Impact of early hearing screening and treatment on language development and education level: Evaluation of 6 years of universal newborn hearing screening (ALGO((R))) in Flanders, Belgium

from the International Journal of Pediatric Otorhinolaryngology

OBJECTIVES: Early intervention in hearing-impaired children may improve language outcomes and subsequent school and occupational performance. The objective of this study was to retrospectively analyze over 6 years the educational outcome and language development of a first cohort of children, detected by the Flemish universal newborn hearing screening (UNHS) program based on automated auditory brainstem response (AABR), with the oldest children being in primary school. METHODS: We studied 229 hearing-impaired children from 1998 till 2003. The following variables were considered: the age during the school year 2005-2006, the degree of hearing loss, additional impairments including presence of intellectual disability, school placement and early intervention. RESULTS: Analysis showed that 85.4% of the children with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Further detailed description was provided for the outcomes of children with uni- and bilateral cochlear implants. Overall results stress that 46% of all children with a cochlear implant obtain mainstream education. Of all cochlear implant (CI) children above 5.5 years, without additional handicaps, 78.9% of children attend primary mainstream school. Data on language development show that up to 45% of the children with unilateral cochlear implant and no additional disabilities had normal to slight delay on language development. These data are fulfilling the goals stated by the JCIH and the American Academy of Pediatrics (AAP) in 2000. The role and impact of additional handicaps is discussed. The importance of early hearing loss identification and hearing therapy for appropriate language development is highlighted. Finally our preliminary results on children with bilateral cochlear implants without additional handicaps present an improved language development in comparison to unilateral CI-children. CONCLUSION: A vast majority of the children detected by the UNHS program, with moderate, severe or profound hearing loss and no additional disability, older than 5.5 years, reach mainstream education. Additional disabilities have a major influence.

Performance benefits for adults using a cochlear implant with adaptive dynamic range optimization (ADRO): a comparative study

from Cochlear Implants Internations

The aim of this study was to assess the qualitative and quantitative benefits for speech-recognition ability of a preprocessing strategy known as adaptive dynamic range optimization (ADRO), used in conjunction with the subject’s standard MAP, in comparison with the subject’s standard MAP alone, for a group of experienced German-speaking adults using the Nucleus® 24 Cochlear implant.
In a prospective, single-subject, comparative study design, experienced adult CI-users were asked to trial and compare both their standard MAP and the newly fitted ADRO MAP (ADRO MAP fitting – week 0) following a take-home trial period of 5 weeks. Assessment of speech recognition ability performed in quiet (at 50, 60 and 70 dB SPL) and adaptively in noise was carried out repeatedly in two test sessions in weeks 5 and 7 (ADRO MAP postfitting) using both MAPs. The order of speech tests and MAPs tested was counterbalanced across the test sessions to control for potential learning effects during the study. Subjective assessments were performed at week 0 to assess details of current usage. Comparative subjective assessments were carried out at weeks 5 and 7 to obtain impressions of loudness of environmental sounds and speech understanding in a variety of conversational situations with both MAPs and finally MAP preference judgements.
Fifteen adult, German-speaking, experienced implant users wearing their body-worn SPrint processor for a minimum of six hours and up to 16 hours per day were enrolled in the study across three university clinic hospitals in Germany.
On average, speech-reception thresholds (SRT) were significantly improved with the ADRO MAP compared to using the standard MAP for all speech materials in quiet. The mean advantage for SRT values with the ADRO MAP was 2.9 dB, ± 2.8 dB (p = 0.002) for the Freiburger Numbers test and 3.3 dB, ± 3.2 dB (p = 0.008) for the Freiburger Monosyllabic Words test. In noise, the ADRO MAP led to a significant improvement for the group for the mean signal-to-noise ratio required for a 50% speech recognition score (SNR 50) for the Oldenburger sentences of 1.74 dB, ± 3.2 dB (p = 0.048). Comparison of subjective impressions of loudness of environmental sounds revealed no significant difference in the ratings observed with either MAP. For speech understanding in a variety of listening situations, 35% of subjects preferred the ADRO MAP, 29% preferred the standard MAP whereas 36% reported no difference. Statistically the MAP preferences for the groups were not significant, however a significant MAP preference was noted in four subjects for the ADRO MAP and in two subjects for the standard MAP.
Our study results demonstrate significant benefits of ADRO for speech recognition ability in quiet and in noise for both soft and conversational levels of speech. For the majority of subjects, both the ADRO and standard MAPs were found to be useful on a daily basis. No reductions in performance were noted for speech recognition or loudness scaling judgements of environmental sounds when using the newly fitted ADRO MAP, suggesting a smooth transition to the use of the preprocessing algorithm. It is recommended that an ADRO MAP be provided for all CI users as an additional program option to offer potential added benefit in select environments. Copyright © 2008 John Wiley & Sons, Ltd.

