Monthly Archives: July 2009
Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique
Background: Auditory Processing Disorder (APD) does not feature in mainstream diagnostic classifications such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), but is frequently diagnosed in the United States, Australia and New Zealand, and is becoming more frequently diagnosed in the United Kingdom.
Aims: To familiarize readers with current controversies surrounding APD, with an emphasis on how APD might be conceptualized in relation to language and reading problems, attentional problems and autistic spectrum disorders.
Methods & Procedures: Different conceptual and diagnostic approaches adopted by audiologists and psychologists can lead to a confusing picture whereby the child who is regarded as having a specific learning disability by one group of experts may be given an APD diagnosis by another. While this could be indicative of co-morbidity, there are concerns that different professional groups are using different labels for the same symptoms.
Conclusions & Implications: APD, as currently diagnosed, is not a coherent category, but that rather than abandoning the construct, we need to develop improved methods for assessment and diagnosis, with a focus on interdisciplinary evaluation.
from the International Journal of Language and Communication Disorders
Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique
Background: Auditory Processing Disorder (APD) does not feature in mainstream diagnostic classifications such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), but is frequently diagnosed in the United States, Australia and New Zealand, and is becoming more frequently diagnosed in the United Kingdom.
Aims: To familiarize readers with current controversies surrounding APD, with an emphasis on how APD might be conceptualized in relation to language and reading problems, attentional problems and autistic spectrum disorders.
Methods & Procedures: Different conceptual and diagnostic approaches adopted by audiologists and psychologists can lead to a confusing picture whereby the child who is regarded as having a specific learning disability by one group of experts may be given an APD diagnosis by another. While this could be indicative of co-morbidity, there are concerns that different professional groups are using different labels for the same symptoms.
Conclusions & Implications: APD, as currently diagnosed, is not a coherent category, but that rather than abandoning the construct, we need to develop improved methods for assessment and diagnosis, with a focus on interdisciplinary evaluation.
from the International Journal of Language and Communication Disorders
Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique
Background: Auditory Processing Disorder (APD) does not feature in mainstream diagnostic classifications such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), but is frequently diagnosed in the United States, Australia and New Zealand, and is becoming more frequently diagnosed in the United Kingdom.
Aims: To familiarize readers with current controversies surrounding APD, with an emphasis on how APD might be conceptualized in relation to language and reading problems, attentional problems and autistic spectrum disorders.
Methods & Procedures: Different conceptual and diagnostic approaches adopted by audiologists and psychologists can lead to a confusing picture whereby the child who is regarded as having a specific learning disability by one group of experts may be given an APD diagnosis by another. While this could be indicative of co-morbidity, there are concerns that different professional groups are using different labels for the same symptoms.
Conclusions & Implications: APD, as currently diagnosed, is not a coherent category, but that rather than abandoning the construct, we need to develop improved methods for assessment and diagnosis, with a focus on interdisciplinary evaluation.
from the International Journal of Language and Communication Disorders
Cleft Audit Protocol for Speech (CAPS-A): a comprehensive training package for speech analysis
Methods & Procedures: Thirty-six specialist speech and language therapists undertook the training programme over four days. This consisted of two days’ training on the CAPS-A tool followed by a third day, making independent ratings and transcriptions on ten new cases which had been previously recorded during routine audit data collection. This task was repeated on day 4, a minimum of one month later. Ratings were made using the CAPS-A record form with the CAPS-A definition table. An analysis was made of the speech and language therapists’ CAPS-A ratings at occasion 1 and occasion 2 and the intra- and inter-rater reliability calculated.
Outcomes & Results: Trained therapists showed consistency in individual judgements on specific sections of the tool. Intraclass correlation coefficients were calculated for each section with good agreement on eight of 13 sections. There were only fair levels of agreement on anterior oral cleft speech characteristics, non-cleft errors/immaturities and voice. This was explained, at least in part, by their low prevalence which affects the calculation of the intraclass correlation coefficient statistic.
Conclusions & Implications: Speech and language therapists benefited from training on the CAPS-A, focusing on specific aspects of speech using definitions of parameters and scalar points, in order to apply the tool systematically and reliably. Ratings are enhanced by ensuring a high degree of attention to the nature of the data, standardizing the speech sample, data acquisition, the listening process together with the use of high-quality recording and playback equipment. In addition, a method is proposed for maintaining listening skills following training as part of an individual’s continuing education.
from the International Journal of Language and Communication Disorders
Cognitive-linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis
Methods & Procedures: The Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles and Tomoeda 1993), The Assessment of Intelligibility of Dysarthric Speech (AIDS) Sentence Intelligibility Task (Yorkston and Beukelman 1984), and the Modified Barthel Activities of Daily Living Index (MBADLI) (Shah 1998) were administered to 24 chronic progressive multiple sclerosis participants with dysarthria. A total of 24 non-neurologically impaired participants, matched for gender, age and education, formed a control group.
