a/phonation. The results were as follows: (1) frequency perturbation parameters (jitter, sPPQ, Vf0) and FTRI of tremor parameter of two patient groups were statistically different from those of the controls (p < .01); (2) measures were higher in short-term and long-term f0 and amplitude perturbation in MSA than IPD; (3) however, any acoustic parameters between IPD and MSA were not statistically different; except for the rate of frequency tremor, 4$\sim$5 Hz in IPD, 5$\sim$11 Hz in MSA and (4) the pattern of regularity for voice tremor through histogram indicated that amplitude of IPD was irregular while both f0 and amplitude of MSA were irregular. In conclusion, F0, rate of frequency tremor, and pattern of f0 regularity may be predictors for differential diagnosis. These findings might signify that voice tremor of parkinsonism was resulted from modulation of f0.

• Phonetics and Speech Sciences
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• v.4 no.4
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• pp.95-107
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• 2012

As BTX-A, which has been known to be the most effective treatment for ADSD, is not effective in treating vocal tremors, voice assessment must be employed to perform differential diagnosis of SD and vocal tremor in an accurate fashion. In this study, the characteristics of vocal changes after botulinum toxin injection were compared by analyzing the voice characteristics resulting from the presence of vocal tremors using objective analysis devices, with the aim of helping to provide prognoses and to determine remedial effects in clinical cases comprising patients with adductor spasmodic dysphonia accompanied by voice tremors. Respiratory function tests, aerodynamic analysis, electroglottography (EGG), acoustic analysis, auditory perception tests, and K-VHI had been conducted at intervals of four, eight, and twelve weeks before and after injection, targeting a group of 17 ADSD female patients (a ADSD group of four with vocal tremor and a ADSD group of 13 without voice tremor). For average FVC and FEV1, the T group showed statistically significant low averages compared with the NT group, whereas the T group showed statistically significant high average ATRI compared with the NT group. In addition, the T group showed a statistically significant Fatr, lower than that of the NT group. For the ADSD group of patients with voice tremor, their vocal tremor remained unchanged despite noticeable decrease in wringing voices. In other words, as the vocal tremor and wringing voices are two distinctive features, there is a need for the two features to be targeted separately for differential diagnosis.

• Phonetics and Speech Sciences
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• v.2 no.4
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• pp.19-28
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• 2010

The purpose of this study was to increase the current understanding of the acoustic characteristics of voices with advancing age. The relationship between age-related changes in body physiology and certain acoustic characteristics of voice was studied in a sample of 80 men representing four chronological age groupings (20-29, 50-59, 60-69, 70-79) who were all of good physical condition. Each subject was asked to phonate the vowel /a/, /i/, and /u/ for as long as possible at comfortable frequency and intensity level and read the sentence. A promising voice analysis program (Multi-Dimensional Voice $Program^{TM}$) was used to measure the fundamental frequency ($f_0$), jitter, shimmer, $f_0$ variation, peak-amplitude variation, smoothed pitch perturbation quotient, smoothed amplitude perturbation quotient, soft phonation index, $f_0$-tremor intensity index, amplitude tremor intensity index, and noise-to-harmonics ratio from the samples.

• Proceedings of the KSPS conference
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• 2007.05a
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• pp.143-145
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• 2007

