Monthly Archives: August 2009
Communication Disorders in Speakers of Tone Languages: Etiological Bases and Clinical Considerations
Lexical tones are a phonetic contrast necessary for conveying meaning in a majority of the world’s languages. Various hearing, speech, and language disorders affect the ability to perceive or produce lexical tones, thereby seriously impairing individuals’ communicative abilities. The number of tone language speakers is increasing, even in otherwise English-speaking nations, yet insufficient emphasis has been placed on clinical assessment and rehabilitation of lexical tone disorders. The similarities and dissimilarities between lexical tones and other speech sounds make a richer scientific understanding of their physiological bases paramount to more effective remediation of speech and language disorders in general. Here we discuss the cognitive and biological bases of lexical tones, emphasizing the neural structures and networks that support their acquisition, perception, and cognitive representation. We present emerging research on lexical tone learning in the context of the clinical disorders of hearing, speech, and language that this body of research will help to address.
The focus of this article is on the potential transfer or generalization of positive effects from a treated to an untreated language in bilingual or multilingual individuals with primary acquired aphasia. Twelve studies are reviewed: All were previously published in English in peer-reviewed journals. Half of these studies failed to account for spontaneous recovery. Results from the remaining case reports and single-subject studies are mixed, with four finding evidence for cross-language generalization under some conditions and two finding that improved language performance was restricted to the treated language. Collective findings are discussed within the broader literature in terms of factors to consider when planning for effective, efficient intervention with bilinguals with aphasia.
Discourses of Dementia: A Call for an Ethnographic, Action Research Approach to Care in Linguistically and Culturally Diverse Environments
The methods of ethnography and action research have much to offer to the field of speech-language pathology, particularly as our clinical populations are becoming increasingly diverse. We suggest that practicing speech-language pathologists and students, as well as researchers, will benefit from strategies that use the methods of participatory action research and ethnography as guiding principles to their work. Ethnography seeks to discover meaningful structures in a culture from the perspective of those whose culture it is. Action research, which shares a methodological basis with ethnography, is undertaken with the aim of improving the functioning of the social institution, practice, or structure investigated for the benefit of those most closely involved with that institution or practice. By way of illustration, we use data collected during fieldwork in Louisiana, involving persons with dementia from linguistically and culturally diverse backgrounds.
Issues and Principles in Service Delivery to Communicatively Impaired Minority Bilingual Adults in Neurorehabilitation
Demographic and epidemiological trends coupled with health-care needs in minority populations highlight the imperative need to develop effective, culturally appropriate clinical approaches for minority adults with communication impairments. The steady increase in linguistic and cultural diversity in the country includes a large number of bilingual adults, which is estimated to continue. Because strokes are quite prevalent in racial/ethnic minorities, the number of bilingual adults with acquired communication disorders will similarly increase. However, members of minority groups presently confront disparities in health-care services compared with the general population that translates into reduced health outcomes. This article discusses the current clinical needs and complexities in service delivery to communicatively impaired minority adults, with a special focus on bilingual adults with aphasia.
Understanding communicatively impaired minority individuals may involve going beyond strictly linguistic and communicative domains. In particular, considering the psychoemotional aspects impacting these clients may be extremely helpful for treating them and enhancing their response to therapy. This article provides an overview of issues on minority bilingual individuals that are relevant to professionals in mental health and speech-language pathology. We use Hispanics, the fastest growing minority in the United States, for illustration. The material discussed in this article highlights some of the benefits of collaborative communication between mental health professionals and speech-language pathologists (SLPs). Such communication would enhance SLPs’ understanding of the interesting interconnections among emotions, culture, and language in immigrant and minority persons with valuable applications to therapeutic services with these individuals.
African American adults have a disproportionately high incidence and prevalence of cognitive-communicative disorders, yet their use of speech-language pathology services does not reflect their need for clinical intervention. The purpose of this article is to issue a call to action aimed at moving toward the development of model-informed interventions for African American adults with cognitive-communicative disorders. We propose the development of model-driven interventions that are designed to reflect the values and preferences of many African American adults in terms of culturally distinctive opportunities for activities and participation within their communities. Examples of culturally distinctive activities and participatory roles are offered as a starting point for establishing social validity and empirical support for underlying assumptions. Constructs from the International Classification of Functioning, Disability, and Health and evidence-based practice are juxtaposed to suggest their mutual relevance to developing clinical services that resonate with the values and preferences of many African Americans.
Torontonian Gail Hawkins – founder of an Asperger Syndrome employment consultancy – is the author of a practical guide for the Asperger population that figures prominently in director Max Mayer’s new feature film “Adam”, the Alfred P. Sloan prize winner at the 2009 Sundance Film Festival.
