Speech, language, and cognitive development in children with isolated sagittal synostosis

This study investigated the occurrence, nature, and severity of speech, language, and cognitive impairment in 76 children (61 males, 15 females) with isolated sagittal synostosis (ISS) aged 9 months to 15 years 7 months. There was no increased prevalence of global cognitive impairment in the group but there was a high prevalence rate of speech and/or language impairment with 28 (37%) displaying impairment of whom 20 (71%) had moderate or severe impairments that fulfilled the criteria for specific impairments. Prevalence rates were only increased for children over two years of age. Expressive language impairment occurred most frequently. Raised intracranial pressure, peri-neonatal risk factors, otitis media, or being operated were not associated with impairment. Surgery at a later age and a family history of speech and language impairment were both associated with impairments but numbers were small. The findings suggest that children with ISS are at an increased risk of developing speech and language impairment.

Higher attack rates for left motor deficit among men with cerebrovascular events

The authors report the findings of a prospectively collected database of stroke and TIA recorded from 1998 through 1999 by the 178 family physicians of the Belgian sentinel network. The yearly age-adjusted attack rate per 100,000 men was estimated as 109 (95% CI = 86 to 137) for left motor deficit and 75 (95% CI = 56 to 99) for right motor deficit (p = 0.011). This difference was not observed among women nor in the entire sample population. The authors suggest that handedness should be systematically recorded and compared to both sex and the side of the event.

A comparative study of the phonology of pre-school children with specific language impairment (SLI), language delay (LD) and normal acquisition

The phonology of two groups of SLI (n = 5) and LD (n = 5) children was analysed at age 3 and compared with two control groups: an age control (n = 5) and a language level control (measured using the MLU-W) (n = 5). Children with SLI and LD showed a delay in the acquisition of segments, syllabic structures and word structures, and in the simplification processes, compared with their age control group. However, SLI children also displayed significant differences vis-à-vis their language level controls, mainly in early acquisitions: vowels, nasals and stops at the segmental level, and in CV structures at the syllabic level. There is also a simplification process that seems to be more prevalent in these children than in their language level controls, namely, the deletion of unstressed syllables, mainly initial ones. The results enable SLI to be distinguished from LD and suggest that the development of SLI phonology is deviant. This deviation is interpreted as being a plateau in early acquisitions when later acquisitions have already appeared. The results are considered in the light of Leonard's surface hypothesis and an exclusively linguistic cause for this disorder is ruled out.

Vowel and diphthong development in Cantonese-speaking children

Spontaneous speech samples were collected from 40 Cantonese-speaking children aged between 10 and 27 months. Over 7,000 vowels and diphthongs were transcribed and analysed to determine the accuracy of production of Cantonese vowels and diphthongs. A model of feature complexity was derived from the distinctive features of vowels to predict the route of development of vowels and diphthongs. Two factors were found to affect development: a linguistic factor (frequency of occurrence in the ambient language) and an articulatory factor (feature complexity). Early dependence on the feature complexity of segments at 15-18 months is superseded by ambient language influences by 24 months of age.

Phonetic and otological results after early palate closure in 18 consecutive children presenting with cleft lip and palate

OBJECTIVE

First, to analyze the speech and hearing results at 3.5 years of age when early palate closure has been performed. Second to assess at 7 years of age the need for speech therapy and/or additional surgery in the form of cranial-based pharyngeal flap for obtaining normal speech.

METHODS

Retrospective study in a tertiary teaching hospital concerning 18 consecutive cases presenting cleft lip and palate with no associated abnormalities. Interventions included early palatine closure (velum at 3 months, hard palate and lip at 6 months). Speech therapy was initiated at 3.5 years of age when needed. Cranial-based pharyngeal flap was performed when normal nasal emission was not obtained by speech therapy at 7 years of age. Phonetic and otological assessment were performed in all cases.

RESULTS

Good to excellent speech in the majority (95%) of children, with only 3/18 undergoing pharyngoplasty to obtain type I or I/II speech by the age of 7 (range: 6.5-8.0). 6/18 children had drain insertion, and 2/18 had hearing loss of 20-40 dB in all frequencies.

CONCLUSION

Most children (95%) start school with good or excellent speech. However, the high incidence of middle ear problems shows that more effective screening and treatment are warranted.

Blinded speech evaluation following pharyngeal flap surgery by speech pathologists and lay people in children with cleft palate

METHODS

In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders.

