Monthly Archives: November 2010
Becoming an effective clinician for people who stutter: what do you need to know?
No abstract available.
Becoming an effective clinician for people who stutter: you can do it!Becoming an effective clinician for people who stutter: you can do it!
No abstract available.
Empathy: Perhaps the Most Important E in EBP.
Treatment of stuttering has recently been influenced by calls for evidence-based practice. Unfortunately, most of the existing treatment “evidence” in stuttering focuses on the surface behaviors of the disorder. Although these behaviors are an important part of the problem of stuttering, they may not be the most critical factor to the person who stutters. This article discusses LOSS OF CONTROL as the critical factor in stuttering and examines historical and practical reasons why this part of the disorder has been largely ignored in research about stuttering and stuttering treatment. Suggestions for viewing stuttering from the perspective of the client and the importance of taking this perspective are provided.
Evaluating and treating school-aged children who stutter.
School-based speech-language pathologists are often called upon to treat children who stutter, though many clinicians have reported that they feel uncomfortable working with this population. Fortunately, there is much that speech-language pathologists can do to help children who stutter speak more easily and minimize the adverse impact of stuttering in both academic and social settings. The purpose of this article is to provide clinicians with a guide to some of the key issues they should consider when working with school-aged children who stutter. The goal is to encourage clinicians to develop a better understanding of how stuttering can affect school-aged children, how the adverse effects of the disorder can be documented so children can be qualified for treatment, and, ultimately, how the negative consequences of stuttering can be minimized through a comprehensive approach to treatment.
Evidence of clinically significant change: the therapeutic alliance and the possibilities of outcomes-informed care.
This article addresses the issue of clinically significant (or meaningful) change resulting from treatment for stuttering. Research in both medical and behavioral fields indicates that clients often have their own unique perspective of meaningful clinical change and that this perspective is often different from that of the professional administering the treatment. Among the variables that the client brings to the treatment session are their progression through stages of therapeutic change and the ways in which they believe they are capable of coping with their problem. Research has shown that how an individual interprets the meaning his or her therapeutic experience is central to clinically significant change. Procedures for obtaining feedback from clients concerning clinically significant change and the quality of the therapeutic alliance are described.
Stuttering treatment for adults: an update on contemporary approaches.
This article provides a brief overview of historical and current approaches to stuttering treatment for adults. Treatment is discussed in terms of stuttering management approaches, fluency-shaping approaches, and combined approaches. The evidence base for these various approaches is outlined. Fluency-shaping approaches have the most robust outcome evidence. Stuttering management approaches are based more on theoretical models of stuttering, and the evidence base tends to be inferred from work using the approaches of cognitive behavior therapy and desensitization with other disorders such as anxiety. Finally, comprehensive approaches to treating stuttering are discussed, and several clinical methods are outlined. Comprehensive approaches target both improved speech fluency and stuttering management. Although it is presented that a comprehensive approach to stuttering treatment will provide the best results, no single approach to stuttering treatment can claim universal success with all adults who stutter.
Translating recent research into meaningful clinical practice.
The goal of this article is to provide a synopsis of research, both basic and applied, that can improve the evaluation and treatment of stuttering in children and adults, as well as counseling of clients, families, and other professionals who interact with the person who stutters. Relevant basic research has informed genetic contributions to stuttering and possible neurological substrates of the disorder. Several treatment approaches to stuttering have recently been published, with varying degrees of apparent efficacy. There has also been increased attention to therapeutic outcomes that go beyond the components of the specific therapies themselves, which have the potential to improve therapy outcomes.
What the Literature Tells Us about Listeners’ Reactions to Stuttering: Implications for the Clinical Management of Stuttering.