Outcomes & Results: For multiple sclerosis participants, linear regression analysis showed a strong association between ABCD and AIDS (β = 0.89, p = 0.005), no association between ABCD and either MBADLI or time since onset, a strong association between AIDS and MBADLI (β = 0.60, p = 0.001), and a trend towards an association between AIDS and time since onset (β = -0.29, p = 0.08). Correlations between the four included ABCD construct scores and between these and the total ABCD score were significant (r>0.60, p<0.01). For each of the 15 included ABCD measures and for the four construct scores and the overall ABCD score, multiple sclerosis and control group performances were significantly different (p0.80).
Conclusions & Implications: The results revealed a strong association between dysarthria, as measured by connected speech intelligibility testing, and cognitive-linguistic deficit, in people with chronic progressive-type multiple sclerosis. While some of the impairments that are associated with multiple sclerosis, including motor speech disorder, may influence performance on the ABCD, the data support the conclusion that marked cognitive-linguistic deficit is present in chronic progressive-type multiple sclerosis patients with dysarthria. Deterioration was global, rather than being indicative of a construct specific deficit, and encompassed language, both expression and comprehension. Episodic memory and linguistic expression were especially affected. Speech and language therapists who work with dysarthric patients with chronic progressive multiple sclerosis should monitor cognitive-linguistic impairment. An awareness of this might influence assessment, intervention and management, including the information and advice given to patients and their relatives.
from the International Journal of Language and Communication Disorders
Cognitive-linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis
Methods & Procedures: The Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles and Tomoeda 1993), The Assessment of Intelligibility of Dysarthric Speech (AIDS) Sentence Intelligibility Task (Yorkston and Beukelman 1984), and the Modified Barthel Activities of Daily Living Index (MBADLI) (Shah 1998) were administered to 24 chronic progressive multiple sclerosis participants with dysarthria. A total of 24 non-neurologically impaired participants, matched for gender, age and education, formed a control group.
Outcomes & Results: For multiple sclerosis participants, linear regression analysis showed a strong association between ABCD and AIDS (β = 0.89, p = 0.005), no association between ABCD and either MBADLI or time since onset, a strong association between AIDS and MBADLI (β = 0.60, p = 0.001), and a trend towards an association between AIDS and time since onset (β = -0.29, p = 0.08). Correlations between the four included ABCD construct scores and between these and the total ABCD score were significant (r>0.60, p<0.01). For each of the 15 included ABCD measures and for the four construct scores and the overall ABCD score, multiple sclerosis and control group performances were significantly different (p0.80).
Conclusions & Implications: The results revealed a strong association between dysarthria, as measured by connected speech intelligibility testing, and cognitive-linguistic deficit, in people with chronic progressive-type multiple sclerosis. While some of the impairments that are associated with multiple sclerosis, including motor speech disorder, may influence performance on the ABCD, the data support the conclusion that marked cognitive-linguistic deficit is present in chronic progressive-type multiple sclerosis patients with dysarthria. Deterioration was global, rather than being indicative of a construct specific deficit, and encompassed language, both expression and comprehension. Episodic memory and linguistic expression were especially affected. Speech and language therapists who work with dysarthric patients with chronic progressive multiple sclerosis should monitor cognitive-linguistic impairment. An awareness of this might influence assessment, intervention and management, including the information and advice given to patients and their relatives.
from the International Journal of Language and Communication Disorders
Qualitative aspects of developmental language impairment relate to language and literacy outcome in adulthood
Outcomes & Results: Adults with a history of SLI had persisting language impairment as well as considerable literacy difficulties. Pragmatic deficits also appeared to develop over time in these individuals. The PLI group had enduring difficulties with language use, but presented with relatively intact language and literacy skills. Although there were some similarities in the language profile of the PLI and ASD groups, the ASD group was found to have more severe pragmatic deficits and parent-reported linguistic difficulties in conversational speech.