Muscle groups that are located in and around the vocal tract can produce audible changes in frequency and/or intensity of the voice. Vocal vibrato is a characteristic feature in the singing of performers trained in the western classical tradition and vibrato is generally considered to result from modulation in frequency amplitude and timbre. Vocal tremor is also characterized by periodic fluctuations in the voice frequency or intensity and vocal tremor is symptom of a neurological disease as Spasmodic dysphonia , Parkinson's disease. Vocal vibrato and Vocal tremor may have many of the same origins and mechanisms in the voice production systems. The purpose of this study is to find acostic character of Korean traditional song Pansori singer's vibrato and Spasmodic dysphonia patient's vocal tremor. twelve Pansori singers and seven Spasmodic dysponia patients participated to this study. Power spectrum and Real time Spectrogram are used to analyze the acoustic characteristics of Pansori singing and Spasmodic dysphonia patient's voice The results are as follows; First, vowel formant differences between Pansori singing and Spasmodic dysphonia patient's voice are higher F1, F3. Second, The vibrato rate show differences between Pansori singing and Spasmodic dysphonia patients;$4^{\sim}6/sec$ and $5{\sim}6/sec$ Vibrato rate of pitch is 5.7 Hz ${\sim}$ 42.4 Hz for Pansori singing , 3.8 Hz ${\sim}$ 27.9 Hz for Spasmodic dysphonia patients ;Vibrato rate of intensity range is 0.07 dB ${\sim}$ 8.26 dB for Pansori singing and 0.07 dB ${\sim}$ 4.81 dB for Spasmodic dysphonia patients

• Speech Sciences
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• v.8 no.3
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• pp.173-184
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• 2001

The purpose of this study was to examine the effects of manipulating loudness and pitch in terms of speech intelligibility and voice of a patient with Parkinson's Disease. The subject, who was diagnosed as a patient with Parkinson's disease 11 years ago, demonstrated a severely breath voice with low intensity. The accuracy of articulation in consonants was intelligible only at the single word level, and the overall intelligibility in continuous speech was low. The results showed that the subject's articulation accuracy and speech intelligibility was significantly improved after having loudness and pitch training. Habitual Fo, Jitter, Shimmer, Fo tremor, Amp tremor were decreased after training. In addition, the value of HNR also increased after training. It was shown that the changes of these acoustic parameters were closely related to the decrease of breathiness in Parkinson's voice, and this decrease of breathiness affected speech intelligibility considerably. Based on the experimental results, it was claimed that the vocal training by manipulating the loudness and pitch could be highly effective in improving the voice quality and speech intelligibility in Parkinson's Disease.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.9-14
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• 2021

Spasmodic dysphonia, essential tremor, and vocal tremor related with Parkinson's disease are different disorders showing fairly similar symptoms such as difficulty in the speech onset, and tremble in the voice. However, the cause and the resulting treatment of these diseases are different. Spasmodic dysphonia is a vocal disorder characterized by spasms of the laryngeal muscles during a speech, invoking broken, tense, forced, and strangled voice patterns. Such difficult-to-treat dysphonia disease is classified as central-origin-focal dystonia, of a yet unknown etiology. Its symptoms arise because of intermittent and involuntary muscle contractions during speech. Essential tremor, on the other hand, is characterized by a rhythmic laryngeal movement, resulting in alterations of rhythmic pitch and loudness during speech or even at rest. Severe cases of tremor may cause speech breaks like those of adductor spasmodic dysphonia. In the case of hyper-functional tension of vocal folds and accompanying tremors, it is necessary to distinguish these disorders from muscular dysfunction. A diversified assessment through the performance of specific speech tasks and a thorough understanding for the identification of the disorder is necessary for accurate diagnosis and effective treatment of patients with vocal tremors.

• The Journal of Internal Korean Medicine
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• v.42 no.6
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• pp.1319-1330
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• 2021

A 56-year-old male patient with a sudden onset of tremor and involuntary movement of right upper and lower extremities, head, and voice was diagnosed as having a drug-induced tremor, with valproic acid being the culprit drug. The patient had undergone admission treatment at an internal Korean medicine department with herbal medicine according to constitutional diagnosis, acupuncture, moxibustion, cupping, and rehabilitation. The change in the severity of tremor was assessed with the Fahn Tolosa Marine scale. After discharge, the patient took herbal medicine for two more months. After 20 days of admission and 2 months of treatment with herbal medicine, the patient's tremor improved. In this case, the patient with valproic acid-induced tremor showed improvement in symptoms after 20 days of hospitalization and further reduction of tremor and improvement of quality of life were confirmed through follow-up for 2 months.

