Monthly Archives: March 2008

Readability of written health information provided to people with aphasia

from from Aphasiology

Background: Providing appropriate written health materials to people with aphasia presents a challenge for health professionals. To overcome this dilemma, the suitability of current written health materials intended for people with aphasia, and the measures that examine their suitability, need to be assessed.

Aims: The primary aims of this research were to investigate the readability levels of written health materials given to people with aphasia, and to further analyse their appropriateness by considering linguistic parameters that contribute to reading difficulties for people with aphasia. The secondary aims were to investigate if commonly used readability measures are useful tools for assessing the suitability of written information for people with aphasia by: determining the readability measures’ applicability to the wide range of health information received by people with aphasia, determining if there is a significant difference between three commonly applied readability measures, and investigating if there is a relationship between the most applicable readability measure and the linguistic measures.

Methods & Procedure: A total of 114 written health documents were collected from 18 people living with aphasia. Of the materials collected, there were 84 different items, 28 of which could be analysed using three readability formulas: Flesch-Kincaid, Fry, and Simple Measure of Gobbledygook (SMOG). The written health materials were also analysed according to number of sentences and embedded clauses, proportion of passive, complex, and compound sentences, and average word frequency and imageability.

Outcomes & Results: This study found that written health materials obtained from people with aphasia were written at an average grade nine readability level and contained low-frequency words, low-imageability words, and complex sentences. There was no significant difference between the readability of aphasia or speech pathology materials compared to other more general health information. The Flesch-Kincaid readability formula could be applied to more documents than the Fry and SMOG formulas and the mean reading grade levels calculated by these formulas were significantly different. The number of sentences was found to be the only linguistic measure directly related to the readability of a text.

Conclusion: Written health materials are not sufficiently modified to suit the reading ability of people with aphasia. Reducing the readability level of texts is one process that authors can use to ensure that written health information is more accessible for people with aphasia.

Spontaneous speech in Italian agrammatic aphasia: A focus on verb production

from Aphasiology

Background: The spontaneous speech of Italian agrammatic and non-brain-damaged speakers was analysed. The results are compared with those of spontaneous speech analyses of other languages.

Aims: The goal of this study is to describe Italian spontaneous speech data with respect to the production of verbs, and to compare these data with earlier results from Italian and other languages.

Methods & Procedures: The spontaneous speech of seven Italian agrammatic speakers and ten Italian non-brain-damaged speakers was analysed. The corpus for analysis was collected by means of a semi-structured interview, the description of the “Cookie Theft picture”, and the narration of “Little Red Riding Hood”. Relevant verb parameters were analysed for both groups. Verb production was qualitatively and quantitatively analysed for both groups and comparisons between the two were made. Moreover, verb tokens, and verb types were analysed, and the production of lexical verbs, copulae, reflexive verbs, and auxiliaries was studied. All produced verbs were analysed for their verb argument structure.

Outcomes & Results: The results show that agrammatic speakers are impaired in verb production. They omit verbs in obligatory contexts and they make inflectional errors. Also, the diversity of the produced verbs is limited. Their production of lexical verbs, reflexive verbs, modal verbs, and auxiliaries is lower than normal, but the use of copulae does not differ from normal. The agrammatic speakers prefer simple verb-argument structures compared to non-brain-damaged speakers.

Conclusions: The results add data on verb production in Italian aphasic spontaneous speech. They describe some typical agrammatic speech impairments, like omission of verbs, a low diversity of lexical verbs, inflectional errors, as well as novel data about particular verb categories like reflexive verbs, and auxiliaries used in gerund mood. Furthermore, the results provide new data on verb-argument structure in Italian aphasic spontaneous speech. It is argued that this pattern, despite the individual variance, is compatible with an impairment to grammatical encoding.

Intensive language therapy in chronic aphasia: Which aspects contribute most?

from Aphasiology

Background: Recent research suggests the effectiveness of short-term highly intensive treatment approaches in the chronic stage of aphasia. However, the effective elements of such treatment need to be determined.

Aims: The present study’s aim was to evaluate which factors attribute to the success of aphasia therapy. An intensive (3 hours/day, 10 consecutive days) model-orientated aphasia therapy (MOAT), which considers patients’ individual symptoms, was evaluated and therapy effects were compared to those of a similarly intensive training focusing on active speaking elements (constraint-induced aphasia therapy, CIAT) in order to identify the effective elements.