Conclusions & Implications: The pattern of deficits observed in different subtypes of developmental language disorder persists into adulthood. The findings highlight the importance of a wide-ranging clinical assessment in childhood, which may provide an indication of outcome in adulthood.
from the International Journal of Language and Communication Disorders
The link between prosody and language skills in children with specific language impairment (SLI) and/or dyslexia
Methods & Procedures: Six subtests of the Profiling Elements of Prosodic Systems — Child version (PEPS-C) were used to investigate discrimination/comprehension and imitation/production of prosodic forms that were either independent of language or that had one of two linguistic functions: chunking (prosodic boundaries) and focus (contrastive stress). The performance of three groups of 10-14-year-old children with SLI plus dyslexia, SLI, and dyslexia were compared with an age-matched control group and two younger control groups matched for various aspects of language and reading.
Outcomes & Results: The majority of children with SLI and/or dyslexia performed well on the tasks that tested auditory discrimination and imitation of prosodic forms. However, their ability to use prosody to disambiguate certain linguistic structures was impaired relative to age-matched controls, although these differences disappeared in comparison with language-matched controls. No, or only very weak, links were found between prosody and language and literacy skills in children with SLI and/or dyslexia.
Conclusions & Implications: Children with SLI and/or dyslexia aged 10-14 years show an impaired ability to disambiguate linguistic structures for which prosody is required. However, they are able on the whole to discriminate and imitate the actual prosodic structures themselves, without reference to linguistic meaning. While the interaction between prosody and other components of language such as syntax and pragmatics is problematic for children with SLI and/or dyslexia, prosody itself does not appear to be a core impairment.
Apraxic agraphia: An insight into the writing disturbances of posterior aphasias Gopee Krishnan1, Soorya Narayana Rao2, Bellur Rajashekar1 1 Department of Speech and Hearing, Kasturba Hospital, Manipal University, India 2 Department of Neurology, Kasturba Hospital, Manipal University, India
Background: Reading and writing disturbances are common accompaniments of aphasia following brain damage. However, impaired writing in the absence of apparent primary linguistic disturbances is infrequently reported in the literature. Materials and Methods: A 67-year-old right-handed subject underwent neurological, neuroradiological, and linguistic investigations following development of a minimal right upper limb weakness. Result: The patient had polycythemia and the neurological investigation revealed right upper limb paresis. The neuroradiological investigation revealed hypodense areas involving the gray-white matter of the left postero-parietal and frontal lobe, left caudate and lentiform nuclei, and the anterior limb of the internal capsule, suggesting an infarct. The linguistic investigation revealed a mild anomic aphasia with apraxic agraphia. This mild anomic aphasia resulted primarily from the relatively poor scores on the verbal fluency tests. Discussion: The marked writing impairment, even with the left hand, points to disturbances in written output – apraxic agraphia – in the presence of near-normal spoken output. This finding should raise suspicion about hidden apraxic agraphia in subjects with posterior aphasias.
Comparison of acoustic and kinematic approaches to measuring utterance-level speech variability
Purpose: The spatio-temporal index (STI) is one measure of variability. As currently implemented, kinematic data are used, requiring equipment that cannot be used with some patient groups or in scanners. An experiment is reported that addressed whether STI can be extended to an audio measure of sound pressure of the speech envelope over time, that did not need specialized equipment.
Method: STI indices of variability were obtained from lip track (L-STI) and amplitude envelope (E-STI) signals. These measures were made concurrent whilst either fluent speakers or speakers who stutter repeated “Buy Bobby a puppy” 20 times.
Results: L-STI and E-STI correlated significantly. STI reduced with age for both L-STI and E-STI. E-STI scores and L-STI scores discriminated successfully between fluent speakers and speakers who stutter.
Conclusion: The amplitude envelope over time STI scores can be used to obtain an STI score. This STI score can be used in situations where lip movement STI scores are precluded.
Development and Perceptual Evaluation of Amplitude Based F0 Control in Electrolarynx Speech
Purpose: Current electrolarynx (EL) devices produce a mechanical speech quality which has been largely attributed to the lack of natural fundamental frequency (F0) variation. In order to improve the quality of EL speech, the present study aimed to develop and evaluate an automatic F0 control scheme, in which F0 was modulated based on variations in the root-mean-squared (RMS) amplitude of the EL speech signal.
Method: Recordings of declarative sentences produced by 2 male subjects before and after total laryngectomy were used to develop procedures for calculating F0 contours for EL speech. Specifically, the positive linear relationship between F0 and RMS amplitude observed in pre-laryngectomy speech was used as the basis for generating an F0 contour based on the amplitude variation of EL speech. An analysis-by-synthesis approach was employed to modify the F0 contour, and a perceptual experiment was conducted to examine its impact on the quality of the EL speech.
