Vestibular Evoked Myogenic Potentials: Clinical Implications of a Normative Investigation

from the Australian and New Zealand Journal of Audiology

Vestibular Evoked Myogenic Potential (VEMP) assessment may assist in the diagnosis of balance disorders. Currently, however, there are limited guidelines available for clinicians to maximise its application. This study aimed to develop procedures for ensuring reliable VEMP recordings in the clinical setting and to provide comprehensive normative data. VEMP responses from 30 normal adults were collected using the Biologic Navigator. The factors of stimulus type, frequency and intensity were considered. Only stimulus type had a significant effect on VEMP recordings, with responses from click stimuli having lower thresholds, shorter latencies and higher test–retest correlations than the tone burst stimuli. However, as the maximum click intensity of the system was 90 dB nHL, the click stimulus only elicited responses from 73.3% of ears. The results of this investigation, along with a review of the existing literature, have led to the creation of a clinical protocol for VEMP testing.

Brain Activation for Consonants and Vowels

from Cerebral Cortex

Previous behavioral and electrophysiological studies have shown dissociation between consonants and vowels. We used functional magnetic resonance imaging to investigate whether vowel and consonant processing differences are expressed in the neuronal activation pattern and whether they are modulated by task. The experimental design involved reading aloud and lexical decision on visually presented pseudowords created by transposing or replacing consonants or vowels in words. During reading aloud, changing vowels relative to consonants increased activation in a right middle temporal area previously associated with prosodic processing of speech input. In contrast, during lexical decision, changing consonants relative to vowels increased activation in a right middle frontal area associated with inhibiting go-responses. The task-sensitive nature of these effects demonstrates that consonants and vowels differ at a processing, rather than stimulus, level. We argue that prosodic processing of vowel changes arise during self-monitoring of speech output, whereas greater inhibition of go-responses to consonant changes follows insufficient lexico-semantic processing when nonwords looking particularly like words must be rejected. Our results are consistent with claims that vowels and consonants place differential demands on prosodic and lexico-semantic processing, respectively. They also highlight the different types of information that can be drawn from functional imaging and neuropsychological studies.

Dinner conversations with a trilingual two-year-old: Language socialization in a multilingual context

from First Language

Family dinner conversations can serve as a medium for the mutual involvement of children and parents in language socialization. In this study, early pragmatic development in a trilingual child is addressed from the perspective of the language dynamics of a multilingual family. How young children learn to adjust their speech to their interlocutors can be seen clearly in the language choices and the mixing patterns of the trilingual two-year-old. The child selected language(s) not only from the language(s) spoken to her but also with attention to her interlocutor’s linguistic proficiencies and the language context in which she found herself along a monolingual to trilingual continuum. She shifted languages in family dinner conversations according to the norms established in the home.

Evaluating Loss to Follow-up in Newborn Hearing Screening in Massachusetts

from Pediatrics

OBJECTIVE. The purpose of this work was to examine loss to follow-up on the use of diagnostic or intervention services for Massachusetts infants and children screened or diagnosed with hearing loss and risk factors for becoming lost to follow-up.

METHODS. We used data from the Massachusetts Childhood Hearing Data System and Early Intervention Information System. We calculated the percent use of audiologic evaluation for Massachusetts infants born in 2002–2003 who did not pass hearing screening and Early Intervention services for those with hearing loss. We generated crude and adjusted relative risks, as well as confidence intervals, to estimate associations of maternal and infant factors with the use of audiologic evaluation and early intervention services. Factors evaluated included child’s birth weight and hearing screening or diagnostic results and maternal age, race or ethnicity, marital status, smoking status during pregnancy, educational attainment, health insurance, and residence region.

RESULTS. In 2002–2003, 11% of Massachusetts children who did not pass hearing screening became lost to follow-up on the audiologic evaluation, and 25% of those with hearing loss did not receive early intervention services. Children were at higher risk of becoming lost to follow-up on audiologic evaluation if their mothers were nonwhite, covered by public insurance, smokers during pregnancy, or residing in western, northeastern, or southeastern Massachusetts compared with those in the Boston region. Of children with hearing loss, those with a unilateral or mild or moderate degree of hearing loss, normal birth weight, or living in the southeastern or Boston region were more likely to go without early intervention services.

CONCLUSIONS. Massachusetts has excellent follow-up rates overall. Our analyses allow the program to prioritize limited resources to subgroups of infants who are at high risk of becoming lost to follow-up.

Girls talk about dolls and boys about cars? Analyses of group and individual variation in Danish children’s first words

from First Language

Based on data from the Danish Longitudinal CDI study on 182 Danish children, we analyse aspects of variation in the children’s first 100 words (produced). First, we demonstrate the effect of gender and birth order (number of siblings) on acquisition times of first words by identifying single words which are significantly earlier in the productive repertoire of, for instance, girls versus boys. We also investigate the effect of the same factors on the composition of the vocabulary where the definition of categories (word classes) is based on the CDI’s thematic categorization. Finally, we investigate the individuality of the lexicon’s composition and find time-persistent differences between children for some word classes at this early stage.