Methods & Procedures: 12 patients with chronic aphasia received 30 hours of MOAT over 10 days. Language functions were assessed with a standardised language test (Aachen Aphasia Test) and a naming task prior to therapy, after therapy, and at a 6-month follow-up. In addition, the amount and quality of communication were assessed with questionnaires as an indication of transfer to everyday communication. Results of this treatment group were compared to those of 27 patients who were treated according to principles of CIAT.

Outcomes & Results: Language functions improved significantly following treatment relative to the pre-treatment scores, and the improvements remained stable across the follow-up period. Effects were comparable to those of CIAT for most variables, except for written language and perception of everyday communication which improved more after MOAT than after CIAT. The naming task disclosed generalisation to untreated items for MOAT.

Conclusions: Results confirm that an intense training focused on individual deficits leads to substantial and durable improvements in language functions in patients with chronic aphasia. The comparison across treatments suggests consideration of the functional deficit, written language, and everyday communication as effective elements in the rehabilitation of chronic aphasia.

Integrating technology and targeted treatment to improve narrative production in aphasia: A case study

from Aphasiology

Background: Studies of aphasic sentence production have identified a number of promising approaches to improving performance at the single sentence level, but these studies have typically failed to show measurable effects on multi-sentence productions (spontaneous or narrative speech). The difficulty for aphasic speakers of producing connected speech during therapy is likely to contribute to this effect. Computer software that allows patients to record, replay, and concatenate partial utterances has shown promise in allowing narrative-level practice during treatment of even severely non-fluent patients.

Aims: This single-case study continues research using SentenceShaper ®, a computer program that supports speakers’ productions while they are being formulated. The goal is to investigate the utility of a two-step treatment that supplements improvements achieved from use of the software alone with explicit structural treatment (of multi-clause sentences).

Methods and Procedures: We describe an aphasic speaker (CI) with severely non-fluent, fragmented, and agrammatic speech who participated in two treatment phases. Initially, as in previous studies, CI practised producing narratives (based on wordless picture books or silent videos) while using SentenceShaper, with no explicit focus on specific syntactic elements. This phase produced marked structural improvement, so a second treatment, focused on the production of multi-clause sentences, was designed to exploit his success using the system. Following a period of targeted treatment on such structures, CI practiced producing narratives that incorporated these structures with the help of SentenceShaper. Structural analyses based on the Quantitative Production Analysis system compared Baseline and Post-treatment 1 performance, and then compared improvements Post-treatment 1 with those shown after treatment 2.

Outcomes & Results: Structural measures (including mean sentence length, proportion of words in sentences and sentence well-formedness) improved significantly from Baseline following Treatment 1, and improved significantly again following Treatment 2, such that sentence length and well-formedness moved into the normal range.

Conclusions: Results indicate that this combined approach may be helpful in improving the connected speech of even chronic and severely non-fluent speakers. The characteristics of this aphasic speaker that might have contributed to this outcome, and the limitations of this study, are considered.

The use of cueing to alleviate recurrent verbal perseverations: Evidence from transcortical sensory aphasia

from Aphasiology

Background: Previous studies have demonstrated that stimulus factors, including item frequency, presentation rate, stimulus repetition, and semantic relatedness, can influence the rate of recurrent verbal perseverations. These manipulations alter the balance of activation between current targets and past responses, suggesting that perseverations arise when the activation of a previously presented item overrides the weak processing of a new stimulus. By this view, cues and sentence contexts that bias inter-item competition towards the target and away from earlier responses should dramatically reduce the frequency of perseverative errors. However, the influence of these factors on perseverations has not been previously investigated.

Aims: To examine the effect on perseverative rate of altering the activational balance between past and present responses using both intrinsic and extrinsic stimulus manipulations.

Methods & Procedures: This study examined repetition, reading, and picture naming in a highly perseverative patient with transcortical sensory aphasia.

Outcomes & Results: The patient’s strong perseverative tendencies were impervious to the stimulus factors listed above but he was able to overcome these errors to produce more correct responses when he was provided with phonemic, word, and sentence cues. These environmental constraints had a similar effect on perseverations in reading aloud and picture naming, although active repetition was necessary for a cue to benefit reading, whereas passively hearing the cue was sufficient to improve picture naming.

Conclusions: This task difference is likely to reflect the greater reliance of picture naming on semantic processing, which will benefit from cues regardless of whether they are repeated. We propose that poor internal control of language production allowed perseverations to dominate our patient’s output. External constraints in the form of cues/sentence contexts overcame this deficit, dramatically reducing the rate of perseverations.

