Monthly Archives: August 2008

Renewed prescription of hearing aids: A clinically based study

from Audiological Medicine

We explored whether or not perceived health, subjective well-being, everyday life consequences of hearing loss, and/or use of communication strategies in experienced hearing aid users were associated with the outcome of renewed counselling, i.e. a prescription of a new hearing aid(s) (HA(s))or keeping the existing HA(s). The study included 170 subjects (84 men and 86 women) who had previously undergone HA fitting and audiological rehabilitation and at study entry had indications for a renewed rehabilitation and HA prescription. Self-report inventories assessed general health, well-being, activity limitation, participation restriction, and use of communication strategies. The outcome was studied by logistic regression. Review of medical records 18 months after the renewed counselling showed that 147 (86.5%) subjects had been fitted with new hearing aids. Gender, duration of hearing loss and previous use of one versus two aids influenced the outcome under study. Reported high degree of activity limitation and dissatisfaction with life were related to decreased odds for a renewed prescription. On the other hand, a favourable self-report of general health, use of communication strategies and participation restriction were not associated with the outcome. Self-reported anxiety seemed to more than double the odds for not being prescribed a new HA. In conclusion, patients with reported anxiety, dissatisfaction with life and a high degree of activity limitation were more likely to end counselling without a renewed prescription.

Teacher identification of speech and language impairment in kindergarten students using the Kindergarten Development Check

from the International Journal of Speech-Language Pathology

The purpose of this paper was to profile the extent and accuracy of teacher identification of speech and language impairment within a kindergarten student population in Tasmania, Australia, using the Kindergarten Development Check (KDC). A total of 286 kindergarten students (aged 4-5 years and in their first year of formal schooling) were screened by teachers with the KDC on two separate occasions over their kindergarten year. In the following academic year, each of the same 286 students were assessed by a speech-language pathologist, and diagnosed with either typically developing or impaired speech and/or language skills. Review of KDC data determined the number of students identified by teachers with speech and language impairment at each occasion during their kindergarten year. Comparison of data from the later KDC administration and speech-language pathology assessment then determined the correspondence between identification of speech and language impairment by teachers and speech-language pathologists. Upon initial administration of the KDC, 51 (17.8%) students were identified by teachers with language impairment and 47 (16.4%) students with speech impairment. Following the second administration of the KDC 3 months later, 20 (7.0%) students continued to be identified with language impairment, and 39 (13.6%) with speech impairment. Comparison of speech-language pathology testing results and KDC data from the second administration found the overall validity of teacher identification was 86.4% and 71% for speech and language impairment respectively. Specificity rates were high, with 93% and 97% of students with typically developing speech and language skills respectively, correctly classified on the KDC. However, the sensitivity was only 50% for speech impairment and 15% for language impairment, indicating that 50% of students presenting with speech impairment and 85% of students with language impairment in their subsequent academic year were not recorded by teachers as having such a difficulty on the later KDC administration during their kindergarten year. The KDC appears to be ineffective in supporting kindergarten teachers to identify students with ongoing speech and to a greater extent, language impairment. Measures to improve the sensitivity of the KDC in particular need to be considered by speech-language pathologists and educational professionals in Tasmania.

Reading, dyslexia and the brain

from Educational Research

Background: Neuroimaging offers unique opportunities for understanding the acquisition of reading by children and for unravelling the mystery of developmental dyslexia. Here, I provide a selective overview of recent neuroimaging studies, drawing out implications for education and the teaching of reading.

Purpose: The different neuroimaging technologies available offer complementary techniques for revealing the biological basis of reading and dyslexia. Functional magnetic resonance imaging (fMRI) is most suited to localisation of function, and hence to investigating the neural networks that underpin efficient (or inefficient) reading. Electroencephalography (EEG) is sensitive to millisecond differences in timing, hence it is suited to studying the time course of processing; for example, it can reveal when networks relevant to phonology versus semantics are activated. Magnetic source imaging (MSI) gives information about both location in the brain and the time course of activation. I illustrate how each technology is most suited to answering particular questions about the core neural systems for reading, and how these systems interact, and what might go wrong in the dyslexic brain.