The influence of syllable onset complexity and syllable frequency on speech motor control

from Brain and Language

Functional imaging studies have delineated a “minimal network for overt speech production”, encompassing mesiofrontal structures (supplementary motor area, anterior cingulate gyrus), bilateral pre- and postcentral convolutions, extending rostrally into posterior parts of the inferior frontal gyrus (IFG) of the language-dominant hemisphere, left anterior insula as well as bilateral components of the basal ganglia, the cerebellum, and the thalamus. In order to further elucidate the specific contribution of these cerebral regions to speech motor planning, subjects were asked to read aloud visually presented bisyllabic pseudowords during functional magnetic resonance imaging (fMRI). The test stimuli systematically varied in onset complexity (CCV versus CV) and frequency of occurrence (high-frequency, HF versus low-frequency, LF) of the initial syllable. A cognitive subtraction approach revealed a significant main effect of syllable onset complexity (CCV versus CV) at the level of left posterior IFG, left anterior insula, and both cerebellar hemispheres. Conceivably, these areas closely cooperate in the sequencing of subsyllabic aspects of the sound structure of verbal utterances. A significant main effect of syllable frequency (LF versus HF), by contrast, did not emerge. However, calculation of the time series of hemodynamic activation within the various cerebral structures engaged in speech motor control revealed this factor to enhance functional connectivity between Broca’s area and ipsilateral anterior insula.

Cochlear Implant Supports an Author’s Active Life

from the New York Times

Josh Swiller was 22 and profoundly deaf when he applied to the Peace Corps in search of adventure. And indeed, adventure he found. His experiences in Zambia are eloquently recounted in his hard-to-put-down memoir of deafness and Africa, “The Unheard” (Holt, 2007). . . .

Functional outcome after total and subtotal glossectomy with free flap reconstruction

from Head and Neck

Background
The aim of this study was to evaluate postoperative oral functions of patients who had undergone total or subtotal (75%) glossectomy with preservation of the larynx for oral squamous cell carcinomas.

Methods
Speech intelligibility and swallowing capacity of 17 patients who had been treated between 1992 and 2002 were scored and classified using standard protocols 6 to 36 months postoperatively. The outcomes were finally rated as good, acceptable, or poor.

Results
The 4-year disease-specific survival rate was 64%. Speech intelligibility and swallowing capacity were satisfactory (acceptable or good) in 82.3%. Only 3 patients were still dependent on tube feeding. Good speech perceptibility did not always go together with normal diet tolerance, however.

Conclusions
Our satisfactory results are attributable to the use of large, voluminous soft tissue flaps for reconstruction, and to the instigation of postoperative swallowing and speech therapy on a routine basis and at an early juncture. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Speech Handicap Index in patients with oral and pharyngeal cancer: Better understanding of patients’ complaints

from Head and Neck

Background
A Speech Handicap Index (SHI) questionnaire with 30 items on speech problems was developed and validated in 92 patients with cancer of the oral cavity or pharynx and 110 healthy subjects.

Methods
All subjects completed the SHI and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head & Neck module (QLQ-H&N35). Twenty-nine patients completed the SHI twice to assess test-retest reliability.

Results
Factor analysis identified 2 well-defined subscales, assessing speech function and psychosocial functioning related to speech. Internal consistency and test-retest reliability were high. Construct validity was evidenced by its ability to distinguish between patient subgroups formed on the basis of tumor grade. A cut-off score of 6 points was defined to identify patients with speech problems.

