Monthly Archives: January 2009
Unlike semantic degradation disorders, the mechanisms and the anatomical underpinnings of semantic access disorders are still unclear. We report the results of a case series study on the effects of temporal lobe gliomas on semantic access abilities of a group of 20 patients. Patients were tested 1–2 days before and 4–6 days after the removal of the tumour. Their semantic access skills were assessed with two spoken word-to-picture matching tasks, which aimed to separately control for rate of presentation, consistency and serial position effects (Experiment 1) and for word frequency and semantic distance effects (Experiment 2). These variables have been held to be critical in characterizing access in contrast to degraded-store semantic deficits, with access deficits characterized by inconsistency of response, better performance with slower presentation rates and with semantically distant stimuli, in the absence of frequency effects. Degradation deficits show the opposite pattern. Our results showed that low-grade slowly growing tumours tend not to produce signs of access problems. However, high-grade tumours especially within the left hemisphere consistently produce strong semantic deficits of a clear access type: response inconsistency and strong semantic distance effects in the absence of word frequency effects were detected. However, effects of presentation rate and serial position were very weak, suggesting non-refractory behaviour in the tumour patients tested. This evidence, together with the results of lesion overlapping, suggests the presence of a type of non-refractory semantic access deficit. We suggest that this deficit could be caused by the disconnection of posterior temporal lexical input areas from semantic system.
Considering that orthognathic surgery promotes changes in orofacial structures constituting the resonating system, functional changes secondary to surgery are expected to affect speech, leading to the need for further speech and voice adjustments. Thus, understanding the possible relationships of these structures with voice production is important. Therefore, this study aimed to describe the changes in voice fundamental frequency of a patient submitted to orthognathic surgery and observe if there is a relationship with hyoid bone positioning at the different treatment periods. The results revealed that voice fundamental frequency increased after surgery, returning to values close to the preoperative condition, which corresponded to vertical movement of the hyoid bone.
from the Journal of Craniofacial Surgery
Is There a Relationship Between the Severity of Metopic Synostosis and Speech and Language Impairments?
The occurrence of cognitive impairment and behavioral problems in patients with metopic synostosis has been described. The relationship between the severity of metopic synostosis and the incidence of speech and language delays has not been established. Twenty patients with nonsyndromic isolated metopic synostosis were evaluated. Five different preoperative measurements (metopic angle at the roof of the orbit, angle of lateral orbital wall at the sella, cranial indices, and distances between medial orbital walls and lateral orbital walls) were taken from computed tomography and compared with results from postoperative speech and language assessments. Frontal orbital advancement and remodeling were carried out by the same surgical team at a mean age of 1 year 4 months. Speech and language were assessed at 3 and 5 years. Six of the 20 patients had delayed speech and language developments. No consistent trend was observed linking the severity of frontal stenosis using the measured parameters with speech and language delays. Speech and language impairments in these patients cannot be explained by a physical concept, causing mechanical compression of the frontal lobes.
from the Journal of Craniofacial Surgery
Speech Evaluation After Repair of Unilateral Complete Cleft Palate Using Modified 2-Flap Palatoplasty
Two-flap palatoplasty using mucoperiosteal flaps is becoming popular for wide cleft palates. We found that elevation of the cleft-side mucoperiosteal flap was sufficient to close the defect without elevation or relaxing incision in the noncleft side when performing 2-flap palatoplasty for a complete unilateral cleft palate. We have termed this modified 2-flap palatoplasty. The present study compared speech after classic and modified 2-flap palatoplasty for unilateral complete cleft palate.
Methods: Of 31 unilateral complete cleft lip and palate patients, 16 underwent the classic 2-flap palatoplasty between September 1998 and September 2000, and 15 underwent modified 2-flap palatoplasty between November 2000 and November 2002. Postoperative speech evaluation was undertaken by a speech pathologist. Patients with functional speech problems such as hypernasality or compensatory articulation were recommended for speech therapy. In cases where speech therapy did not result in normal speech, patients underwent secondary velopharyngeal surgery and further speech therapy.
Results: Fifteen of 16 patients who underwent the classic procedure were followed up, of which 5 showed hypernasality or compensatory articulation upon speech evaluation. Four of those patients required secondary velopharyngeal surgery. All 15 patients who underwent the modified procedure were followed up. Six of those patients showed hypernasality or compensatory articulation, of which 2 required secondary velopharyngeal surgery. There was no statistically significant difference between the classic and modified groups in terms of palatal fistula rate, speech, and secondary surgery rate.
