Monthly Archives: July 2009
Effectiveness of Lee Silverman Voice Treatment (LSVT)® on hypernasality in non-progressive dysarthria: the need for further research
Methods & Procedures: Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT® (n = 5) or individually tailored traditional dysarthria therapy (n = 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at follow-up 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively.
Outcomes & Results: Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT®, but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up.
Conclusions & Implications: Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT® on nasality with a larger population with different dysarthria types is essential.
from the International Journal of Language and Communication Disorders
Legal decision-making by people with aphasia: critical incidents for speech pathologists
Methods: & Procedures: The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software.
Outcomes & Results: The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication.
Conclusions: & Implications: The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area.
from the International Journal of Language and Communication Disorders
Activities That Get Children 2 Months To 48 Months Talking Are Most Conducive To Language Acquisition
Adult-child conversations have a more significant impact on language development than exposing children to language through one-on-one reading alone, according to a new study in the July issue of Pediatrics, the journal of the American Academy of Pediatrics.
“Pediatricians and others have encouraged parents to provide language input through reading, storytelling and simple narration of daily events,” explains study’s lead author, Dr. Frederick J. Zimmerman, associate professor in the Department of Health Services in the UCLA School of Public Health. “Although sound advice, this form of input may not place enough emphasis on children’s role in language-based exchanges and the importance of getting children to speak as much as possible.”
The study of 275 families of children ages 0-4 was designed to test factors that contribute to language development of infants and toddlers. Participants’ exposure to adult speech, child speech and television was measured using a small digital language recorder or processor known as the LENA System. This innovative technology allowed researchers to hear what was truly going on in a child’s language environment, facilitating access to valuable new insights.
The study found that back-and-forth conversation was strongly associated with future improvements in the child’s language score. Conversely, adult monologueing, such as monologic reading, was more weakly associated with language development. TV viewing had no effect on language development, positive or negative.
Zimmerman adds, “What’s new here is the finding that the effect of adult-child conversations was roughly six times as potent at fostering good language development as adult speech input alone.”
The Voice Handicap Index with post-laryngectomy male voices
Background: Surgical treatment for advanced laryngeal cancer involves complete removal of the larynx (‘laryngectomy’) and initial total loss of voice. Post-laryngectomy rehabilitation involves implementation of different means of ‘voicing’ for these patients wherever possible. There is little information about laryngectomees’ perception of their changed voice quality and communication status. Surgical voice restoration (SVR) has become the ‘gold standard’ rehabilitation, but there continue to be patients who use other methods of communication. There is no clear evidence comparing patients’ perception of their voice handicap across different types of alaryngeal communication.
Aims: To compare the self-assessed vocal handicap of laryngectomees using SVR with those using non-SVR methods of post-laryngectomy communication.
Methods & Procedures: Potential participants were identified from one Head and Neck cancer centre in South Wales. They included both male and female participants using all methods of post-laryngectomy communication. Each patient’s Voice Handicap Index (VHI) score, sub-set scores, and group means were calculated. Two major confounding factors: age and time since surgery, and communication method (SVR/non-SVR), were considered to identify factors, other than method of communication, which may influence rehabilitation outcomes.
Outcomes & Results: A total of 71 questionnaires were sent out and 62 (82%) were returned from 35 patients who had undergone SVR and 27 patients who used non-SVR methods of communication. Of the non-SVR group, twelve used oesophageal voice, eleven an electrolarynx, two writing and two mouthing for communication. The gender ratio (53:9), age (43-90 years) and time since surgery (1-40 years) were broadly representative of this population, but because of the small number of females, we excluded the women from further analysis. Individual VHI scores ranged from 4 to 106. Both the SVR and non-SVR group mean scores: 44.7 and 50.9, were within the range of moderately severe voice handicap. There was no significant difference between the groups for total VHI scores or two of the three sub-domains, nor any significant effect on voice handicap due to the confounding factors assessed: age or time since surgery. The total VHI score was better by 6.5 ( – 4.9 to 17.9) points in the SVR group (p = 0.3), probably reflecting the literature reporting superior voice in SVR.