Conclusions
Results of this initial psychometric study indicate that the SHI is a reliable and valid questionnaire for assessing speech problems. Additional research is needed to evaluate responsiveness of the questionnaire to changes in speech-related problems over time. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Aphasia during the Acute Phase in Ischemic Stroke

from Cerebrovascular Diseases

Objectives: We investigated the incidence, clinical characteristics, outcome and factors associated with aphasia and early improvement in acute ischemic stroke. Methods: We consecutively studied 855 patients with acute ischemic stroke who were admitted to our hospital within 48 h after onset and who were not comatose on admission. Assessment of aphasia was performed on admission (day 0) and day 10. We examined the incidence, severity, and subtypes of aphasia, and compared the clinical background of patients with and without aphasia on admission, and also those with and without early improvement by day 10. In addition, we investigated the independent factors associated with the presence of aphasia on admission and with early improvement. Results: Of the 855 patients, 130 (15.2%) had aphasia on admission. The National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.21; 95% CI 1.17-1.26) was a significant and independent factor associated with the presence of aphasia on admission. Early improvement was seen in 56 of 121 aphasic patients (46.3%) who were still alive on day 10. A history of hypercholesterolemia (OR 3.27; 95% CI 1.14-9.39) was a significant and independent factor associated with early improvement in aphasia during the acute phase and NIHSS on admission (OR 0.95; 95% CI 0.90-0.99) was marginally significant. Conclusion: It is difficult to predict the outcome of aphasia within the first few days after the onset of ischemic stroke.

Development of word reading fluency and spelling in a consistent orthography: An 8-year follow-up

from the Journal of Educational Psychology

In a longitudinal study, development of word reading fluency and spelling were followed for almost 8 years. In a group of 115 students (65 girls, 50 boys) acquiring the phonologically transparent German orthography, prediction measures (letter knowledge, phonological short-term memory, phonological awareness, rapid automatized naming, and nonverbal IQ) were assessed at the beginning of Grade 1; reading fluency and spelling were tested at the end of Grade 1 as well as in Grades 4 and 8. Reading accuracy was close to ceiling in all reading assessments, such that reading fluency was not heavily influenced by differences in reading accuracy. High stability was observed for word reading fluency development. Of the dysfluent readers in Grade 1, 70% were still poor readers in Grade 8. For spelling, children who at the end of Grade 1 still had problems translating spoken words into phonologically plausible letter sequences developed problems with orthographic spelling later on. The strongest specific predictors were rapid automatized naming for reading fluency and phonological awareness for spelling. Word recognition speed was a relevant and highly stable indicator of reading skills and the only indicator that discriminated reading skill levels in consistent orthographies. Its long-term development was more strongly influenced by early naming speed than by phonological awareness. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Early first-language reading and spelling skills predict later second-language reading and spelling skills

from the Journal of Educational Psychology

This prospective study examined early first-language (L1) predictors of later second-language (L2) reading (word decoding, comprehension) and spelling skills by conducting a series of multiple regressions. Measures of L1 word decoding, spelling, reading comprehension, phonological awareness, receptive vocabulary, and listening comprehension administered in the 1st through 5th grades were used as predictors of L2 reading (word decoding, comprehension) and spelling skills in high school. The best predictor of L2 decoding skill was a measure of L1 decoding, and the best predictors of L2 spelling were L1 spelling and L1 phonological awareness. The best predictor of L2 reading comprehension was a measure of L1 reading comprehension. When L2 word decoding skill replaced L1 word decoding as a predictor variable for L2 reading comprehension, results showed that L2 word decoding was an important predictor of L2 reading comprehension. The findings suggest that even several years after students learn to read and spell their L1, word decoding, spelling, and reading comprehension skills transfer from L1 to L2. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Early identification of reading difficulties using heterogeneous developmental trajectories

from the Journal of Educational Psychology

Serious conceptual and procedural problems associated with current diagnostic methods call for alternative approaches to assessing and diagnosing students with reading problems. This study presents a new analytic model to improve the classification and prediction of children’s reading development. Growth mixture modeling was used to identify the presence of 10 different heterogeneous developmental patterns. In all, 411 children in kindergarten through Grade 2 from 3 elementary schools in Texas were administered measures of phonological awareness, word recognition, and rapid naming skills 4 times a year. The mean ages were 5.8 years (SD = 0.35) for the kindergartners, 6.9 years (SD = 0.39) for Grade 1, and 8.0 years (SD = 0.43) for Grade 2; the percentage of boys was 50%. The results indicate that precursor reading skills such as phonological awareness and rapid naming are highly predictive of word reading (word recognition) and that developmental profiles formed in kindergarten are directly associated with development in Grades 1 and 2. Students identified as having reading-related difficulties in kindergarten exhibited slower development of word recognition skills in subsequent years of the study. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Text comprehension in Chinese children: Relative contribution of verbal working memory, pseudoword reading, rapid automated naming, and onset-rime phonological segmentation