Conclusions: There was no difference between the classic and modified 2-flap palatoplasty in terms of postoperative palatal fistula rate, speech, and secondary surgery rate. Because of the advantages of the modified procedure in terms of fewer incisions, these findings indicate that larger long-term studies are warranted, particularly to evaluate maxillary bone growth.
from the Journal of Craniofacial Surgery
Cognitive neuropsychological and regional cerebral blood flow study of a Japanese–English bilingual girl with specific language impairment (SLI)
We report here on an investigation into the possible factors which might have contributed to language impairment (LI) in EM, a 14-year-old Japanese–English bilingual girl. EM was born in the UK to Japanese parents with no other siblings, and used English to communicate with all other people except for her parents. A delay in her English language development was identified at primary school in the UK, which was attributed to her bilingualism. The deficiency in her English language skills persisted into her adolescence despite more than adequate educational opportunities (including additional language support). At the start of her secondary education, language ability/literacy attainment tests were conducted in both English and Japanese, and the results suggested specific language impairment (SLI) in both languages. Further, her brain Single Photon Emission Computed Tomography (SPECT) revealed significantly lower Regional Cerebral Blood Flow(rCBF) in the left temporo-parietal area, which is also similar to the area of dysfunction often found among Japanese individuals with SLI.
Sex and performance level effects on brain activation during a verbal fluency task: A functional magnetic resonance imaging study
Neuroimaging studies investigating the neural correlates of verbal fluency (VF) focused on sex differences without taking into account behavioural variation. Nevertheless, group differences in this verbal ability might account for neurocognitive differences elicited between men and women. The aim of this study was to test sex and performance level effects and the combination of these on cerebral activation. Four samples of 11 healthy students (N = 44) selected on the basis of sex and contrasted VF scores, high fluency (HF) versus low fluency (LF), performed a covert phonological VF task during scans. Within- and between-group analyses were conducted. Consistent with previous studies, for each sample, the whole-group analysis reported activation in the inferior frontal gyrus (IFG), insula, anterior cingulate cortex (ACC), medial frontal gyrus (mFG), superior (SPL) and inferior parietal lobules (IPL), inferior visual areas, cerebellum, thalamus and basal ganglia. Between-group analyses showed an interaction between sexes and performances in the right precuneus, left ACC, right IFG and left dorsolateral prefrontal cortex (dlPFC). HF men showed more activation than LF ones in the right precuneus and left dlPFC. LF men showed more activation in the right IFG than HF ones and LF women elicited more activation in the left ACC than HF ones. A sex main effect was found regardless of performance in the left inferior temporal gyrus (ITG), cerebellum, anterior and posterior cingulate cortexes and in the right superior frontal gyrus (SFG) and dlPFC, lingual gyrus and ACC, with men eliciting significantly greater activations than women. A performance main effect was found for the left ACC and the left cerebellum regardless of sex. LF subjects had stronger activations than HF ones in the ACC whereas HF subjects showed stronger activations in the cerebellum. Activity in three discrete subregions of the ACC is related to sex, performance and their interaction, respectively. Our findings emphasize the need to consider sex and performance level in functional imaging studies of VF.
Background: Individuals with aphasia often experience difficulties in writing. Word processors with a spell checker and a grammar checker can compensate for some of the writing difficulties associated with aphasia.
Aims: To determine if writing difficulties associated with aphasia may be reduced by the use of a computerised writing aid when training patients.
Methods & Procedures: The writing aids used in this study were originally designed specifically for persons with developmental reading and writing difficulties and are based on statistics of frequent misspellings and phonotactic rules. Three participants with aphasia selected one of two offered writing aids. Written production during treatment and evaluation was recorded and analysed by keystroke logging. The study had a single-subject ABA design replicated across three participants. The baseline (A) was established by measuring four dependent variables. During a 9-week intervention phase (B) the dependent variables were measured once a week. A follow-up (A) was done 10 months after the training was finished. The dependent variables were: total number of words in a writing task; proportion of correctly written words; words per minute; proportion of successful edits. The results were analysed both visually and by statistical calculations.
Outcomes & Results: All participants experienced a positive improvement in their writing ability. Results showed individual differences; after completed training the first participant made more successful edits, the second wrote more words, had a larger proportion of correctly written words, and made more successful edits. The third participant’s results did not show any improvement that could be statistically supported.
Conclusions: This study showed that the computerised training facilitated the generating process and made the revision process more efficient for the participants. The results are important in that they indicate possible ways of designing writing treatment. However, they also show the need for careful analyses when evaluating different treatment strategies and in discussing what improved writing ability may be.
Background: It is has been estimated that aphasia occurs in one-third to half of patients who have had a left hemisphere brain tumour resection. While studies have documented aphasia before malignant brain tumour resection, little is known about the type and severity of aphasia after tumour resection.
Aims: The aims of this study were (1) to describe the subtypes and severity of aphasia during the acute recovery period after malignant brain tumour resection; (2) to describe potential associations between acute language outcomes and tumour characteristics; and (3) to compare our findings to those reported in the literature to identify possible language differences between patients who suffer stroke and patients who undergo brain tumour resection.