Design and methods: Following a brief overview of behavioural studies of reading acquisition in different languages, selected neuroimaging studies of typical development are discussed and analysed. Those studies including the widest age ranges of children have been selected. Neuroimaging studies of developmental dyslexia are then reviewed, focusing on (a) the neural networks recruited for reading, (b) the time course of neural activation and (c) the neural effects of remediation. Representative studies using the different methodologies are selected. It is shown that studies converge in showing that the dyslexic brain is characterised by under-activation of the key neural networks for reading.

Conclusions: Different neuroimaging methods can contribute different kinds of data relevant to key questions in education. The most informative studies with respect to causation will be longitudinal prospective studies, which are currently rare.

Storytelling as a democratic approach to data collection: interviewing children about reading

from Educational Research

Background Before the 1990s, an individual or medical model dominated educational research methodology with respect to younger children: the subjects of the research were usually considered untrustworthy sources of information. A subsequent shift towards an ecological model has focused on the child’s perspective: however, Lewis and Lindsay have described the development of methods for conducting research with children as slow.

Purpose This paper examines how storytelling can be used as a method of collecting authentic and revealing research data from children. The method is suggested as a valuable way in which to gain insights into children’s discourse, and is used in this paper in relation to children’s discourse about reading.

Sample, design and methods The storytelling method was initially trialled in one school with 36 children aged between 5 and 11 years. The storytelling interview was then used in case studies over a period of a year in three schools, with a total of 88 7- and 8-year-old children. During the interviews, children were asked to tell a story entitled ‘The child who didn’t like reading’. Systematic content analysis was undertaken to identify emergent cultural norms and models in the stories. Information on the children’s reading practices, and their observations on reading, was also collected for the purposes of triangulation.

Results The children’s storytelling gave access to their cultural models of reading. It was found that the stories demonstrated sufficient triangulation with the other data about the children’s reading practices to support a sociocultural production of the children’s discourse.

Conclusions Storytelling can provide a useful and credible method of collecting research data from children. It may be especially useful with poor readers as there are no literacy demands, and in this respect, affords socially inclusive research.

Whether SentenceShaper®, a computerized communication system, supports verbal production in individuals with aphasia remains to be seen

from Evidence-Based Communication Assessment and Intervention

No abstract available.

A Mini-Mental Status Examination for the hearing impaired

from Age and Ageing

SIR—The Folstein Mini-Mental State Examination (MMSE), developed in 1975 as a bedside test of cognitive function, has been extensively used in clinical practice and research and is widely accepted as a clinical tool for diagnosing and monitoring dementia [1]. Despite its low sensitivity and specificity (0.56 and 0.73, respectively, in one recent study) [2], comparable tools, including the Modified MMSE of Teng and Chui [3] have not received such widespread acceptance.
It contains 11 questions that test orientation, registration, attention, calculation, recall, language and visuospatial functioning, with a maximum score of 30. It takes minutes to administer and is practical for routine clinical use. Most questions are administered verbally. Hearing loss reduces performance on the verbal parts of the examination even in cognitively intact patients, with potential diagnostic error and alteration of management [4]. This is of concern, as hearing impairment affects over one-fourth of people over 65 years of age, and half of those over 75 years in most industrialised nations [5].

Uhlmann [6] tested 71 Alzheimer’s disease subjects with varying levels of hearing, using both written and standard versions of the MMSE. Paradoxically, they found that hearing-impaired subjects scored higher in the standard than the written version, while subjects with normal hearing performed better using the written version, although these findings were not statistically significant.

We (M.M.) developed a written version of the MMSE, found it clinically useful, and report here an evaluation of its performance in a hospital-based population of older people.

Making an Effort to Listen: Mechanical Amplification in the Ear

from Neuron

The inner ear’s performance is greatly enhanced by an active process defined by four features: amplification, frequency selectivity, compressive nonlinearity, and spontaneous otoacoustic emission. These characteristics emerge naturally if the mechanoelectrical transduction process operates near a dynamical instability, the Hopf bifurcation, whose mathematical properties account for specific aspects of our hearing. The active process of nonmammalian tetrapods depends upon active hair-bundle motility, which emerges from the interaction of negative hair-bundle stiffness and myosin-based adaptation motors. Taken together, these phenomena explain the four characteristics of the ear’s active process. In the high-frequency region of the mammalian cochlea, the active process is dominated instead by the phenomenon of electromotility, in which the cell bodies of outer hair cells extend and contract as the protein prestin alters its membrane surface area in response to changes in membrane potential.