Results: The results of perceptual experiments showed that modulating the F0 of EL speech using a linear relationship between amplitude and frequency made it significantly more natural sounding than EL speech with constant F0.
Conclusions: The current study provides preliminary support for amplitude-based control of F0 in EL speech.
Directional effects on infants and young children in real life: Implications for amplification
Results: Averaged across 4 scenarios, children looked in the direction of a talker for 40% of the time when speech was present. Head orientation was not affected by age or hearing status. The STI measurements revealed a directional advantage of 3 dB when a child looked at a talker, but a deficit of 2.8 dB when the talker was sideways or behind the child. The overall directional effect in real life was between –0.4 and 0.2 dB.
Conclusions: The findings suggest that directional microphones in personal hearing devices for young children are not detrimental, and have much potential for benefits in real life. The benefits may be enhanced by fitting directionality early and by counselling caregivers on ways to maximize benefits in everyday situations.
Brain Section Multitasks, Handling Phonetics And Decision-Making
A front portion of the brain that handles tasks like decision-making also helps decipher different phonetic sounds, according to new Brown University research.
This section of the brain – the left inferior frontal sulcus – treats different pronunciations of the same speech sound (such as a ‘d’ sound) the same way.
In determining this, scientists have solved a mystery.
“No two pronunciations of the same speech sound are exactly alike. Listeners have to figure out whether these two different pronunciations are the same speech sound such as a ‘d’ or two different sounds such as a ‘d’ sound and a ‘t’ sound,” said Emily Myers, assistant professor (research) of cognitive and linguistic sciences at Brown University. “No one has shown before what areas of the brain are involved in these decisions.”
Sheila Blumstein, the study’s principal investigator, said the findings provide a window into how the brain processes speech.
“As human beings we spend much of our lives categorizing the world, and it appears as though we use the same brain areas for language that we use for categorizing non-language things like objects, said Blumstein, the Albert D. Mead Professor of Cognitive and Linguistic Sciences at Brown.
Researchers from Brown University’s Department of Neuroscience and from the Department of Psychiatry at the University of Cincinnati also took part in the study. Details will be published in the July issue of the journal Psychological Science.
Development and validation of the singing voice handicap-10
Methods:
Patients presenting to two tertiary care voice clinics prospectively completed the SVHI. Principal component analysis was performed. Individual item to total correlations were calculated, and individual items were also evaluated for bipolar response patterns. A clinical consensus conference prioritized each individual item. Items were then eliminated, and the internal consistency was evaluated. A second cohort of patients with singing voice problems completed the Voice Handicap Index-10 (VHI-10) and SVHI-10 at two time points. Singers without voice problems also completed the SVHI-10. SVHI-10 scores were compared between the groups, correlations between the SVHI-10 and VHI-10 were performed, and test-retest reliability of the SVHI-10 assessed.
Results:
Singers with voice problems had worse SVHI-10 scores than normal singers (P < .0001, t test). Test-retest reliability was high (Spearman correlation = 0.86, P < .001). Internal consistency of the SVHI-10 demonstrated a Cronbach of .94, and the correlation between the SVHI-10 and VHI-10 was 0.7 (P < .001, Spearman correlation).
Conclusions:
The SVHI-10 is a valuable instrument to assess self-perceived handicap associated with singing voice problems with reduced patient burden. Laryngoscope, 2009
from The Laryngoscope
Coprevalence and impact of dysphonia and hearing loss in the elderly
Methods:
Main outcome measures include prevalence of dysphonia and hearing loss, Voice Related Quality of Life (VRQOL), Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), and the Center for Epidemiologic Studies Depression (CES-D) scale. Relationships between continuous variables were analyzed with Spearman correlation, between categorical variables with chi-square, and between categorical and continuous variable with analysis of variance (ANOVA) on ranks.
Results:
A total of 248 residents responded with a mean age of 82.4 years. Of those, 19.8% had dysphonia, 50.0% had hearing loss, and 10.5% had both. Respondents with hearing loss were more likely to have dysphonia than those without hearing loss (odds ratio = 2.31, 95% confidence interval, 1.19-4.47). Worse VRQOL scores were associated with more impairment on the HHIE-S (Spearman correlation = -0.36, P < .001). Respondents with both dysphonia and hearing loss had greater depression scores than those with neither symptom (median CES-D score 13 vs. 8, P = .03, ANOVA on ranks, Dunn's method, P < .05).
Conclusions:
Voice problems and hearing loss are common in the elderly, adversely impact quality of life, and require simultaneous management. Laryngoscope, 2009
from The Laryngoscope