RESULTS

Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68-0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73-1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 +/- 0.32 scale points when judged by lay people, and 0.75 +/- 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients.

CONCLUSION

The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.

Speech loudness and quality 12 months after intensive voice treatment (LSVT) for Parkinson's disease: a comparison with an alternative speech treatment

Thirty-five individuals with idiopathic Parkinson's disease were enrolled in speech treatment. Twenty-two were enrolled in a high-effort phonatory-respiratory treatment program (Lee Silverman Voice Treatment, LSVT) and 13 were enrolled in a high-effort respiratory treatment program (RET). Perceptual judgments of speech loudness and quality were made independently by 6 listeners on recordings of the 'Rainbow Passage'. These recordings had been obtained just before treatment (pre) and at 12 months' follow-up (FU12). The speech samples in the LSVT group, but not in the RET group, were significantly more likely to be perceived 'louder' and 'better quality' at FU12 than at pre (p < 0.0001). These findings, along with others, suggest that the long-term effects of the LSVT are perceptible, clinically significant and treatment-specific.

Descriptive study of 192 adults with speech and language disturbances

CONTEXT

Aphasia is a very disabling condition caused by neurological diseases. In Brazil, we have little data on the profile of aphasics treated in rehabilitation centers.

OBJECTIVE

To present a descriptive study of 192 patients, providing a reference sample of speech and language disturbances among Brazilians.

DESIGN

Retrospective study.

SETTING

Speech Pathology Unit linked to the Neurology Division of the Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo.

SAMPLE

All patients (192) referred to our Speech Pathology service from 1995 to 2000.

PROCEDURES

We collected data relating to demographic variables, etiology, language evaluation (functional evaluation, Boston Diagnostic Aphasia Examination, Boston Naming and Token Test), and neuroimaging studies.

MAIN MEASUREMENTS

The results obtained in language tests and the clinical and neuroimaging data were organized and classified. Seventy aphasics were chosen for constructing a profile. Fourteen subjects with left single-lobe dysfunction were analyzed in detail. Seventeen aphasics were compared with 17 normal subjects, all performing the Token Test.

RESULTS

One hundred subjects (52%) were men and 92 (48%) women. Their education varied from 0 to 16 years (average: 6.5; standard deviation: 4.53). We identified the lesion sites in 104 patients: 89% in the left hemisphere and 58% due to stroke. The incidence of aphasia was 70%; dysarthria and apraxia, 6%; functional alterations in communication, 17%; and 7% were normal. Statistically significant differences appeared when comparing the subgroup to controls in the Token Test.

CONCLUSIONS

We believe that this sample contributes to a better understanding of neurological patients with speech and language disturbances and may be useful as a reference for health professionals involved in the rehabilitation of such disorders.

Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study

BACKGROUND AND PURPOSE

Although patterns of stroke occurrence and mortality have been well studied, few epidemiological data are available regarding the clinical characteristics of stroke events.

METHODS

We evaluated hospitalized stroke events reported in the Atherosclerosis Risk in Communities (ARIC) Study to describe the clinical characteristics of incident stroke. Confirmed stroke cases (n=474) were evaluated for stroke symptoms (headache, vertigo, gait disturbance, convulsions) and stroke signs (hemianopia, diplopia, speech deficits, paresis, paresthesia/sensory deficits) and their univariate associations with race, sex, and stroke subtype.

RESULTS

Over 9.2 years of follow-up, 402 (85%) ischemic and 72 (15%) hemorrhagic strokes occurred. Frequency of stroke symptoms (95% CIs) were as follows: headache (27.4%; 23.4% to 31.4%), gait disturbance (10.8%; 7.9% to 13.6%), convulsions (4.4%; 2.6% to 6.3%), and vertigo (2.1%; 0.8% to 3.4%). Speech deficits occurred in 24.0% (20.2% to 27.9%), hemianopia in 14.6% (11.4% to 17.7%), and diplopia in 5.5% (3.4% to 7.5%) of cases. Most cases involved paresis (81.6%; 78.1% to 85.1%), while fewer cases experienced sensory deficits (44.5%; 40.0% to 49.0%). Blacks were more likely than whites to experience paresis (85.4% versus 78.2%; P=0.044). Men were more likely than women to experience a gait disturbance (14.4% versus 6.7%; P=0.007). Persons with hemorrhagic strokes had a higher proportion of headaches (55.6% versus 22.4%; P=0.001) and convulsions (11.1% versus 3.2%; P=0.003) than those with ischemic events, while speech and sensory deficits were more common in ischemic strokes (26.1% versus 12.5%, P=0.013, and 49.0% versus 19.4%, P=0.001, respectively).

