Altered speech patterns in subjects with post-traumatic headache due to mild traumatic brain injury

DOI: https://doi.org/10.1186/s10194- 021- 01296- 6

Abstract-Summary Speech samples of subjects with PTH were compared to HC.

To assess speech changes associated with PTH, speech samples of subjects during

headache were compared to speech samples when subjects were headache-free.

Regardless of headache presence or absence, PTH subjects had longer pause

rates and reductions in vowel and consonant articulation precision relative to HC.

On days when speech was collected during a headache, there were longer pause rates, slower sentence speaking rates and less precise consonant articulation com- pared to the speech production of HC.

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During headache, PTH subjects had slower speaking rates yet more precise

vowel articulation compared to when they were headache-free.

Compared to HC, subjects with acute PTH demonstrate altered speech as mea-

sured by objective features of speech production.

For individuals with PTH, speech production may have been more effortful resulting in slower speaking rates and more precise vowel articulation during head- ache vs. when they were headache-free, suggesting that speech alterations were related to PTH and not solely due to the underlying mTBI.

Extended: Regardless of headache presence or absence, individuals with PTH had significantly reduced consonant precision (not normalized: p = 0.008; normal- ized: p  =  0.0015) and vowel precision (not normalized: p  =  0.007; normalized: p = 0.0368) and longer pause rates (0.0098) relative to healthy controls.

On days when PTH subjects had headache, subjects had significantly longer pause rates (p = 0.0043), slower sentence speaking rates (not normalized: p = 0.0369; normalized: p = 0.0137) and less precise vowel (not normalized: p = 0.049; normal- ized vowel articulation was not significant: p = 0.1948) and consonant articulation (not normalized: p = 0.0028; normalized: p = 0.0038) compared to healthy controls. During headache, PTH subjects had significantly slower sentence speaking rates (not normalized: p = 0.002; normalized: p < 0.0001) but more precise vowel articu- lation (normalized: p = 0.0052) compared to when they were headache-free. For individuals with PTH, history of headache or migraine was allowed. The overarching goal of this study was to determine whether objective features measured from speech samples obtained from individuals with acute PTH could provide a surrogate measure of headache burden, which could have utility in the future for tracking headache persistence and recovery.

Introduction A recent study that used a standardized speech production task demonstrated objec- tive changes in speech patterns in people with migraine during the attack relative to healthy controls, as well as within-subject changes during the attack compared to between-attacks [182].

In order to determine speech changes in individuals with PTH, we used a speech elicitation task embedded within a mobile app to assess objective measures of speech that relate to a combination of motor and cognitive-linguistic components of speech.

These measures were collected to: (1) investigate speech differences between individuals with PTH and healthy controls, and (2) assess whether individuals with PTH have speech changes during headaches compared to when they are headache-free.

The overarching goal of this study was to determine whether objective features measured from speech samples obtained from individuals with acute PTH could provide a surrogate measure of headache burden, which could have utility in the future for tracking headache persistence and recovery.

Methods The speech application was specifically developed for the objective evaluation of the following measures: sentence speaking rate, average pitch, pitch variance, vowel

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space area vowel and consonant articulation precision, and the spontaneous pause rate.

As part of the speech app, subjects were asked to read out loud five sentences (sentence reading task) and to use spontaneous speech to describe activities of the previous day (spontaneous speaking task).

The use of random slopes tests not only whether there was a mean difference in the metrics when subjects had a headache compared to when they were headache- free but it also tests the extent to which participants differed on their changes on speech measures (e.g., some participants might have very different speaking rates when they have a headache as compared to when they are headache-free, while oth- ers may not change much).

Results On days when PTH subjects had headache, subjects had significantly longer pause rates (p = 0.0043), slower sentence speaking rates (not normalized: p = 0.0369; nor- malized: p = 0.0137) and less precise vowel (not normalized: p = 0.049; normalized vowel articulation was not significant: p = 0.1948) and consonant articulation (not normalized: p = 0.0028; normalized: p = 0.0038) compared to healthy controls.

A significant p-value indicates that the mean speech measure differed signifi-

cantly between the control and PTH groups.

Discussion The results of this study demonstrate longer pause rates, slower sentence speaking rates and less precise vowel and consonant articulation in patients with PTH during headache compared to healthy controls as well as slower sentence speaking rates and altered vowel articulation in individuals with PTH during headache as com- pared to when PTH subjects were headache-free.

Individuals with PTH during headache also showed alterations in the precision

of articulation, specifically reduced vowel space area relative to healthy controls.

Subjects had depression symptoms within normal/healthy range, therefore we posit that reduced vowel space area may be a manifestation of either speech produc- tion under stress (i.e., headache pain intensity) or related to difficulties with speech- motor control due to the underlying mTBI.

Future studies are needed that assess speech features in subjects with mTBI with- out headache to subjects with PTH to specifically disentangle speech changes due to mTBI from speech changes due to headache.

Conclusion Our results indicated changes in speech rate and rhythm and alterations in precision of articulation in individuals with PTH to due mTBI relative to healthy controls as well as a reduction in sentence speaking rate and alterations in vowel articulation precision when individuals with PTH had a headache compared to when they were headache-free—potentially suggesting that PTH-related pain can modify healthy speech patterns.

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The current results indicate that speech detection using a speech application downloaded on a mobile device might be a practical, objective, and early rapid screening tool for assessing headache-related burden and may have potential for predicting headache recovery in subjects with acute PTH.

The recognition of speech changes in individuals with acute PTH could be important for identifying those individuals at ‘high risk’ for developing persistent post-traumatic headache and may allow physicians to begin headache treatment early, when it might be most effective, in order to prevent headache chronification. Relative to healthy controls, individuals with acute PTH show aberrations in

objective speech features.

Acknowledgement A machine generated summary based on the work of Chong, Catherine D.; Zhang, Jianwei; Li, Jing; Wu, Teresa; Dumkrieger, Gina; Nikolova, Simona; Ross, Katherine; Stegmann, Gabriela; Liss, Julie; Schwedt, Todd J.; Jayasuriya, Suren; Berisha, Visar 2021 in The Journal of Headache and Pain.

Persistent post-traumatic headache vs. migraine: an MRI study demonstrating differences in brain structure