Testing the interplay of structure and meaning in aphasic sentence production

from Aphasiology

Background: Improving aphasic sentence production is a challenging endeavour, both for the speaker who must recover the linguistic skill and for the therapist who attempts to guide the process. Studies have demonstrated that treatment can often improve the sentence production ability of aphasic speakers, but with limited generalisation to new lexical content and untrained sentence structure. One factor that limits the outcome of production therapy may be the complexity of the relationship between the form and the meaning of a sentence. This is confounded by a limited array of diagnostic approaches for revealing what linguistic resources remain available to the aphasic speaker.

Aims: In this study we tested a new format for eliciting sentence production in aphasia. Our goal was to reveal whether or not individual aphasic speakers were sensitive to certain semantic and syntactic elements of sentences that are believed to influence the sentence production process.

Methods & Procedures: Using a modified sentence repetition format we explored the sentence production abilities of five fluent aphasic speakers under different conditions of lexical and/or structural manipulations. Lexical manipulations required substitution of a semantically related verb; structural manipulations required reordering of the post-verbal arguments in different dative constructions (double object and prepositional) that express essentially the same message.

Outcomes & Results: Response patterns obtained from the five aphasic participants revealed individual patterns of skill and sensitivity based on residual language ability. The implications of these results are discussed with reference to the potential for revealing elements of normal production patterns in aphasic speech, and the assumption that such information is important for developing more effective therapy for individuals with aphasia.

Conclusions: Patterns of sentence production elicited in a modified sentence repetition task may reveal syntactic flexibility and residual syntactic knowledge in speakers with aphasia.

Speech identification and cortical potentials in individuals with auditory neuropathy

from Behavioral and Brain Functions

Present study investigated the relationship between speech identification scores in quiet and parameters of cortical potentials (latency of P1, N1, and P2; and amplitude of N1/P2) in individuals with auditory neuropathy.

Ten individuals with auditory neuropathy (five males and five females) and ten individuals with normal hearing in the age range of 12 to 39 yr participated in the study. Speech identification ability was assessed for bi-syllabic words and cortical potentials were recorded for click stimuli.

Results revealed that in individuals with auditory neuropathy, speech identification scores were significantly poorer than that of individuals with normal hearing. Individuals with auditory neuropathy were further classified into two groups, Good Performers and Poor Performers based on their speech identification scores. It was observed that the mean amplitude of N1/P2 of Poor Performers was significantly lower that of Good Performers and those with normal hearing. There was no significant effect of group on the latency of the peaks. Speech identification scores showed a good correlation with the amplitude of cortical potentials (N1/P2 complex) but did not show a significant correlation with the latency of cortical potentials.

Results of the present study suggests that measuring the cortical potentials may offer a means for predicting perceptual skills in individuals with auditory neuropathy.

Brief report: Immediate memory for movement sequences in children with and without language impairment

from the Canadian Journal of Speech-Language Pathology and Audiology

This study investigated the immediate recall and reproduction of visually presented movements by children with and without language impairments (LI). Ten children with LI ranging in age from 6:0 to 8:9 (years:months) and 10 age-matched peers with typically-developing language completed tasks requiring them to reproduce sequences of nonsymbolic arm movements that were presented at eight different rates of speed ranging from .5 s per movement to 4 s per movement. The children with LI performed significantly poorer than the control group in recalling arm movements across the presentation rates. Both groups of children tended to recall and reproduce arm movements presented at very slow intervals (4 s per movement) better than they recalled and reproduced arm movements presented at very fast intervals (.5 s per movement). These results suggest that children with LI have immediate visuospatial memory deficits for serial position and that children both with and without LI benefit from having visual information presented at a slow rate.

Dysphagia service delivery by speech-language pathologists in Canada: Results of a national survey

from Canadian Journal of Speech-Language Pathology and Audiology

In 2006, a committee was formed to develop a new position paper on dysphagia (swallowing disorders) for the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA). In the course of their work, the committee conducted an electronic survey of Canadian speech-language pathologists who practice in the area of dysphagia. The survey explored the contexts in which dysphagia services are provided and identified trends and issues in dysphagia service delivery across Canada. The results of this survey, completed by 396 speech-language pathologists, are reported in this article.