CONCLUSIONS

We present epidemiological data concerning the clinical characteristics of incident stroke in a population-based cohort. Although minor differences by race, sex, and stroke subtype were observed, data from additional follow-up are required to confirm observed variations.

Neurological basis of deficits in affective prosody comprehension among alcoholics and fetal alcohol-exposed adults

Affective prosody is a nonlinguistic aspect of language that conveys emotions and attitudes during discourse. In this study the neurological basis of affective prosodic comprehension (APC) dysfunction in alcoholics (ALC) and fetal alcohol-exposed adults (FAexp) was explored. Subjects were previously tested for APC by use of the Aprosodia Battery, including 9 right-brain-damaged and 10 left-brain-damaged subjects. ALC and FAexp subjects were significantly less accurate than control subjects in APC, and scored similarly to patients with focal brain lesions. The specific APC impairment found in ALC and FAexp may be a consequence of both callosal and right cortical dysfunction or damage.

Speech and language outcomes of children with bronchopulmonary dysplasia

A prospective follow-up of very low birth weight infants (VLBW) with (n = 89) and without (n = 71) bronchopulmonary dysplasia (BPD) and Term control children (n = 93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrollment in special classes and speech-language therapy, with almost half (48%) of the BPD group enrolled in speech-language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW.

LEARNING OUTCOMES

(1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.

Gender and masculinity-femininity ratings of tracheoesophageal speech

Tracheoesophageal (TE) speech is frequently characterized as low pitched and hoarse. In laryngeal speakers, these features are most often associated with males. Because lower pitch and hoarseness are anticipated for male and female TE speakers, one might predict that females are at risk for being perceived as male. The purposes of this pilot study were to assess the reliability and accuracy of listeners' perceptions of TE speaker gender and to evaluate the relationship between gender ratings and masculinity-femininity ratings. Twenty-five naïve listeners rated the gender and the masculinity-femininity of 12 TE speakers from audio recordings of a reading passage. Listeners were able to reliably rate gender and masculinity-femininity. They accurately identified speaker gender at a high rate that was comparable for males and females. However, female speakers, despite being accurately identified as female, were at an elevated risk of being rated as masculine or neutral on the masculinity-femininity scale.

LEARNING OUTCOMES

As a result of this activity, the participant will be able to: (1) describe the reliability and accuracy of listener perceptions of the gender and the degree of masculinity-femininity of TE speakers; and (2) discuss the relationship between TE speaker gender identification and masculinity-femininity ratings for males and females, respectively.

Speech disfluency in centenarians

Other than a single case presentation of a 105-year-old female, no other studies have addressed the speech fluency characteristics of centenarians. The purpose of this study was to provide descriptive information on the fluency characteristics of speakers between the ages of 100-103 years. Conversational speech samples from seven speakers were evaluated for the frequency and types of disfluencies and speech rate. The centenarian speakers had a disfluency rate similar to that reported for 70-, 80-, and early 90-year-olds. The types of disfluencies observed also were similar to those reported for younger elderly speakers (primarily whole word/phrase, or formulative fluency breaks). Finally, the speech rate data for the current group of speakers supports prior literature reports of a slower rate with advancing age, but extends the finding to centenarians.

LEARNING OUTCOMES

As a result of this activity, participants will be able to: (1) describe the frequency of disfluency breaks and the types of disfluencies exhibited by centenarian speakers, (2) describe the mean and range of speaking rates in centenarians, and (3) compare the present findings for centenarians to the fluency and speaking rate characteristics reported in the literature.

Interaction of speech coders and atypical speech II: effects on speech quality

We investigated how standard speech coders, currently used in modern communication systems, affect the quality of the speech of persons who have common speech and voice disorders. Three standardized speech coders (GSM 6.10 RPE-LTP, FS1016 CELP, and FS1015 LPC) and two speech coders based on subband processing were evaluated for their performance. Coder effects were assessed by measuring the quality of speech samples both before and after processing by the speech coders. Speech quality was rated by 10 listeners with normal hearing on 28 different scales representing pitch and loudness changes, speech rate, laryngeal and resonatory dysfunction, and coder-induced distortions. Results showed that (a) nine scale items were consistently and reliably rated by the listeners; (b) all coders degraded speech quality on these nine scales, with the GSM and CELP coders providing the better quality speech; and (c) interactions between coders and individual voices did occur on several voice quality scales.