Advance planning of form properties in the written production of single and multiple words

from Language and Cognitive Processes

Three experiments investigated the scope of advance planning in written production. Experiment 1 manipulated phonological factors in single word written production, and Experiments 2 and 3 did the same in the production of adjective-noun utterances. In all three experiments, effects on latencies were found which mirrored those previously documented with spoken responses, and are taken to suggest that writers planned the entire utterance before initiating a response. Additionally, response durations were measured, and these provided further support for the complete planning assumption. The results suggest that writers, like speakers, plan utterances of at least two words in their entirety before initiating a response.

Study Finds Troubled Children Adversely Affect Peers’ Test Scores, Behavior

from Medical News

Troubled children hurt their classmates’ math and reading scores and worsen their behavior, according to new research by economists at the University of California, Davis, and University of Pittsburgh

Assessing Acquired Language Disorders in Adults via the Internet

from Telemedicine and e-Health

Aphasia, a language disturbance, frequently occurs following acquired brain impairment in adults. Because management of aphasia is often long-term, provision of ongoing and equitable access to treatment creates a significant challenge to speech-language pathologists (SLPs). This study aimed to determine the validity and reliability of assessing aphasia using standardized language assessments via an Internet-based videoconferencing system using a bandwidth of 128 kbits/sec. Thirty-two participants with aphasia due to stroke or traumatic brain injury were assessed simultaneously in either a face-to-face or online-led environment by two SLPs. Short forms of the Boston Diagnostic Aphasia Examination (BDAE-3) and the Boston Naming Test (BNT, 2nd edition) were administered. An eight-item participant satisfaction questionnaire was completed by 15 participants assigned to the online-led assessment. Results failed to identify any significant differences between the 24 subtest scores of the BDAE-3 and the BNT scores obtained in the online and face-to-face test environments (p > 0.01). Weighted kappa statistics indicated moderate to very good agreement (0.59–1.00) between the two assessors for the 24 subtests and eight rating scales of the BDAE-3, the BNT, and for aphasia diagnosis. Good to very good inter- and intra-rater reliability for the online assessment was found across the majority of assessment tasks. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the online environment. This study supports the validity and reliability of delivering standardized assessments of aphasia online and provides a basis for ongoing development of telerehabilitation as an alternate mode of service delivery to persons with aphasia.

When Communication Is Lost


Aphasia is like a prison, but new research offers hope of escape.

Brain hyper-reactivity to auditory novel targets in children with high-functioning autism

from Brain

Although communication and social difficulties in autism have received a great deal of research attention, the other key diagnostic feature, extreme repetitive behaviour and unusual narrow interests, has been addressed less often. Also known as ‘resistance to change’ this may be related to atypical processing of infrequent, novel stimuli. This can be tested at sensory and neural levels. Our aims were to (i) examine auditory novelty detection and its neural basis in children with autism spectrum conditions (ASC) and (ii) test for brain activation patterns that correlate quantitatively with number of autistic traits as a test of the dimensional nature of ASC. The present study employed event-related fMRI during a novel auditory detection paradigm. Participants were twelve 10- to 15-year-old children with ASC and a group of 12 age-, IQ- and sex-matched typical controls. The ASC group responded faster to novel target stimuli. Group differences in brain activity mainly involved the right prefrontal–premotor and the left inferior parietal regions, which were more activated in the ASC group than in controls. In both groups, activation of prefrontal regions during target detection was positively correlated with Autism Spectrum Quotient scores measuring the number of autistic traits. These findings suggest that target detection in autism is associated not only with superior behavioural performance (shorter reaction time) but also with activation of a more widespread network of brain regions. This pattern also shows quantitative variation with number of autistic traits, in a continuum that extends to the normal population. This finding may shed light on the neurophysiological process underlying narrow interests and what clinically is called ‘need for sameness’.