Maternal uses of non-object terms in child-directed speech: Color, number and time

from First Language

Non-object terms including color, number and time words pose a challenge for word learning due in part to non-obvious word-referent mappings. Finding early word-word knowledge for such terms, Shatz has suggested that exposure to them in varied conversational contexts might facilitate word-word mappings. To address whether input feasibly carries such information, we examined longitudinal transcripts from the CHILDES database for the frequency and uses of subsets of color and number words in mothers’ speech to toddlers and of time words to preschoolers. All the mothers studied made varied uses of the terms from these lexical categories. The findings support the argument that varied conversational input provides useful data for children to create early word-word mappings for non-object terms.

Cortical language localization in left, dominant hemisphere

from the Journal of Neurosurgery

The localization of cortical sites essential for language was assessed by stimulation mapping in the left, dominant hemispheres of 117 patients. Sites were related to language when stimulation at a current below the threshold for afterdischarge evoked repeated statistically significant errors in object naming. The language center was highly localized in many patients to form several mosaics of 1 to 2 sq cm, usually one in the frontal and one or more in the temporoparietal lobe. The area of individual mosaics, and the total area related to language was usually much smaller than the traditional Broca-Wernicke areas. There was substantial individual variability in the exact location of language function, some of which correlated with the patient’s sex and verbal intelligence. These features were present for patients as young as 4 years and as old as 80 years, and for those with lesions acquired in early life or adulthood. These findings indicate a need for revision of the classical model of language localization. The combination of discrete localization in individual patients but substantial individual variability between patients also has major clinical implications for cortical resections of the dominant hemisphere, for it means that language cannot be reliably localized on anatomic criteria alone. A maximal resection with minimal risk of postoperative aphasia requires individual localization of language with a technique like stimulation mapping.

Population-Based Assessments of Ophthalmologic and Audiologic Follow-up in Children With Very Low Birth Weight Enrolled in Medicaid: A Quality-of-Care Study

from Pediatrics

OBJECTIVE. The purpose of our work was to determine whether children with very low birth weight (<1500 g) who are at high risk for vision and hearing problems and enrolled in Medicaid receive recommended follow-up vision and hearing services and to examine predictors of services.

PATIENTS AND METHODS. We conducted a retrospective analysis of 2182 children born in South Carolina from 1996 to 1998 with birth weights of 401 to 1499 g, gestations of 24 weeks, and survival of 90 days of life. Receipt of services for Medicaid-enrolled children was assessed by using a linked data set that included files from vital records, death certificates, Medicaid, Chronic Rehabilitative Services, and the Early Intervention Program. We assessed the receipt of hearing rehabilitation by 6 months of age for children with nonconductive hearing loss and routine ophthalmologic examination between ages of 1 and 2 years for all children with very low birth weight. Multivariate logistic regression was restricted to ophthalmologic examinations because of sample size.

RESULTS. Among children with very low birth weight with nonconductive hearing loss, 20% received hearing rehabilitation by 6 months of age. Twenty-three percent of children with very low birth weight received an ophthalmologic examination between the ages of 1 and 2 years. Limiting our analysis to children <1000 g or extending the measurement period to 7 months (hearing) and age 3 years (vision) did not substantially increase the percentage of children receiving the services. The receipt of an ophthalmologic examination was associated positively with Medicaid enrollment by the time of hospital discharge and birth in a level-3 hospital and negatively associated with higher birth weight, an Apgar score of 7, and black maternal race. Among children born at <1000 g, all of whom were eligible for the Early Intervention Program, the receipt of an ophthalmologic examination was positively associated with program enrollment.

CONCLUSIONS. There is a shortfall in the provision of critical services for children with very low birth weight. These findings reinforce the Institute of Medicine’s concerns regarding inadequate outcome data and health care services for preterm infants and support the importance of enrollment in the Early Intervention Program for children with very low birth weight.

Toddlers’ persistence when communication fails: Response motivation and goal substitution

from First Language

Communicative breakdowns were created in response to toddlers’ single-word requests by means of two feedback conditions: one involving goal substitution, the other stating explicitly that the speaker was not understood (i.e., `I don’t know what you mean’). Participants were 15 children, ages 17—25 months. Children typically abandoned their original requests in response to goal substitution but revised or repeated their requests when confronted with `I don’t know what you mean.’ Thus, in the early stages of language development, toddlers’ response persistence appeared to depend in large part upon motivation for goal attainment.

It’s either a cook or a baker: Patients with conduction aphasia get the gist but lose the trace

from Brain and Language

Patients with conduction aphasia have been characterized as having a short-term memory deficit that leads to relative difficulty on span and repetition tasks. It has also been observed that these same patients often get the gist of what is said to them, even if they are unable to repeat the information verbatim. To study this phenomenon experimentally, patients with conduction aphasia and left hemisphere-injured controls were tested on a repetition recognition task that required them to listen to a sentence and immediately point to one of three sentences that matched it. On some trials, the distractor sentences contained substituted words that were semantically-related to the target, and on other trials, the distractor sentences contained semantically-distinct words. Patients with conduction aphasia and controls performed well on the latter condition, when distractors were semantically-distinct. However, when the distractor sentences were semantically-related, the patients with conduction aphasia were impaired at identifying the target sentence, suggesting that these patients could not rely on the verbatim trace. To further understand these results, we also tested elderly controls on the same task, except that a delay was introduced between study and test. Like the patients with conduction aphasia, the elderly controls were worse at identifying target sentences when there were semantically-related distractors. Taken together, these results suggest that patients with conduction aphasia rely on non-phonologic cues, such as lexical-semantics, to support their short-term memory, just as normal participants must do in long-term memory tasks when the phonological trace is no longer present.

