Reorganization of the cerebro-cerebellar network of language production in patients with congenital left-hemispheric brain lesions

from Brain and Language

Patients with congenital lesions of the left cerebral hemisphere may reorganize language functions into the right hemisphere. In these patients, language production is represented homotopically to the left-hemispheric language areas. We studied cerebellar activation in five patients with congenital lesions of the left cerebral hemisphere to assess if the language network is reorganized completely in these patients, i.e. including also cerebellar language functions. As compared to a group of controls matched for age, sex, and verbal IQ, the patients recruited an area not in the right but in the left cerebellar hemisphere. The extent of laterality of the cerebellar activation correlated significantly with the laterality of the frontal activation. We suggest that the developing brain reacts to early focal lesions in the left hemisphere with a mirror-image organization of the entire cerebro-cerebellar network engaged in speech production.

Does long-term unilateral deafness change auditory evoked potential asymmetries?

from Clinical Neurophysiology

OBJECTIVE: To investigate the long-term cortical changes in auditory evoked potential (AEP) asymmetries associated with profound unilateral deafness. METHODS: Electroencephalographic (EEG) recordings from 68 channels were used to measure auditory cortex responses to monaural stimulation from 7 unilaterally deaf patients and 7 audiogram-matched controls. Source localization of the AEP N100 response was carried out and regional source waveform amplitude and latency asymmetries were analysed for activity in the N100 latency range and for the middle latency response (MLR) range. RESULTS: Asymmetry indices (contralateral-ipsilateral)/(contralateral+ipsilateral) showed that matched control subjects, like normally hearing participants, produced activity in the N100 latency range that was more contralaterally dominant for left compared to right ear stimulation. Contrary to expectation, source waveforms and asymmetry indices in the MLR and N100 latency range were similar for unilaterally deaf patients, their matched controls and a group of normally hearing participants. CONCLUSIONS: Regional source waveform analysis revealed no evidence of systematic cortical changes in hemispheric asymmetries associated with long-term unilateral deafness. It is possible that a reorganization of cortical asymmetries to a ‘normal’ pattern had taken place in the years between deafness and testing. SIGNIFICANCE: Electrophysiological measures of auditory hemispheric asymmetries do not suggest long-term cortical reorganisation as a result of profound unilateral deafness.

Combined acoustic and electric hearing: Preserving residual acoustic hearing

from Hearing Research

The topic of this review is the strategy of preserving residual acoustic hearing in the implanted ear to provide combined electrical stimulation and acoustic hearing as a rehabilitative strategy for sensorineural hearing loss. This chapter will concentrate on research done with the Iowa/Nucleus 10 mm Hybrid device, but we will also attempt to summarize strategies and results from other groups around the world who use slightly different approaches. A number of studies have shown that preserving residual acoustic hearing in the implanted ear is a realistic goal for many patients with severe high-frequency hearing loss. The addition of the electric stimulation to their existing acoustic hearing can provide increased speech recognition for these patients. In addition, the preserved acoustic hearing can offer considerable advantages, as compared to a traditional cochlear implant, for tasks such as speech recognition in backgrounds or appreciation of music and other situations where the poor frequency resolution of electric stimulation has been a disadvantage.

Judging stuttering in an unfamiliar language: The importance of closeness to the native language

from Clinical Linguistics and Phonetics

In order to test the hypothesis that closeness to the listener’s native language is a determining factor when identifying stuttering in an unfamiliar language, three panels of different linguistic background were asked to make judgements of stuttering in a sample of Dutch speakers. It was found that a panel speaking Dutch and a panel speaking English (both West Germanic languages) performed better in identifying Dutch people who stutter and people who do not stutter than a panel speaking Brazilian Portuguese (a Romance language) thus confirming the existence of a closeness of language influence. Further analysis showed that when the native language is more remote from the unfamiliar language there is the possibility of a higher risk for false positive identification.

Narrative organization skills in children with attention deficit hyperactivity disorder and language impairment: Application of the causal network model

from Clinical Linguistics and Phonetics

Studies suggest that the oral narratives of children with attention deficit hyperactivity disorder (ADHD) are less organized than those of typically developing peers. Many studies, however, do not account for children’s language abilities. Because language impairment (LI) is a frequent comorbid condition in children with ADHD, this exploratory study investigated language abilities and narrative organization skills in children with and without ADHD. Narratives were elicited using the picture-sequence task and the single-picture task from the Test of Narrative Language (Gillam & Pearson, 2004). The causal network model (Trabasso, Van den Broek, & Suh, 1989) was applied to analyse the narratives. Specifically, narratives were examined to identify complete and incomplete superordinate and subordinate Goal-Attempt-Outcome (GAO) units. The results revealed no differences among the groups in the picture-sequence task. Children with ADHD+LI produced significantly fewer complete superordinate GAO units than typical children in the single-picture task. Theoretical and clinical implications are discussed.