Occurrence of otitis media and hearing loss among first nations elementary school children

from the Canadian Journal of Speech-Language Pathology and Audiology

This study investigated the occurrence of otitis media and hearing loss among First Nations children for different age groups. The study also explored whether the presence of otitis media and hearing loss persisted throughout the school year. The 48 participants were children of Mi’kmaq heritage from a First Nations elementary school in Nova Scotia. Children underwent pneumatic otoscopy, tympanometry, and pure tone audiometry on two separate occasions 6 month apart. Three age groups (3-5 years, 6-8 years, and 9-11 years) were compared. Consistent with previous research, results revealed that First Nations children suffer from high occurrence of otitis media and hearing loss. Indeed, middle ear pathology and hearing loss were found in more than 20% of the children. Otitis media with effusion was the most common type of middle ear pathology observed. Although the occurrence of hearing loss tended to decline with increasing age, the 6 to 11 year-old children continued to show an abnormally high occurrence of middle ear pathology and hearing loss, a trend contradictory to that found in the general population. In each age group, occurrences of otitis media and hearing loss were similar for the two evaluations conducted 6 months apart, suggesting that otitis media remains high throughout the school year. Half of the children found to have middle ear pathology in the first evaluation presented with the same pathology 6 months later. The importance of regular hearing screenings and proper audiological and medical follow-up in First Nations children is highlighted.

Kids who talk to themselves do better while performing tasks: Study


The next time you see your kids chatting to themselves, don’t worry – for a new study has shown that children who talk to themselves do better on motor tasks. via Daily India

The Science Behind Cross-Linguistic Psychology

from Medical News

While communication may be recognized as a universal phenomenon, differences between languages — ranging from word-order to semantics — undoubtedly remain as they help to define culture and develop language. Yet, little is understood about similarities and differences in languages around the world and how they affect communication. Recently, however, two studies have emerged that aid in our understanding of cross-linguistic distinctions in language usage.

Vocal Nodules and Edema May Be Due to Vibration-Induced Rises in Capillary Pressure

from Laryngoscope

Hypothesis: Vocal fold vibration may physically raise intravascular pressure to levels high enough to damage capillaries and result in leakage of erythrocytes. This type of injury is commonly seen in benign vocal fold lesions and is not well explained.

Study Design: Theoretical, retrospective.

Methods: The relationship of intravascular pressure to vibration frequency and amplitude is derived and confirmed with a physical blood vessel model, then applied to published human measurements to estimate human intravascular pressures.

Results: Vocal fold intravascular pressure is predicted to have a quadratic dependence on both frequency and amplitude. During speaking, the pressure may rise to over 20 cmH2O, and may reach levels far higher for screaming and singing. Such pressure magnitudes are known to trigger inflammatory cascades and can lead to fluid leakage. They also have the potential for pharmacologic control with [beta]-agonists.

Conclusions: Intravascular pressure likely rises significantly during vocal fold vibration and may lead to the type of injury seen in benign vocal fold lesions. The results support voice therapy aimed at reducing vibratory amplitude. More vibratory amplitude measurements need to be performed in a wider range of subjects before the full range of human vocal fold vascular pressures can be estimated.

Relation of Distortion Product Otoacoustic Emission With Tinnitus

from Laryngoscope

Objective: To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus.

Study Design: This is a case control study.

Subjects and Methods: The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study.

Results: The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients.

Conclusion: Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.

Phonovibrogram Visualization of Entire Vocal Fold Dynamics

from Laryngoscope

Objectives: High-speed (HS) video recordings are the up-to-date method for visualizing irregular vocal fold vibrations. However, perceptive evaluation during offline replay is time consuming and shows high inter-rater variability.

Method: A visualization procedure is presented that extracts vocal fold vibrations from HS videos and transfers the motion information into a set of three phonovibrogram (PVG) images that make visual vocal fold displacements (PVG-0), velocities (PVG-1), and accelerations (PVG-2).

Results: The principles of PVG computation as well as their application to three clinical examples (normal voice, laryngeal nerve paralysis, functional voice disorder with vocal nodules) are presented. For normal and dysphonic subjects, the PVG images show the characteristics of vocal fold vibrations as concern the dynamic patterns of displacements, velocities, and accelerations.

Conclusion: The PVG approach makes visual the entire range of motion of vibrating vocal fold edges in easy-to-read color images for differentiation of normal and pathologic voices. PVG images are printable and can be stored on a hard-disc drive, enabling the documentation of the course of voice disorders that is essential for evidenced-based medicine. PVG visualization has the potential to overcome the subjective quality of assessing HS videos, which makes it a valuable tool with broad clinical application.