It is known that listeners harbor negative stereotypes toward people who stutter but there are a host of other findings in the literature that provide a broader perspective about how listeners react to stuttering. The focus of this article is a discussion of four areas of research related to listener reactions to stuttering: (1) how stuttering impacts listeners’ reactions to mild, moderate, and severe stuttering; (2) how stuttering interferes with listener recall and comprehension of story information; (3) how children react to stuttering; and (4) how listeners react to strategies plus use in stuttering therapy programs. Studies associated with these four areas of research are summarized and discussed. Clinical implications that emerge from these studies are described to assist clinicians in the treatment of children and adults who stutter.
Working with young children who stutter: raising our game.
Several therapy programs have been demonstrated to be effective in supporting the development of fluency in preschool children who stutter. However, there is increasing evidence in allied fields suggesting that a positive therapy outcome cannot be entirely attributed to the therapy program itself, but also depends on what the therapist brings to the therapeutic context. This article seeks to discuss the therapist’s skills and attributes that play a part in the development of the therapeutic alliance, which underpins therapy involving parents of young children who stutter. Using a model of clinical expertise development, the article discusses the attributes and skills that are necessary for the development of expertise, along with the behavioral and cognitive changes that evolve as a therapist becomes increasingly expert at using one particular program, Palin Parent-Child Interaction Therapy.
Elevated pulse pressure is associated with age-related decline in language ability
Recent research suggests that pulse pressure (PP), a putative marker of vascular integrity, may be associated with brain microvascular damage and age-related cognitive decline. Thus, the present study examined the relationship between PP and cognition in a sample of healthy nondemented older adults. One hundred nine participants were administered neurological and neuropsychological evaluations and determined to be nondemented. Regression analyses were used to examine the relationships among pulse pressure (PP) [systolic blood pressure (SBP) – diastolic blood pressure (DBP)], age, and cognition. PP and related measures were inversely correlated with global cognitive functioning and scores on a composite measure of language function, even after adjusting for age, education, and relevant vascular risk factors. Results indicate that increases in the pulsatile component of blood pressure may convey added risk of global cognitive decline and specific impairment in language abilities. (JINS, 2010, 16, 933–938.)
from the Journal of the International Neuropsychological Society
Elevated pulse pressure is associated with age-related decline in language ability
Recent research suggests that pulse pressure (PP), a putative marker of vascular integrity, may be associated with brain microvascular damage and age-related cognitive decline. Thus, the present study examined the relationship between PP and cognition in a sample of healthy nondemented older adults. One hundred nine participants were administered neurological and neuropsychological evaluations and determined to be nondemented. Regression analyses were used to examine the relationships among pulse pressure (PP) [systolic blood pressure (SBP) – diastolic blood pressure (DBP)], age, and cognition. PP and related measures were inversely correlated with global cognitive functioning and scores on a composite measure of language function, even after adjusting for age, education, and relevant vascular risk factors. Results indicate that increases in the pulsatile component of blood pressure may convey added risk of global cognitive decline and specific impairment in language abilities. (JINS, 2010, 16, 933–938.)
from the Journal of the International Neuropsychological Society
Speech perception; rapid temporal processing; and the left hemisphere: A case study of unilateral pure word deafness.
The mechanisms and functional anatomy underlying the early stages of speech perception are still not well understood. One way to investigate the cognitive and neural underpinnings of speech perception is by investigating patients with speech perception deficits but with preserved ability in other domains of language. One such case is reported here: patient NL shows highly impaired speech perception despite normal hearing ability and preserved semantic knowledge, speaking, and reading ability, and is thus classified as a case of pure word deafness (PWD). NL has a left temporoparietal lesion without right hemisphere damage and DTI imaging suggests that he has preserved cross-hemispheric connectivity, arguing against an account of PWD as a disconnection of left lateralized language areas from auditory input. Two experiments investigated whether NL’s speech perception deficit could instead result from an underlying problem with rapid temporal processing. Experiment 1 showed that NL has particular difficulty discriminating sounds that differ in terms of rapid temporal changes, be they speech or non-speech sounds. Experiment 2 employed an intensive training program designed to improve rapid temporal processing in language impaired children (Fast ForWord; Scientific Learning Corporation, Oakland, CA) and found that NL was able to improve his ability to discriminate rapid temporal differences in non-speech sounds, but not in speech sounds. Overall, these data suggest that patients with unilateral PWD may, in fact, have a deficit in (left lateralized) temporal processing ability, however they also show that a rapid temporal processing deficit is, by itself, unable to account for this patient’s speech perception deficit.