Conclusions & Implications: The data suggest that where patient-assessed quality of life is concerned, SVR and non-SVR outcomes are comparable. This is an important consideration when planning and carrying out treatment recommendations. The study has clear clinical implications; understanding the potential of all methods of post-laryngectomy communication is essential for holistic patient management.
from the International Journal of Language and Communication Disorders
What Is Stammering, Stuttering? What Causes Stammering, Stuttering?
Stammering and stuttering have the same meaning – it is a speech disorder in which the person repeats or prolongs words, syllables or phrases. The person with a stutter (or stammer) may also stop during speech and make no sound for certain syllables. People who stutter often find that stress and fatigue make it harder for them to talk flowingly, as well as situations in which they become self-conscious about speaking, such as public speaking or teaching. Most people who stutter find that their problem eases if they are relaxed.
According to Medilexicon’s medical dictionary, to stammer is “To hesitate in speech, halt, repeat, and mispronounce, by reason of embarrassment, agitation, unfamiliarity with the topic, or as yet unidentified physiologic causes. To mispronounce or transpose certain consonants in speech.”
We all have the capacity to stutter if pushed far enough. This may happen during a very stressful interrogation in a police station, talking to emergency services on the telephone, or trying to respond to a particularly agile and aggressive lawyer while on the witness stand in court.
Famous people who stammered
Stammering does not reflect a person’s intelligence or personality. Here is a list of famous people who stammer/stammered:
Aesop – Greek storyteller
Bill Withers – Singer, songwriter (Ain’t no sunshine)
Stuttering is common when children are learning to speak. However, the majority of kids grow out of this stage of initial stuttering. For some, however, the problem persists and requires some kind of professional help, such as speech therapy. It is important that parents do not add to a child’s stress by drawing too much attention to the problem when they are trying to communicate verbally. The calmer a child feels the less acute the symptoms tend to become.
Activities That Get Children 2 Months To 48 Months Talking Are Most Conducive To Language Acquisition
Adult-child conversations have a more significant impact on language development than exposing children to language through one-on-one reading alone, according to a new study in the July issue of Pediatrics, the journal of the American Academy of Pediatrics.
“Pediatricians and others have encouraged parents to provide language input through reading, storytelling and simple narration of daily events,” explains study’s lead author, Dr. Frederick J. Zimmerman, associate professor in the Department of Health Services in the UCLA School of Public Health. “Although sound advice, this form of input may not place enough emphasis on children’s role in language-based exchanges and the importance of getting children to speak as much as possible.”
The study of 275 families of children ages 0-4 was designed to test factors that contribute to language development of infants and toddlers. Participants’ exposure to adult speech, child speech and television was measured using a small digital language recorder or processor known as the LENA System. This innovative technology allowed researchers to hear what was truly going on in a child’s language environment, facilitating access to valuable new insights.
The study found that back-and-forth conversation was strongly associated with future improvements in the child’s language score. Conversely, adult monologueing, such as monologic reading, was more weakly associated with language development. TV viewing had no effect on language development, positive or negative.
Zimmerman adds, “What’s new here is the finding that the effect of adult-child conversations was roughly six times as potent at fostering good language development as adult speech input alone.”
