Monthly Archives: December 2009
Contextual Thematic Group Treatment for Individuals With Dementia
Purpose: Group treatment for individuals with dementia is an option to target activity and participation for residents in long-term care facilities to engage them in meaningful conversation and potentially improve their quality of life. The purpose of this article is to describe a theme-based group treatment approach that capitalizes on the use of the environment through context.
Method: Rationale for this group treatment approach is presented, including a brief description and evidence supporting clinical techniques utilized. These include reminiscence therapy, multisensory stimulation, and use of environmental aids. In addition, background is provided regarding capitalizing on memory and linguistic strengths and compensating for weaknesses. Modifications of clinician behaviors are presented to best facilitate successful group interactions.
Results and Conclusions: The article culminates in a detailed description of contextual thematic group treatment. This description includes an example lesson plan with corresponding rationale for activities. Data supporting the individual clinical techniques utilized in this group treatment approach are adequate; however, the evidence supporting the combination of these techniques in this format is meager and requires further investigation.
from Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders
Effects of Vascular Dementia on Cognition and Linguistic Communication: A Case Study
Purpose: Vascular dementia is the second most common cause of dementia after Alzheimer’s's disease. The purpose of this case report is to describe the evolution and progression of vascular dementia over two years and detail its effects on multiple measures of cognition and linguistic communication.
Methods: Data from multiple sources (e.g., medical records, direct testing, staff reports, and client observations) has been integrated to provide a detailed report of the effects of vascular dementia on global cognitive status and on specific domains of attention, episodic and semantic memory, executive function, visuospatial ability, linguistic comprehension, and linguistic expression.
Results and Conclusions: Vascular dementia affects multiple cognitive domains including language and communicative function. Clinical implications are presented for choice of tests and language tasks for evaluating the effects of vascular dementia on linguistic communication.
from Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders
Frontotemporal Lobar Degeneration: Characterizing Semantic Binding and Abstracted Meaning Abilities
Purpose: Frontotemporal lobar degeneration (FTLD) encompasses a group of neurodegenerative disorders characterized by gradual and progressive decline in behavior and/or language. Identifying the subtypes of FTLD can be challenging with traditional assessment tools. Growing empirical evidence suggests that language measures might be useful in differentiating FTLD subtypes.
Method: In this paper, we examined the performance of five individuals with FTLD (two with frontotemporal dementia, two with semantic dementia, and one with progressive nonfluent aphasia) and 10 cognitively normal older adults on measures of semantic binding (Semantic Object Retrieval Test and semantic problem solving) and abstracted meaning (generation of interpretive statement and proverb interpretation).
Results and Conclusion: A differential profile of impairment was observed in the three FTLD subtypes on these four measures. Further examination of these measures in larger groups will establish their clinical utility in differentiating the FTLD subtypes.
from Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders
The Effects of Question Type on Conversational Discourse in Alzheimer’s Disease
Purpose: The purpose of this study was to investigate the effects of asking open-ended episodic memory questions versus open-ended semantic memory questions on the conversational discourse of individuals with Alzheimer’s disease (AD).
Methods: Four females diagnosed with probable AD participated in the study. A within-subjects experimental design was employed to assess the effects of the different question types on participants’ spoken language. Transcripts were analyzed using specific discourse measures used in previous research involving individuals with AD.
Results: Participants in this study produced more meaningful and relevant statements, as measured by ratios of on-topic utterances, when responding to the semantic memory questions as compared to episodic memory questions. Participants made few negative comments overall; however, more negative self-evaluative statements were made in the episodic memory condition. When considered in conjunction with previous research, the results support the use of multiple question types in conversation with individuals with mild and moderate AD. However, communication partners should limit their use of open-ended questions that primarily tax episodic memory.
from Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders
Blowing ratio as an evaluation tool for velopharyngeal function after oral and oropharyngeal cancer
Background.
Our objective was to evaluate the value of the blowing test to measure the speech and swallowing function after resection of oral or oropharyngeal cancer.
Methods.
Speech and swallowing functions of the patients after surgical resection of oral or oropharyngeal cancer were assessed by a speech intelligibility test, blowing time, questionnaires, and oropharyngeal pressures. Blowing time (pressure) ratio was determined by dividing blowing time (pressure) with open nose by blowing time (pressure) with closed nose.
Results.
Blowing time ratio had significant correlation with blowing pressure ratio (p = .014), score of speech intelligibility test (p = .0014), questionnaire for aspiration (p = .029), nasopharyngeal backflow (CC = 0.676, p = .032), amount of food to swallow (p = .037), and oropharyngeal pressure during swallowing (p = .024).
Conclusion.