Computer-Based Exercises for Learning to Read and Spell by Deaf Children

from the Journal of Deaf Studies and Deaf Education

There is a surprising lack of systematic research evaluating the effects of reading exercises for young deaf children. Therefore, for this article, two computer-based exercises were developed and learning effects were determined by posttests. One (spelling oriented) exercise was to select the correct word among three orthographically similar alternatives that corresponds to a drawing or a sign (digital video). The other (meaning oriented) exercise was to select the correct sign or picture among three alternatives that corresponds to a written word. Eleven deaf Dutch children with a mean age of 7 years 10 months participated in the study. A first question was whether in single-word exercises the meaning or the spelling of a word should be emphasized. A second question was whether there was any effect of using drawings or signs to refer to the meaning of the word. The results reveal that emphasizing the word spelling is most effective for learning to read for deaf children and the findings also suggest that drawings are more efficient in the current exercises.

Hearing Screening at Birth

from JAMA

All newborns should be screened for congenital hearing loss before 1 month of age, according to a recommendation from the US Preventive Services Task Force (USPSTF) published in July (US Preventive Services Task Force. Pediatrics. 2008;122[1]:143-148). Those who do not pass this hearing test should then undergo otoacoustic emissions testing before they are 3 months old. The recommendation and a summary of evidence supporting it are available online at

In 2001, the USPSTF found insufficient evidence to recommend for or against such screening. A more recent review of the literature concluded that there is good evidence that such screening is highly accurate and leads to early identification and treatment of infants with hearing loss and that early intervention improves language outcomes.

Newborn hearing screening is already a common practice in many areas, and 39 states have laws either mandating or encouraging such screening.

Response monitoring, repetitive behaviour and anterior cingulate abnormalities in autism spectrum disorders (ASD)

from Brain

Autism spectrum disorders (ASD) are characterized by inflexible and repetitive behaviour. Response monitoring involves evaluating the consequences of behaviour and making adjustments to optimize outcomes. Deficiencies in this function, and abnormalities in the anterior cingulate cortex (ACC) on which it relies, have been reported as contributing factors to autistic disorders. We investigated whether ACC structure and function during response monitoring were associated with repetitive behaviour in ASD. We compared ACC activation to correct and erroneous antisaccades using rapid presentation event-related functional MRI in 14 control and ten ASD participants. Because response monitoring is the product of coordinated activity in ACC networks, we also examined the microstructural integrity of the white matter (WM) underlying this brain region using diffusion tensor imaging (DTI) measures of fractional anisotropy (FA) in 12 control and 12 adult ASD participants. ACC activation and FA were examined in relation to Autism Diagnostic Interview-Revised ratings of restricted and repetitive behaviour. Relative to controls, ASD participants: (i) made more antisaccade errors and responded more quickly on correct trials; (ii) showed reduced discrimination between error and correct responses in rostral ACC (rACC), which was primarily due to (iii) abnormally increased activation on correct trials and (iv) showed reduced FA in WM underlying ACC. Finally, in ASD (v) increased activation on correct trials and reduced FA in rACC WM were related to higher ratings of repetitive behaviour. These findings demonstrate functional and structural abnormalities of the ACC in ASD that may contribute to repetitive behaviour. rACC activity following errors is thought to reflect affective appraisal of the error. Thus, the hyperactive rACC response to correct trials can be interpreted as a misleading affective signal that something is awry, which may trigger repetitive attempts at correction. Another possible consequence of reduced affective discrimination between error and correct responses is that it might interfere with the reinforcement of responses that optimize outcomes. Furthermore, dysconnection of the ACC, as suggested by reduced FA, to regions involved in behavioural control might impair on-line modulations of response speed to optimize performance (i.e. speed-accuracy trade-off) and increase error likelihood. These findings suggest that in ASD, structural and functional abnormalities of the ACC compromise response monitoring and thereby contribute to behaviour that is rigid and repetitive rather than flexible and responsive to contingencies. Illuminating the mechanisms and clinical significance of abnormal response monitoring in ASD represents a fruitful avenue for further research.