from Neuropsychología
Learning to read shapes the activation of neural lexical representations in the speech recognition pathway
It has been demonstrated that written and spoken language processing are tightly linked. Here we focus on the development of this relationship at the time children start reading and writing. We hypothesize that the newly acquired knowledge about graphemes shapes lexical access in neural spoken word recognition. A group of preliterate children (six years old) and two groups of beginning readers (six and eight years old) were tested in a spoken word identification task. Using word onset priming we compared behavioural and neural facilitation for target words in identical prime-target pairs (e.g., mon-monster) and in prime target pairs that varied in the first speech sound (e.g., non – monster, variation condition). In both groups of beginning readers priming was less effective in the variation condition than in the identity condition. This was indexed by less behavioural facilitation and enhanced P350 amplitudes in the event related potentials (ERPs). In the group of preliterate children, by contrast, both conditions did not differ. Together these results reveal that lexical access in beginning readers is based on more acoustic detail than lexical access in preliterate children. The results are discussed in the light of bidirectional speech and print interactions in readers.
Lower-Frequency Event-Related Desynchronization: A Signature of Late Mismatch Responses to Sounds, Which Is Reduced or Absent in Children with Specific Language Impairment
Poor discrimination of nonlinguistic sounds has been implicated in language-learning problems in children, but research evidence has been inconsistent. This study included 32 participants with specific language impairment (SLI) and 32 typically developing controls aged 7–16 years. Frequency discrimination thresholds were estimated in a task where participants had to distinguish a higher-frequency tone from a 1000 Hz tone. Neurophysiological responses were assessed in an oddball paradigm. Stimuli were either 1030 or 1200 Hz pure tones (deviants) presented in a series of standard 1000 Hz tones, or syllables (deviant [da] or [bi] in a series of standard /ba/). On the behavioral task, children (7- to 11-year-olds) had high thresholds, regardless of language status, but teenagers (12–16 years) with SLI had higher thresholds than their controls. Conventional analysis of electrophysiological responses showed no difference between groups for the mismatch negativity (MMN), but the late discriminative negativity (LDN) was reduced in amplitude for smaller deviants in participants with SLI. Time–frequency analysis revealed that, whereas the MMN reflected enhanced intertrial coherence in the theta frequency band, the LDN corresponded to a period of event-related desynchronization extending across a wide low-frequency band including delta, theta, and alpha. This manifested as a drop in power in those frequencies, which was marked in the controls but reduced or absent in children with SLI across all stimulus types. This provides compelling evidence for a low-level auditory perceptual impairment in SLI that affects a processing stage after initial detection of a sound change.
from the Journal of Neuroscience
The effects of word frequency and context variability in cued recall
Normative word frequency and context variability affect memory in a range of episodic memory tasks and place constraints on theoretical development. In four experiments, we independently manipulated the word frequency and context variability of the targets (to-be-generated items) and cues in a cued recall paradigm. We found that high frequency targets were better recalled in both pure and mixed lists, even when context variability was held constant. High frequency cues were slightly more effective, but this benefit was eliminated when context variability was held constant. Low context variability cues were most effective while the context variability of the target had little effect on performance. The data suggest that words with fewer pre-experimental connections are better able to isolate the list and that generation of an item from memory benefits from frequency, perhaps due to the ease of generating common orthographic and phonological features. Implications for current models of memory and the prospects of future models are discussed.
from the Journal of Memory and Language