The present results demonstrated the value of blowing time ratio as a simple objective tool for speech and swallowing ability related to velopharyngeal function after resection of oral and oropharyngeal cancers. © 2009 Wiley Periodicals, Inc. Head Neck, 2010
from Head and Neck
Vestibular evoked myogenic potentials in chronic otitis media before and after surgery
Conclusion. The pathology of chronic otitis media (COM) could delay and reduce the energy transfer of sound to the inner ear. The significant improvement of postoperative vestibular evoked myogenic potential (VEMP) response rate and p13 latencies in the group of patients with no or negative postoperative ABG gain provided evidence that the sound energy inducing a VEMP might be different from the energy producing the auditory perception. Objective. To evaluate the VEMP in patients with COM before and after surgery. Subjects and methods. Twenty-four subjects with unilateral COM were enrolled. A pure tone audiogram and VEMP using 500 Hz unilateral short tone-burst stimulations were recorded before and 3 months after surgery. The postoperative VEMP responses were compared with the responses before surgery and the healthy controls. Results. After surgery, the 500 Hz air-bone gap (ABG) decreased significantly and the VEMP response rate increased significantly from 41.7% to 66.7% (p<0.05, bi-test). However, both the preoperative and postoperative p13 latencies were significantly longer than those of the healthy controls (p<0.05, Wilcoxon rank-sum test). In the 18 patients whose 500 Hz ABG did not improve with surgery, the p13 latencies were significantly shorter postoperatively (p<0.05, sign test), and the response rate also improved significantly from 44.4% (8/18) to 77.8% (14/18) (p<0.05, bi-test).
A Mathematical Model of Human Semicircular Canal Geometry: A New Basis for Interpreting Vestibular Physiology
We report a precise, simple, and accessible method of mathematically measuring and modeling the three-dimensional (3D) geometry of semicircular canals (SCCs) in living humans. Knowledge of this geometry helps understand the development and physiology of SCC stimulation. We developed a framework of robust techniques that automatically and accurately reconstruct SCC geometry from computed tomography (CT) images and are directly validated using micro-CT as ground truth. This framework measures the 3D centroid paths of the bony SCCs allowing direct comparison and analysis between ears within and between subjects. An average set of SCC morphology is calculated from 34 human ears, within which other geometrical attributes such as nonplanarity, radius of curvature, and inter-SCC angle are examined, with a focus on physiological implications. These measurements have also been used to critically evaluate plane fitting techniques that reconcile many of the discrepancies in current SCC plane studies. Finally, we mathematically model SCC geometry using Fourier series equations. This work has the potential to reinterpret physiology and pathophysiology in terms of real individual 3D morphology.
from JARO — Journal of the Association for Research in Otolaryngology
Functional results of 394 bilateral stapedotomies evaluated with the Glasgow Benefit Plot
This study aimed to evaluate the results of 394 bilateral stapedotomies according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) guidelines and with the Glasgow Benefit Plot (GBP) and also analyze the benefit of a second-ear stapedotomy in achievement of normal and symmetrical hearing using retrospective chart review. The charts of 1,369 stapedotomies performed by senior author (J.H.) from 1991 to 2006 were reviewed. Results of 394 bilateral stapedotomies were included. The hearing results were evaluated according to the 1995 AAO–HNS Committee on Hearing and Equilibrium (CHE) guidelines and the GBP criteria. Success rates after the first and second ear surgeries were separately analysed. ABG closure ≤20 dB was demonstrated in 98% of cases after both first and second procedures. Postoperative AC gain was higher in the first ear surgery compared with the second ear surgery in all groups of preoperative hearing impairment. As a result of first ear surgery, 142 (72%) patients changed into the category of unilateral hearing loss. As a result of second ear surgery, 125 (64%) patients changed into the category of normal and symmetric hearing. In this study the largest group of 394 primary bilateral stapedotomies was simultaneously evaluated according to AAO–HNS guidelines and GBP criteria. The results showed that the first ear surgery was more successful in achievement of normal hearing in the operated ear. Second ear surgery was more beneficial in providing symmetric hearing.
from ORL -Journal for Oto-Rhino-Laryngology and Its Related Specialties
Building speech-language pathologist capacity for evidence-based practice: A unique graduate course approach
A speech-language pathology graduate-level course using the systematic review and meta-analytic process as a learning tool is described. The course design, content, activities, and pedagogical methods are discussed in depth. Three groups of students worked collaboratively to produce three systematic reviews in the area of language and literacy. This course provided a framework for the completion of the reviews and the development of the students as expert consumers of research. It is suggested that this course framework be used as a tool for building speech-language pathologist capacity in the use of evidence-based decision making.
from Evidence-Based Communication Assessment and Intervention
The Auditory System Involvement in Parkinson Disease: Electrophysiological and Neuropsychological Correlations
In the course of Parkinson disease (PD), apart from motor symptoms, presence of mental disturbances such as dementia and depression is common. The aims of this study were to assess the auditory system involvement in patients with PD using electrophysiological and neuropsychological tests and to correlate the cognitive impairment and the auditory evoked potentials tests results. The auditory and cognitive functions were studied in 53 patients with idiopathic PD, mean age 65.8 ± 9.1 years; mean disease duration 7.8 ± 5.0 years; mean motor disability score 2.5 ± 0.8 points in Hoehn-Yahr scale compared with a control group matched for age and sex. In patients and controls, cognitive functions were analyzed electrophysiologically using middle latency auditory evoked potentials (MLAEP) and long latency (event-related potentials, P300) auditory evoked potentials.
from the Journal of Clinical Neurophysiology
A Comparative Study of Two Acoustic Measures of Hypernasality
Purpose: This study aimed to compare 2 quantitative acoustic measures of nasality in children with cleft lip and palate (CLP) and healthy controls using formalized perceptual assessment as a guide.
