Developing Digital Speech Biomarkers of Bulbar Disease Decline in Spanish-Speaking persons with Amyotrophic Lateral Sclerosis

. ALS is a rapidly progressive neurodegenerative disease in which 90% of patients will experience loss of speech and swallowing, significantly impacting quality of life and survival. Although the loss of speech and swallowing functions have been cited as the worst aspects of the disease, little is known about the trajectory of bulbar disease decline and thus interventions are primarily reactive in nature. Recent advances in remote data collection have enabled the assessment of bulbar decline through speech recordings; however, these tools have been validated exclusively in English, limiting their applicability to Spanish-language speakers. The primary aim of this project is to develop and validate digital biomarkers of bulbar decline in Spanish-speaking persons with ALS (pALS). Speech and respiratory parameters will be collected using a smartphone application in Spanish and compared to equivalent measures from Spanish-speaking caregivers, clinical outcomes (Spanish ALS Functional Rating Scale), and across ALS phenotypes (Aim 1). Additionally, we will assess the sensitivity of maximum phonation time in detecting changes in respiratory function (Aim 2). The project leverages innovative technology to improve disease management for pALS, enabling earlier detection of bulbar disease decline and earlier intervention to extend functional independence.