Salivary cortisol levels, subjective stress, and tinnitus intensity in tinnitus sufferers during noise exposure in the laboratory

from the International Journal of Hygiene and Environmental Health

Tinnitus, a chronic internal noise, is thought to increase in intensity during or following external noise exposure. Yet there is no empirical evidence for this complaint in the extant literature. Recently, cortisol has been advanced as a useful tool for studying the physiological effects of noise on stress, but few, if any, studies have examined the short-term effects of noise on cortisol levels in tinnitus sufferers. This study assesses the effects of noise exposure on cortisol levels and subjective stress in tinnitus participants and controls without tinnitus. Twenty tinnitus participants and 20 controls without tinnitus were exposed to a 20-min broadband noise with amplified low frequencies. Saliva samplings for cortisol analysis and subjective stress and tinnitus intensity ratings (for tinnitus participants) were performed at regular intervals throughout testing. Results show higher cortisol levels for both groups immediately before, immediately after, and 10min after the end of noise than at other time points. The tinnitus group had lower overall cortisol levels than controls. In contrast, subjective stress ratings were higher for the tinnitus group, and higher at midpoint and immediately after the noise ended. Tinnitus subjective intensity increased throughout testing, especially for the group with high tinnitus-related distress. Overall results show that noise exposure influences cortisol response, subjective stress, and tinnitus intensity.

A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children

from the American Journal of Speech-Language Pathology

Purpose: To review the content and psychometric characteristics of 6 published tests currently available to aid in the study, diagnosis, and treatment of motor speech disorders in children.

Method: We compared the content of the 6 tests and critically evaluated the degree to which important psychometric characteristics support the tests’ use for their defined purposes.

Results: The tests varied considerably in content and methods of test interpretation. Few of the tests documented efforts to support reliability and validity for their intended purposes, often when relevant information was probably available during the test’s development.

Conclusions: Problems with the reviewed tests appear related to overly broad plans for test development and inadequate attention to relevant psychometric principles during the development process. Recommendations are offered for future test revisions and development efforts that can benefit from recent research in test development and in pediatric motor speech disorders.

Comparison of Accuracy and Efficiency of Directed Scanning and Group-Item Scanning for Augmentative Communication Selection Techniques With Typically Developing Preschoolers

from the American Journal of Speech-Language Pathology

Purpose: Directed scanning and group-item scanning both represent options for increased scanning efficiency. This investigation compared accuracy and speed of selection with preschoolers using each scanning method. The study’s purpose was to describe performance characteristics of typically developing children and to provide a reliable assessment protocol to evaluate scanning skills.

Method: Investigators examined within-participant performance on an identity matching-to-sample task using directed and group-item scanning with 13 typically developing preschoolers. Children selected line-drawn symbols from a 36-symbol display configured for each scanning method.

Results: Children were more accurate using directed than group-item scanning. They required a greater number of cursor movements to accurately select symbols with group-item than with directed scanning; however, no differences in actual selection time were apparent. Further analyses comparing performance using group-item scanning for selections requiring either a low or a high number of cursor movements revealed no differences in children’s accuracy or efficiency.

Conclusions: Children were more accurate using directed scanning to select target symbols. However, directed scanning did not afford a relative advantage in children’s selection efficiency compared with group-item scanning. Performance using group-item scanning does not appear to be affected by requisite cursor movements for selection. Limitations and educational implications are discussed.

Preparation in Augmentative and Alternative Communication: An Update for Speech-Language Pathology Training

from the American Journal of Speech-Language Pathology

Purpose: To report on data from the current survey about academic and clinical education in augmentative and alternative communication (AAC), as well as to compare these findings with earlier surveys in an attempt to identify any changes being made as programs in the United States implement the new certification standards of the American Speech-Language-Hearing Association in the area of speech-language pathology.

Method: A survey was sent to all speech-language pathology training programs in the United States via e-mail directed to program directors or faculty teaching in AAC.

Results: A total of 168 surveys were returned, for a return rate of 57.93%. Seventy-three percent of the respondents had a separate course in AAC, and 80% indicated AAC content was infused in other courses.

Conclusions: Academic preparation in AAC, while varying across academic programs, has in general increased over the past decade. Data also suggested a continuing critical need for more academic and clinical preparation in this area.

A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease

from the Journal of Speech, Language, and Hearing Research

Purpose: This study was designed to identify which of 3 treatments for aspiration on thin liquids—chin-down posture, nectar-thickened liquids, or honey-thickened liquids—results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson’s disease.

Method: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study.

Results: Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids.

Conclusion: To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson’s disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient’s management plan. The longer-term impact of short-term prevention of aspiration requires further study.