Perception of the auditory-visual illusion in speech perception by children with phonological disorders

from Clinical Linguistics and Phonetics

Abstract
An example of the auditory-visual illusion in speech perception, first described by McGurk and MacDonald, is the perception of [ta] when listeners hear [pa] in synchrony with the lip movements for [ka]. One account of the illusion is that lip-read and heard speech are combined in an articulatory code since people who mispronounce words respond differently from controls on lip-reading tasks. A same-different judgment task assessing perception of the illusion showed no difference in performance between controls and children with speech difficulties. Another experiment compared children with delayed and disordered speech on perception of the illusion. While neither group perceived many illusions, a significant interaction indicated that children with disordered phonology were strongly biased to the auditory component while the delayed group’s response was more evenly split between the auditory and visual components of the illusion. These findings suggest that phonological processing, rather than articulation, supports lip-reading ability.

Speech fluency in fragile X syndrome

from Clinical Linguistics and Phonetics

Abstract
The present study investigated the dysfluencies in the speech of nine French speaking individuals with fragile X syndrome. Type, number, and loci of dysfluencies were analysed. The study confirms that dysfluencies are a common feature of the speech of individuals with fragile X syndrome but also indicates that the dysfluency pattern displayed is not identical to developmental stuttering. To what extent the pattern of dysfluency in individuals with fragile X syndrome is syndrome specific is not yet clear.

Influence of silence and attention on tinnitus perception

from Otolaryngology–Head and Neck Surgery

Objective
The purpose of this study was to study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal-hearing adults.

Study Design
Cross-sectional survey.

Subjects and Methods
While sitting in a sound booth, 66 volunteers (age range, 18-65; mean age, 37.3) performed 3 experiments of 5 minutes each, consecutively and randomly presented. Two deviated attention from auditory system (Hanoi and visual attention experiments), and 1 drove attention to the auditory system (auditory attention). After each experiment, participants were asked about their auditory and visual perception. No sound or light change was given at any moment.

Results
Of the participants, 19.7% experienced tinnitus during Hanoi, 45.5% during visual attention, and 68.2% during auditory attention experiment, with no significant differences for studied variables.

Conclusion
Tinnitus-like perceptions may occur in a nonclinical population in a silent environment. Concomitant auditory attention plays an important role on the emergence of tinnitus.

Retrocochlear mass lesion in mid-frequency sudden deafness

from Otolaryngology–Head and Neck Surgery

Objective
This study retrospectively reviewed all cases of mid-frequency sudden deafness to understand the clinical significance of this hallmark finding.

Study Design
Retrospective study.

Subjects and Methods
From 1992 to 2006, a total of 556 patients with sudden deafness were experienced. Based on the audiographic configuration, these patients were classified into: flat-type group, 272 cases; high-frequency group, 146 cases; low-frequency group, 70 cases; mid-frequency group, 30 cases; and unclassified group, 38 cases. All patients underwent a battery of audiovestibular function testing.

Results
Among 556 sudden deafness patients, 17 patients (3%) were proved to have a retrocochlear tumor, including mid-frequency group (10), high-frequency group (4), flat-type group (2), and low-frequency group (1). Thus, the mid-frequency group had significantly higher (33%) association with a retrocochlear tumor than other groups.

Conclusion
One-third of the patients with mid-frequency sudden deafness harbor a true retrocochlear mass lesion; hence, MR imaging is mandatory in such cases.

Speech understandability of repaired cleft palate patients pre and post caregiver training

from the Indian Journal of Plastic Surgery

Background: Treating speech and language problems in repaired cleft palate patients in India is still an uphill task due to lack of facilities. This study attempted to use parents as team members for the speech management of cleft palate patients in Andhra Pradesh, India. Objectives: To investigate whether a positive change in speech understandability for individuals with cleft palate will result from a parent-administered intervention program. Materials and Methods: Twenty-eight parents had enrolled for the speech camp held in September 2004. The parent-training program at the speech camp ensured that parents were given adequate awareness. Out of the 28, 18 (64.28%) reported for one follow-up, referred to in this article as Group I. Ten (35.72%) out of the 28 came for two consecutive follow-ups, referred to in this article as Group II. Results: Pre and post training understandability scores obtained in the known context (reciting a familiar poem in the native language, counting 1 to 10) and unknown context (peer group names, family information, describing their journey from home to hospital) for Group I and Group II were evaluated. Results revealed that a higher percentage of cases showed significant improvement in understandability in the unknown context after treatment. Unknown context can be considered a measure to assess speech understandability after training. Further, it shows that parent training without practice at home may not show the desired results. Conclusion: This study reveals that parents can effect a positive change in the speech understandability of their children following training, provided the exercises are carried out regularly at home and the parents report for the follow-up assessments and guidance.

The use of Sanskrit, an ancient language, as a tool to evaluate cleft palate speech problems

from the Indian Journal of Plastic Surgery

Speech is a complex process. The evaluation of speech in an individual with cleft palate is difficult, and the existing classification of phonemes is complicated.
Sanskrit, an ancient language, has an arrangement of alphabets that is orderly and scientific and therefore provides a simple means to understand the production of phonemes and memorize them. This article demonstrates the inherent advantage of this arrangement of Sanskrit alphabets to effectively analyze defective cleft palate speech and provides a tool for surgeons to decide a course of action in their routine clinical practice. Improved insight into the speech defect by the surgeon also facilitates better coordination with the speech language pathologist in assessment and treatment of a child with cleft palate.