from the Journal of Educational Psychology

The present study examined the role of verbal working memory (memory span, tongue twister), 2-character Chinese pseudoword reading, rapid automatized naming (letters, numbers), and phonological segmentation (deletion of rimes and onsets) in inferential text comprehension in Chinese in 518 Chinese children in Hong Kong in Grades 3 to 5. It was hypothesized that verbal working memory, together with a small contribution from the other constructs, would explain individual variation in the children’s text comprehension. Structural equation modeling and hierarchical multiple regression analyses generally upheld the hypotheses. Though Chinese pseudoword reading did not play an important mediating role in the effect of verbal working memory on text comprehension, verbal working memory had strong effects on pseudoword reading and text comprehension. The findings on the Chinese language support current Western literature as well as display the differential role of the constructs in Chinese reading comprehension. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

The mnemonic value of orthography for vocabulary learning

from the Journal of Educational Psychology

In 2 experiments, the authors examined whether spellings improve students’ memory for pronunciations and meanings of new vocabulary words. Lower socioeconomic status minority 2nd graders (M = 7 years 7 months; n = 20) and 5th graders (M = 10 years 11 months; n = 32) were taught 2 sets of unfamiliar nouns and their meanings over several learning trials. The words were defined, depicted, and embedded in sentences. During study periods, students were shown written forms of 1 set but not the other set. Spellings were not present during word recall. Results of analyses of variance showed that spellings enhanced memory for pronunciations and meanings compared to no spellings (ps < .01). Better readers and spellers increasingly outdistanced poorer readers and spellers in remembering pronunciations over trials when spellings accompanied learning (p < .05), suggesting a Matthew effect. An explanation is that spellings activated graphophonemic connections to better secure pronunciations and meanings in memory. Results indicate that orthographic knowledge benefited vocabulary learning and diminished dependence on phonological memory. Instructional implications are that teachers should include written words as part of vocabulary instruction and that students should pronounce spellings as well as determine meanings when they encounter new vocabulary words. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Precursors of Dyslexia in Early Conversational Turn Exchange

from Topics in Language Disorders

This study investigated conversational timing patterns among 22 children aged 3 years as each interacted with an adult. Most of the children were at high familial risk for dyslexia. When reading was tested in grade school, a group of 11 children was found to have dyslexia and the remaining 11 children read normally. At the age of 3 years, the 2 groups showed different patterns of timing in conversation. In comparison with children without dyslexia, those with dyslexia were significantly more likely to wait for adults to finish their speaking turn, and then offer a response that was semantically related to the adult’s speech. The 2 groups did not differ in the percentage of no-responses defined as an absence of speech during the 2 seconds following the completion of an adult speaking turn. The results are discussed in terms of speech timing during child–adult interaction and spoken language deficits in dyslexia.

Magnetic resonance imaging with the Digisonic SP Neurelec cochlear implant

from the European Archives of Oto-Rhino-Laryngology

Abstract The goal of this study was to evaluate the MR compatibility of the Neurelec Digisonic SP cochlear implant by performing in vitro and in vivo tests. All tests were performed on 1.5 T machine. Torque and force were measured to observe a potential displacement of the internal receiver. Demagnetisation of the internal magnet was monitored inside the MRI scanner and outside the MRI scanner (in the MRI room). Potential-induced voltage on electrodes was measured in vitro, performing the usual MR sequences. Heating around the internal receiver was measured after the same MR sequences. Following in vitro tests, in vivo MR imaging (brain and posterior fossa MRI) was performed to evaluate the induced signal void and geometrical distortion. In vivo test was performed with one volunteer who had a cochlear implant device fixed to the surface of the skin with a bandage. All the in vitro tests were in compliance with standard EN 45502-2-3 relating to Cochlear Implants. In vivo MRI scans demonstrated an image distortion for spin echo sequences of 7 cm maximum around the internal magnet. Magnetic resonance imaging with the Neurelec Digisonic SP cochlear implant is possible with no measurable adverse effects for either the patient or the device. Image artefact around the internal magnet, however, is unavoidable.