“How To Find Work That Works For People With Asperger Syndrome”, published in 2004, continues to be distributed to an expanding roster of countries worldwide, helping a growing adult Asperger population learn targeted job search strategies, interview techniques and work skills.
The book, passages of which are the source of an interview prep montage in “Adam”, is a compilation of techniques developed by Hawkins over the course of 20 years in a practice that’s evolved to include assessment, coaching, employment placement and employer education – as well as a paid apprenticeship program she’s pioneered at her cafe, Niche Coffee & Tea Company, on Toronto’s trendy Queen West.
A new candidate gene for Specific Language Impairment (SLI) has been identified by a research team directed by Mabel Rice from the University of Kansas, in collaboration with Shelley Smith, University of Nebraska Medical Center, and Javier Gayán of Neocodex, Seville, Spain. The finding, reported in the current issue of the Journal of Neurodevelopmental Disorders, was discovered by examining genes previously identified as candidate genes for reading impairments or speech sound disorders. The results point toward the likelihood of multiple genes contributing to language impairment, some of which also contribute to reading or speech impairment.
A gene on Chromosome 6 – KIAA0319 – was associated with variability in language abilities in a study of children with Specific Language Impairment and their family members, as well as with variability in speech and reading abilities. Children with SLI who were selected for the study had no hearing loss, general intellectual deficit or autism.
Language ability involves vocabulary and grammar, whereas speech involves the accuracy of sound production. Both language and speech ability contribute to a child’s ability to read. The finding that a candidate gene could influence all three abilities suggests a common pathway that could contribute to overlapping strengths or deficiencies across speech, language and reading.
According to Rice, “We don’t understand the biological mechanisms yet but it’s important that we have identified the first gene that could be involved across these three different dimensions of development.”
Previous research has established that Chromosome 6 is among those that are linked to Speech Sounds Disorder (SSD) and Reading Disability/Dyslexia (RD). Rice said the findings are consistent with numerous reports documenting that language impairments and reading disability often co-exist.
The study involved 322 individuals, including children with SLI, their parents, siblings, and other family members. “We have come to realize that language really sets the platform for reading to emerge and to thrive,” Rice added. “Without a solid language system, it’s much harder to get reading going.”
Our vocabulary continues to grow and expand even in adulthood. Just ten years ago, the word ‘blog’ did not yet exist – and now we no longer remember when we heard this word for the first time or when we learned its meaning. At some stage new words become just as familiar to us as words we have learned earlier. One of the areas of interest in the Academy of Finland’s Neuroscience Research Programme (NEURO) is how the process of learning new words is reflected in the function of the brain.
The new research evidence emerging about how the brain processes language and its different levels has important application among other things in the development of language teaching.
In one of the experiments conducted in the NEURO programme, participants learned the name and/or purpose of 150 ancient tools. They had never heard these words before. The subjects’ brain function was measured by means of magnetoencelography during the naming of the tools, both before and after the learning period.
The results show that the brain uses the same neural networks to process both familiar and newly learned words. The names of objects were processed in the left temporal and frontal lobe within half a second of showing the image of the tool to the subject. “If the subject had only recently learned the name of the tool, the the naming process induced an activation that was just as strong or stronger than the activation induced by the image of a familiar object,” says Academy Professor Riitta Salmelin, HUT Low Temperature Laboratory, who is in charge of the research.
According to Salmelin the learning of the meaning of ancient tools did not cause corresponding clear differences in the function of the brain. In other words, it seems that the processing of meanings in the brain differs essentially from the processing of names. On the other hand, the performance results indicated that new definitions were learned even faster than new names.
How are learned words retained?
The research team are now working on a follow-up study to explore the retention of learned words. Is it possible to detect in brain activation some specific phenomenon that predicts good retention of learned knowledge up to several months after learning?
“We are also conducting a separate series of experiments to find out how our brain learns phonetic structures and, on the other hand, how the brain learns to identify letter combinations that are typical of a certain language,” Riitta Salmelin explains.
Another area of interest in the ongoing study is the role of grammar in language learning. The focus here is to explore how the brain learns to use the vocabulary and grammatical structure of an experimental miniature language.
new candidate gene for Specific Language Impairment has been identified by a research team directed by Mabel Rice at the University of Kansas, in collaboration with Shelley Smith, University of Nebraska Medical Center, and Javier Gayán of Neocodex, Seville, Spain.
Mind & Brain
The finding, reported in the current issue of the Journal of Neurodevelopmental Disorders, was discovered by examining genes previously identified as candidate genes for reading impairments or speech sound disorders.
The results point toward the likelihood of multiple genes contributing to language impairment, some of which also contribute to reading or speech impairment.