The effect of home computer practice on naming in individuals with nonfluent aphasia and verbal apraxia

from the Journal of Medical Speech-Language Pathology

This study investigated the impact of daily home computer practice on oral naming of pictures by comparing performance with two other conditions: weekly clinician-only therapy sessions (with no computer) and no treatment. The four participants were diagnosed with nonfluent aphasia and verbal apraxia. For 13 weeks, the participants practiced naming three sets of 10 drawings. Each set was assigned to one of three conditions: independent use of a home computer program (Computer Practice), weekly therapy sessions with a clinician and no computer progr am (Weekly Practice), or no practice (Control). Performance on the stimuli was assessed at the beginning of the study (Baseline), during treatment, at the end of the treatment (Assessment 3), and 5 weeks posttreatment (Maintenance). With Computer Practice, two participants improved statistically (and one approached significance) from Baseline to Assessment 3. From Baseline to Maintenance, three participants maintained statistically significant gains. With Weekly Practice, only one participant improved statistically from Baseline to Assessment 3, and there were no significant improvements from Baseline to Maintenance. The Control condition resulted in no significant improvements in any participant. The results suggest that computer programs are a practical way to provide practice that is relatively independent and appropriate for individuals with aphasia and apraxia.

The effects of supravalvular aortic stenosis elastin gene mutation on voice production

from the Journal of Medical Speech-Language Pathology

Supravalvular aortic stenosis (SVAS) is an autosomal dominant disease that can occur as a part of Williams syndrome or as an isolated condition. It is caused by loss of function mutations within the elastin (ELN) gene leading to a quantitative reduction of elastic fibers due to abnormal elastogenesis. Elastic fibers are known to be present in normal vocal folds. To test the hypothesis that elastic fibers are necessary for normal physiology of the human vocal fold, we have investigated quantitative characteristics of voice production in six individuals (five adults and one child) with positive elastin mutation status compared to age and gender matched normal controls. The voice in all adult SVAS participants was characterized by a low speaking fundamental frequency and greater spectral tilt. The male SVAS participants, who manifested the greatest degree of SVAS phenotypic expression, also produced a limited physiological frequency range. We conclude that elastin haploinsufficiency uniquely influences vocal production characteristics, highlighting the role of elastin in regulating the pitch and range of human voice by contributing to specific vibrational properties of the vocal fold.

Progressive aphasia secondary to Alzheimer disease vs FTLD pathology

from Neurology

Background: The pathology causing progressive aphasia is typically a variant of frontotemporal lobar degeneration, especially with ubiquitin-positive inclusions (FTLD-U). Less commonly the underlying pathology is Alzheimer disease (AD).

Objective: To compare clinicopathologic and MRI features of subjects with progressive aphasia and AD pathology to subjects with aphasia and FTLD-U pathology and subjects with typical AD.

Methods: We identified 5 subjects with aphasia and AD pathology and 5 with aphasia and FTLD-U pathology with an MRI from a total of 216 aphasia subjects. Ten subjects with typical AD clinical features and AD pathology were also identified. All subjects with AD pathology underwent pathologic reanalysis with TDP-43 immunohistochemistry. Voxel-based morphometry (VBM) was used to assess patterns of gray matter atrophy in the aphasia cases with AD pathology, aphasia cases with FTLD-U, and typical AD cases with AD pathology, compared with a normal control group.

Results: All aphasic subjects had fluent speech output. However, those with AD pathology had better processing speed than those with FTLD-U pathology. Immunohistochemistry with TDP-43 antibodies was negative. VBM revealed gray matter atrophy predominantly in the temporoparietal cortices, with notable sparing of the hippocampus in the aphasia with AD subjects. In comparison, the aphasic subjects with FTLD-U showed sparing of the parietal lobe. Typical AD subjects showed temporoparietal and hippocampal atrophy.

Conclusions: A temporoparietal pattern of atrophy on MRI in patients with progressive fluent aphasia and relatively preserved processing speed is suggestive of underlying Alzheimer disease pathology rather than frontotemporal lobar degeneration with ubiquitin-only immunoreactive changes.

The Mini-Mental State Examination in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

from the American Journal of Alzheimer’s Disease and Other Dementias

There is little information regarding the usefulness of the Mini-Mental State Examination (MMSE) for tracking progression of non-Alzheimer’s disease dementias. This study examined the utility of the MMSE in capturing disease severity in the behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA), 2 nonamnestic clinical dementia syndromes. Retrospective data from 41 bvFTD and 30 PPA patients were analyzed. bvFTD patients’ change in MMSE scores over time was significantly correlated with change over time on a measure of activities of daily living. In contrast, PPA patients’ MMSE scores showed greater decline over time than scores on the activities of daily living scale. Results suggest that the MMSE score, heavily dependent on language skill, overestimates dementia severity in PPA patients. However, the score may be a more accurate measure of functional impairment in bvFTD due to the influence of their executive function and attentional deficits on MMSE performance.