Tongue Pressure Patterns During Water Swallowing
Abstract Bolus propulsion during the normal oral phase of swallowing is thought to be characterised by the sequential elevation of the front, middle, and posterior regions of the dorsum of the tongue. However, the coordinated orchestration of lingual movement is still poorly understood. This study examined how pressures generated by the tongue against the hard palate differed between three points along the midline of the tongue. Specifically, we tested three hypotheses: (1) that there are defined individual patterns of pressure change within the mouth during liquid swallowing; (2) that there are significant negative pressures generated at defined moments during normal swallowing; and, (3) that liquid swallowing is governed by the interplay of pressures generated in an anteroposterior direction in the mouth. Using a metal appliance described previously, we measured absolute pressures during water swallows in six healthy volunteers (4 male, 2 female) with an age range of 25–35 years. Participants performed three 10-ml water swallows from a small cup on five separate days, thus providing data for a total of 15 separate water swallows. There was a distinct pattern to the each of the pressure signals, and this pattern was preserved in the mean obtained when the data were pooled. Furthermore, raw signals from the same subjects presented consistent patterns at each of the five testing sessions. In all subjects, pressure at the anterior and hind palate tended to be negative relative to the preswallow value; at mid–palate, however, pressure changes were less consistent between individuals. When the pressure differences between the sites were calculated, we found that during the swallow a net negative pressure difference developed between anterior and mid-palate and a net positive pressure difference developed between mid-palate and hind palate. Large, rapid fluctuations in pressure occurred at all sites and these varied several-fold between subjects. When the brief sharp reduction in pressure that occurred early in each swallow was used to determine the sequence of events, we found that activity occurred first at the anterior of the palate followed by the mid-palate and then the hind palate.
from Dysphagia
Characterizing Response to Elemental Unit of Acoustic Imaging Noise: An fMRI Study
Acoustic imaging noise produced during functional magnetic resonance imaging (fMRI) studies can hinder auditory fMRI research analysis by altering the properties of the acquired time-series data. Acoustic imaging noise can be especially confounding when estimating the time course of the hemodynamic response (HDR) in auditory event-related fMRI (fMRI) experiments. This study is motivated by the desire to establish a baseline function that can serve not only as a comparison to other quantities of acoustic imaging noise for determining how detrimental is one’s experimental noise, but also as a foundation for a model that compensates for the response to acoustic imaging noise. Therefore, the amplitude and spatial extent of the HDR to the elemental unit of acoustic imaging noise (i.e., a single ping) associated with echoplanar acquisition were characterized and modeled. Results from this fMRI study at 1.5 T indicate that the group-averaged HDR in left and right auditory cortex to acoustic imaging noise (duration of 46 ms) has an estimated peak magnitude of 0.29% (right) to 0.48% (left) signal change from baseline, peaks between 3 and 5 s after stimulus presentation, and returns to baseline and remains within the noise range approximately 8 s after stimulus presentation.
Brief Communications I Heard That Coming: Event-Related Potential Evidence for Stimulus-Driven Prediction in the Auditory System
The auditory system has been shown to detect predictability in a tone sequence, but does it use the extracted regularities for actually predicting the continuation of the sequence? The present study sought to find evidence for the generation of such predictions. Predictability was manipulated in an isochronous series of tones in which every other tone was a repetition of its predecessor. The existence of predictions was probed by occasionally omitting either the first (unpredictable) or the second (predictable) tone of a same-frequency tone pair. Event-related electrical brain activity elicited by the omission of an unpredictable tone differed from the response to the actual tone right from the tone onset. In contrast, early electrical brain activity elicited by the omission of a predictable tone was quite similar to the response to the actual tone. This suggests that the auditory system preactivates the neural circuits for expected input, using sequential predictions to specifically prepare for future acoustic events.
from the Journal of Neuroscience
The Cross-linguistic Study of Sentence Production
The mechanisms underlying language production are often assumed to be universal, and hence not contingent on a speaker’s language. This assumption is problematic for at least two reasons. Given the typological diversity of the world’s languages, only a small subset of languages has actually been studied psycholinguistically. And, in some cases, these investigations have returned results that at least superficially raise doubt about the assumption of universal production mechanisms. The goal of this paper is to illustrate the need for more psycholinguistic work on a typologically more diverse set of languages. We summarize cross-linguistic work on sentence production (specifically: grammatical encoding), focusing on examples where such work has improved our theoretical understanding beyond what studies on English alone could have achieved. But cross-linguistic research has much to offer beyond the testing of existing hypotheses: it can guide the development of theories by revealing the full extent of the human ability to produce language structures. We discuss the potential for interdisciplinary collaborations, and close with a remark on the impact of language endangerment on psycholinguistic research on understudied languages.