A gene on Chromosome 6 – KIAA0319 – was associated with variability in language abilities in a study of children with Specific Language Impairment (SLI) and their family members, as well as with variability in speech and reading abilities. Children with SLI who were selected for the study had no hearing loss, general intellectual deficit or autism.
Immediate Effects of Thermal–Tactile Stimulation on Timing of Swallow in Idiopathic Parkinson’s Disease
Abstract Oropharyngeal dysphagia frequently presents in people with idiopathic Parkinson’s disease (IPD). Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. Thermal–tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The effects of TTS on swallowing have not yet been investigated in IPD. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12–0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08–0.66, p = 0.01). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00–1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08–1.46, p = 0.033). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12–0.34, p = 0.002). TTS did not significantly alter median oral transit time on either fluid or paste consistency. TTS significantly reduced temporal measures of the pharyngeal phase of swallowing in the IPD population. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. It is still unclear whether these findings will translate into a clinically beneficial effect.
In aphasia literature, it has been considered that a speech repetition defect represents the main constituent of conduction aphasia. Conduction aphasia has frequently been interpreted as a language impairment due to lesions of the arcuate fasciculus (AF) that disconnect receptive language areas from expressive ones. Modern neuroradiological studies suggest that the AF connects posterior receptive areas with premotor/motor areas, and not with Broca’s area. Some clinical and neurophysiological findings challenge the role of the AF in language transferring. Unusual cases of inter-hemispheric dissociation of language lateralization (e.g. Broca’s area in the left, and Wernicke’s area in the right hemisphere) have been reported without evident repetition defects; electrocortical studies have found that the AF not only transmits information from temporal to frontal areas, but also in the opposite direction; transferring of speech information from the temporal to the frontal lobe utilizes two different streams and conduction aphasia can be found in cases of cortical damage without subcortical extension. Taken altogether, these findings may suggest that the AF is not required for repetition although could have a subsidiary role in it. A new language network model is proposed, emphasizing that the AF connects posterior brain areas with Broca’s area via a relay station in the premotor/motor areas.
Tone Discrimination and Speech Perception Benefit in Mandarin-Speaking Children Fit With HiRes Fidelity 120 Sound Processing
Results: Statistically significant improvements from baseline with HiRes to 6 months with HiRes 120 were found for tone discrimination (61.4 to 73.2%, p = 0.006) and for SPIN low predictability (65.7 to 74.7%, p = 0.039). Mean score changes of 47.4 to 50.4% (p = 0.499) for consonant perception, 82.9 to 86.4% for M-LNT (easy words; p = 0.322), 77.1 to 81.0% for M-LNT (hard words; p = 0.423), and 72.3 to 78.5% for SPIN high predictability (p = 0.427) showed trends for improvement but were not statistically significant. Questionnaire results indicated that all children and parents preferred HiRes 120 to HiRes. Strength of preference was 8.9 for children and 8.1 for parents on a scale of 1 to 10 (1 = weak preference, 10 = strong preference).
Conclusion: Taken together, the improved tone discrimination and speech perception results, along with subjective improvements in speech fluency, discrimination, and music appreciation, indicate a trend toward superior listening benefit with HiRes 120 compared with standard HiRes in Mandarin-speaking children.
Picture-Book Reading as an Intervention to Teach the Use of Line Drawings for Communication with Students with Severe Intellectual Disabilities
Picture-book reading provides an effective intervention context for young children learning spoken language and may also be appropriate for teaching the use of augmentative and alternative communication to children with severe intellectual disabilities. This study reports on a group intervention using a semiscripted book reading routine implemented by a teacher in a classroom for students with severe intellectual disabilities. Student use of line drawings was observed over the course of the intervention. Students’ abilities to match words, line drawings, book illustrations, and real objects were assessed weekly. There were differences between baseline and intervention performances for all students, and these differences were particularly noticeable for one student.
Purpose: To examine the effects of an intensive Smooth Speech therapy technique on the speech production of an individual with ataxic dysarthria and on the individual’s level of functioning on the domains of the International Classification of Functioning, Disability and Health (ICF).
Method: This study utilized a single-subject experimental design. One individual with ataxic dysarthria took part in an intensive Smooth Speech therapy programme. Measurements of the participant’s speech and level of functioning on the domains of the ICF were made before therapy, after 1 week of intensive therapy, after 7 weeks of follow-up therapy and 4 weeks after completion of therapy.
Results: No significant change in speech intelligibility was evident following Smooth Speech therapy. However, significant improvements in the participant’s ability to achieve improved speech naturalness through enhanced control of prosodic elements and more comprehensible speech were evident. The participant also demonstrated an improved level of functioning on selected domains of the ICF.
Conclusions: The results of this study indicate that elements of Smooth Speech Therapy may prove effective in the treatment of ataxic dysarthria, particularly in the treatment of prosodic defects.
from Brain Injury