• Phonetics and Speech Sciences
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• v.8 no.2
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• pp.57-63
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• 2016

Recently, the Lax Vox voice therapy has been used as one of the SOVTE(Semi-Occluded Vocal Tracts Exercise). The purpose of this study was to explore the effect of Lax Vox voice therapy for a patient with Spasmodic dysphonia on voice improvement. One female spasmodic dysphonia patient(age=27) who had been diagnosed by a laryngologist received Lax Vox voice therapy. The Lax Vox protocol was configured as 5 steps (1 warm-up and 4 steps : bubbling without / with phonation/ gliding with phonation/ generalization) in this study. A total of 11 sessions were performed by a certified speech language pathologist. The present study evaluated the acoustic, aerodynamic, auditory perceptual, and patient's self-rating between pre-, mid-, and post- voice therapy. All objective and subjective parameters were improved after voice therapy; Reduced frequency variation, increased maximum phonation time, enlarged voice range, improved 'G' and 'S' in GRBAS & USDRS, and reduced VHI were observed. Especially, decreased $f_0$ and remarkably reduced voice tremor were also demonstrated following Lax Vox voice therapy. Accordingly, Lax Vox voice therapy technique can be useful for improving voice and quality of life in patients with spasmodic dysphonia.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.188-195
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• 2000

Objective : Essential tremor(ET) is the most common movement disorder, however, there has been little agreement in the neurologic literature regarding diagnostic criteria for ET. Familial ET is an autosomal dominant disorder presenting as an isolated postural tremor. The main feature of ET is postural tremor of the arms with later involvement of the head, voice, or legs. In previous studies, it was reported that ET susceptibility was inherited in an autosomal dominant inheritance. As previous results, it would suggest that ET might be associated with defect of mitochondrial or nuclear DNA. Recent studies are focusing on molecular genetic detection of movement disorders, such as essential tremor and restless legs syndrome. Moreover, authors have analysed mitochondrial DNA(mtDNA) from the blood cell of positive control(PC) and ET patients via long and accurate polymerase chain reaction(LA PCR). Materials & Methods : Blood samples were collected from PC and 9 ET patients. Total DNA was extracted twice with phenol followed by chloroform : isoamylalcohol. For the analysis of mtDNA, LA PCR was performed by mitochondrial specific primers. Results : With this technique, deletions of large quantities were detected within several regions of mtDNA in ET patients except for D-loop and CO I regions. Conclusion : The authors believe that ET is a genentic disorder with deficiency of mitochondrial DNA multicomplexes and mitochondiral dysfunction could be one of major causative factors of ET. Mitochondrial dysfunction may play an important role in the pathogenesis and possibility of disease progression among familial group with ET patients.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.158-166
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• 2023

Background: Adductor spasmodic dysphonia (ASD) is caused by the involuntary contraction of laryngeal muscles due to dystonia localized to the larynx. In the case of ASD, conventional treatment is mainly performed with a botulinum toxin injection. However, the botulinum toxin injection has a short-lasting effect and requires repeated injections. Alternatives are needed due to concerns over adverse effects, such as general weakness and airway aspiration caused by the botulinum toxin injection. Case report: A 46-year-old female patient with ASD complained of voice tremor and hoarseness. The combined Korean medical treatments-Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and transcutaneous electrical nerve stimulation (TENS)-were administered on the first day the patient was hospitalized. The Voice Handicap Index (VHI) was evaluated during the treatment. The VHI taken on the second day totaled 92 points. On the ninth day, 81 points were recorded. Total score gradually improved, and on the 16th day, 62 points were recorded. Combined Korean medical treatment lasted 19 days. Conclusion: The present case report suggests that a combined Korean medical treatment approach with Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and TENS might be effective for symptoms such as voice tremors and hoarseness. Combined Korean medical treatment can be a therapeutic option for patients with ASD.