Method: Fifty participants (23 children with CLP and 27 age- and gender-matched healthy controls) aged between 4 and 12 years produced a variety of high and low vowels that allowed perceptual ratings of nasal resonance severity as well as acoustic analysis of spectral changes. Two objective measures of nasality were used: 1/3 octave spectra analysis and the voice low tone high tone ratio. Each respective technique has been evaluated in previous research, and their potential as an effective means of detecting changes in nasal resonance has been demonstrated.
Results: Only 1/3 octave spectra analysis differentiated between participants with hypernasal speech and those perceived to have normal nasal resonance. Significant differences were also observed between varying levels of perceived severity on vowels within nonnasalized phonemic environments (/pIt/, /tIp/).
Conclusions: Perceptual judgment remains the primary means of evaluating levels of nasality in children with CLP. However, the development and validation of easy-to-use objective techniques remains an important goal for effective clinical and empirical practice.
Characteristics of the Transition to Spoken Words in Two Young Cochlear Implant Recipients
Purpose: This investigation addressed two main questions: (a) How do toddlers’ spoken utterances change during the first year of cochlear implant (CI) use? and (b) How do the time-courses for reaching spoken word milestones after implant activation compare with those reported for typically developing children? These questions were explored to increase understanding of early semantic development in children who receive CIs before their second birthdays.
Methods: Monthly recordings of mother-child interactions were gathered during the first year of CI use by a boy and a girl whose CIs were activated at 11 and 21 months of age, respectively. Child utterances were classified as nonwords, pre-words, single words, or word combinations, and the percentages of these utterance types were calculated for each month. Data were compared to published findings for typically developing children for the number of months of robust hearing (i.e., auditory access to conversational speech) needed to reach spoken word milestones and the chronological ages at which milestones were achieved.
Results: The main findings were that the percentages of nonwords and pre-words decreased as single words and word combinations increased. Both children achieved most spoken word milestones with fewer months of robust hearing experience than reported for typically developing children; the youngest recipient achieved more milestones within typical age ranges than the child implanted later in life.
Conclusions: The children’s expeditious gains in spoken word development appeared to be facilitated by interactions among their pre-implant hearing experiences; their relatively advanced physical, cognitive, and social maturity; participation in intervention programs; and the introduction of robust hearing within the Utterance Acquisition phase of language development according to the neurolingusitic theory (J. Locke, 1997).
Comparison of Two Methods of Voice Activity Detection in Field Studies
Purpose: To evaluate and compare the performance of 2 methods of voice activity detection (neck-attached accelerometer vs. binaural recordings) in field studies in environments where voice activity normally occurs.
Method: A group of 11 healthy adults wore recording equipment during their lunch break. We used binary classification to analyze the results from the 2 methods. The output was compared to a gold standard, obtained through listening tests, and the probability for sensitivity (Ps) and false positive (Pf) was rated. The binary classifiers were set for consistent sensitivity of 99%; thus, the lower false positive rate would indicate the method with the better performance.
Results: The neck-attached accelerometer (Pf = 0.5%) performed significantly (p < .001) better than the binaural method (Pf = 7%).
Conclusion: The neck-attached accelerometer is more suitable than the binaural method for voice assessments in environments where people are speaking in close proximity to each other and where the signal-to-noise ratio is moderate to low.
Computational Neural Modeling of Speech Motor Control in Childhood Apraxia of Speech (CAS)
Purpose: Childhood apraxia of speech (CAS) has been associated with a wide variety of diagnostic descriptions and has been shown to involve different symptoms during successive stages of development. In the present study, the authors attempted to associate the symptoms of CAS in a particular developmental stage with particular information-processing deficits by using computational modeling with the Directions Into Velocities of Articulators (DIVA) model. The hypothesis was that the speech production system in CAS suffers from poor feed-forward control and, consequently, an increased reliance on the feedback control subsystem.
Method: In a series of computer simulations, the authors systematically varied the ratio between feed-forward and feedback control during production attempts in the acquisition of feed-forward motor commands. The simulations were evaluated acoustically on 4 selected key symptoms of CAS.
Results: Results showed that increasing the reliance on feedback control causes increased severity of these 4 symptoms of CAS: deviant coarticulation, speech sound distortion, searching articulation, and increased variability.
Conclusions: The findings support the idea that the key symptoms found in CAS could result from an increased reliance on feedback control due to poor feed-forward commands. Two possible root causes of degraded feed-forward control in CAS are discussed: reduced somatosensory information and increased levels of neural noise.