Methods & Procedures: We retrospectively reviewed the Western Aphasia Battery (WAB) scores during the acute recovery period of individuals who underwent resection of malignant brain tumours to determine patterns of aphasia severity and subtype.
Outcomes & Results: We found that aphasia was usually mild (63% of patients) and that anomic aphasia was the most common subtype (48% of patients) during the acute recovery period after brain tumour resection, regardless of lesion location or tumour grade.
Conclusions: The patterns of postoperative language functioning that we observed during the acute recovery period after surgery for a brain tumour support the perspective that acute aphasia profiles may be fundamentally different in patients with brain tumours compared with patients who have had a stroke.
Background: Nonverbal cognitive constructs are not well understood in patients with acquired aphasia due to stroke. The relative contribution of aphasia, particularly receptive language impairment, to nonverbal function is rarely quantified in studies, although it is assumed to be substantial.
Aims: The purpose of the present study was first to investigate the factor structure of some of the WAIS-III and WMS-III nonverbal tasks in patients with acquired aphasia due to stroke using confirmatory factor-analytic techniques. Second, we sought to determine the degree to which aphasia severity (both auditory comprehension and oral expression), as measured by the Language Competency Index (LCI) of the Boston Diagnostic Aphasia Examination (Goodglass et al., 2001), would account for variance in nonverbal cognitive task performance.
Methods & Procedures: The present study investigated the factor structure of widely used nonverbal cognitive tasks in 136 patients with aphasia due to single left hemisphere stroke, and sought to determine the degree to which language impairment accounted for nonverbal skill. Outcomes & Results: A single factor model representing nonverbal (perceptual) constructs provided the best model fit to the data. The underlying factor structure of nonverbal constructs in patients with aphasia mirrors the structure observed in healthy adults. Although the correlations between language impairment measures and nonverbal skills were moderate, language competence accounted for a minority (about a quarter) of the variance in nonverbal skills.
Conclusions: We conclude that impairment in nonverbal cognitive ability is not fully explained by language competence in people with aphasia.
Children with Specific Language Impairment (SLI) are known to exhibit difficulties on auditory working memory (WM) tasks. This study investigated the impact of providing visual support on children’s performance on an auditory WM task. Three groups of 18 children participated. The groups were children with SLI, age matched, and language matched control children. Participants completed 4 digit recall tasks using different combinations of auditory and visual input and output for a digits forwards (DF) recall condition in the first session and a digits backwards (DB) recall condition in the final session. The digit recall tasks accompany this manuscript and can be downloaded from http://www.informaworld.com/ijslp. For the DF tasks, the SLI and age matched groups recalled significantly more sequences when visual support was provided in input and output, and all groups showed a significant benefit from visual support for the DB condition. These findings provide further evidence that the provision of visual information supports working memory performance in children with SLI and typically developing children. This has implications for the support strategies currently used to assist children with WM difficulties.
Unilateral sensorineural hearing loss (SNHL) can be caused by a variety of lesions of the inner ear and central nervous system. An inner hair cell or neural site of pathology must be suspected when otoacoustic emissions (OAEs) are present, and inconsistent with audiologic data. We reviewed unilateral neural hearing loss (UNHL) in children, to better understand its etiology, clinical and audiologic features.
Tertiary pediatric center.
From a database of 480 children with unilateral SNHL, 148 had OAE data. Patients with a neural pattern (present OAEs in the affected ear) were reviewed.
Clinical course, audiologic data, imaging findings.
Of 148 patients with OAE data, 11 (7.4%) had the unilateral neural phenotype. Most had stable, severe-to-profound loss in the affected ear. MRI determined an etiology in all 10 patients who received it. Absent cochlear nerves were remarkably common, being found in eight patients (73%). Tumors, previously unsuspected, were identified in the other two patients who received MRI.
Cochlear nerve aplasia appears by far the most common cause of UNHL in children. As in adults, mass lesions must also be considered in children with unilateral SNHL with a neural pattern. As both lesions elude diagnosis on CT, MRI is the better modality for evaluating this condition.
The goal of this study was to examine tonal language perception in adults with cochlear implants who are native speakers of Cantonese. Ten adult subjects were implanted with HiRes 90K devices and participated in the study. Baseline data were obtained with standard HiRes and compared with HiRes 120. Subjects were evaluated using a tone identification test and a questionnaire. While objective outcome measures with the tone identification test did not show significant differences between standard HiRes and HiRes 120, subjective evaluation with the questionnaire showed significant differences in the overall satisfaction perceived by subjects. HiRes 120 received a significantly higher rating and the majority of subjects preferred HiRes 120. Copyright © 2009 John Wiley & Sons, Ltd.
Call it a natural earplug: Your ears appear to be able to automatically turn down certain frequencies to protect your hearing, and a new study provides more details about how this mysterious process works.
Abstract Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35–94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.