Common antibacterial treatment linked to sensorineural hearing loss in cystic fibrosis patients
Alexandria, VA – An otherwise effective treatment for cystic fibrosis places patients at a high risk of sensorineural hearing loss, according to new research published in the July edition of Otolaryngology-Head and Neck Surgery.
Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States (70,000 worldwide). A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections; and obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food.
Researchers reviewed the medical records of cystic fibrosis (CF) patients at Children’s Hospital Boston over a 13 year period, and found that seven of 50 CF patients (14%) suffered from sensorineural hearing loss. Of that group, 43 percent of those that had received aminoglycosides intravenously had received more than 10 courses of the treatment; patients who were treated more than five times with nasal irrigation of aminoglycosides were also at risk of sensorineural hearing loss.
Because CF patients are prone to suffer from infections of the pulmonary and sinonasal systems, aminoglycosides are commonly administered to CF patients because of the potent effect they have on bacteria. The treatment is considered so effective that it outweighs the well-known side-effects, which include hair cell loss, and thus hearing loss.
The authors contend that CF patients should have routine hearing evaluations that specifically target the detection of sensorineural hearing loss, especially when repeated courses of systemic or intranasal aminoglycosides have be used in treatment. They also note that further investigation through a prospective study is warranted in order to replicate these results.
from EurekAlert.org
PHONOLOGICAL AWARENESS INSTRUCTION FOR MIDDLE SCHOOL STUDENTS WITH LEARNING DISABILITIES.
Provides information on a study that determined if middle school students with learning disabilities identified as having phonological awareness deficits could improve their phonological awareness skills after instruction, and if these skills could impact word recognition skills. Methodology of the study; Results and discussion on the study.
PREDICTION OF FIRST-GRADE READING ACHIEVEMENT: A COMPARISON OF FALL WINTER KINDERGARTEN SCREENINGS.
The purpose of this study was threefold: (a) to identify a combination of predictive measures that correlate with reading achievement, (b) to examine the predictive accuracy of these measures, and (c) to determine the most accurate time frame for test administration in kindergarten. One hundred and three kindergarten students from three schools participated over a period of two years. Measures representing letter identification, phonological awareness, phonological memory, and rapid automatized naming were administered in the fall and winter of the kindergarten year. Reading achievement was measured at the end of grade 1 using measures that included passage comprehension, fluency, sight-word recognition, and phonemic decoding. Five predictive models representing a combination of the predictive constructs were analyzed. The model combining letter identification, phonological awareness, and rapid automatized naming was identified as the best predictor of early reading achievement. There was no practical, significant difference between the fall and winter testing time frames. These findings hold important implications for predictive research by clarifying the importance of administering standardized measures that reflect the reading process. Most important, the results can provide practitioners with information for identifying the children most in need of early reading interventions. [ABSTRACT FROM AUTHOR]
THE EFFECTIVENESS OF A GROUP READING INSTRUCTION PROGRAM WITH POOR READERS IN MULTIPLE GRADES.
Presents a study which examined the effectiveness of phonologically based reading program on poor readers in multiple grades. Method used in the study; Results; Significance of the program as remedial alternative for deficient readers.
THE RELATIONSHIPS OF PHONEMIC AWARENESS AND RAPID NAMING TO READING DEVELOPMENT.
Describes research studies that analyzed the contributions of phonetic awareness and rapid naming to reading development. Phonological processing variables for the identification of students with reading disabilities; Relationships of phonetic awareness and rapid naming to reading development; Causes of reading disabilities.