Oral ill-health and deprivation among patients of a general dental practice in South Wales

PURPOSE OF STUDY

This study aims to establish and report on whether individuals from deprived areas suffer more ill health than adults from areas considered not to be deprived when visiting a general dental practice.

BASIC PROCEDURES

Between December 1998 and June 1999 registered dental patients over 18 years of age attending for routine care completed a questionnaire measuring functional, experiential and psychosocial impact of oral ill health. In addition the clinical impact of ill health was established from the patient examination and record card. Clinical outcome was assessed by numbers of standing teeth, oral health was assessed using the Subjective Oral Health Status Indicators (SOHSI). The patient's postcode was used to categorise individuals from areas of different deprivation states.

MAIN FINDINGS

99% were dentate with 88.4% having more than 20 teeth. A total of 71.8% were able to eat satisfactorily, 88.2% were able to speak satisfactorily, 54.6% were discontent, 99.4% were worried about their oral health and appearance, 62.8% were satisfied with their oral health, 44.8% experienced discomfort, 65.8% experienced other symptoms, and 86.8% experienced 'general well-being'. No differences were observed for clinical measures between the deprived groups. Only three out of eight oral health measures showed any differences between the deprived groups, namely, ability to speak, discontent and general well-being. More individuals from deprived areas experienced these impacts.

PRINCIPAL CONCLUSIONS

It was anticipated that individuals from deprived areas would experience greater ill-health: this outcome was not as marked as expected.

Long-term follow-up of patients with necrotizing enterocolitis

BACKGROUND/PURPOSE

Despite the rise in the incidence of necrotizing enterocolitis (NEC), there is a paucity of data regarding long-term patient outcome. The authors examined functional outcome of infants with NEC (n = 103) treated at our institution between 1991 and 1995.

METHODS

The authors reviewed the medical records of infants who were treated both operatively and nonoperatively, n = 103. Variables examined included gestational age, birth weight, Bell stage (I through III), operations performed, and mortality rate. Telephone interviews assessed school enrollment, developmental delay, bowel function, and nutritional status.

RESULTS

Children treated operatively had a lower gestational age than those in the nonoperative group. Likewise, birth weight in the operative group was significantly lower. Sixty-three percent of patients had stage III, and the remainder had stage II disease. The telephone response rate was 61%. Mean age at follow-up was 7.5 +/- 2.5 years. All children ate by mouth. Nearly all children were toilet trained. All children were less than the 50th percentile for height and weight, and the majority (83%) were enrolled in school full time.

CONCLUSION

Infants with stage II and III NEC who are treated operatively or nonoperatively have a favorable long-term outcome.

Interaction of speech coders and atypical speech I: effects on speech intelligibility

We investigated how standard speech coders, currently used in modern communication systems, affect the intelligibility of the speech of persons who have common speech and voice disorders. Three standardized speech coders (viz., GSM 6.10 [RPE-LTP], FS1016 [CELP], FS1015 [LPC]) and two speech coders based on subband processing were evaluated for their performance. Coder effects were assessed by measuring the intelligibility of vowels and consonants both before and after processing by the speech coders. Native English talkers who had normal hearing identified these speech sounds. Results confirmed that (a) all coders reduce the intelligibility of spoken language; (b) these effects occur in a consistent manner, with the GSM and CELP coders providing the least degradation relative to the original unprocessed speech; and (c) coders interact with individual voices so that speech is degraded differentially for different talkers.

Verbal short-term memory in Down syndrome: a problem of memory, audition, or speech?

The current study explored three possible explanations of poor verbal short-term memory performance among individuals with Down syndrome in an attempt to determine whether the condition is associated with a fundamental verbal short-term memory deficit. The short-term memory performance of a group of 19 children and young adults with Down syndrome was contrasted with that of two control groups matched for level of receptive vocabulary. The specificity of a deficit was assessed by comparing memory for verbal and visuo-spatial information. The effect of auditory problems on performance was examined by contrasting memory for auditorily presented material with that for material presented both auditorily and visually. The influence of speech-motor difficulties was investigated by employing both a traditional recall procedure and a serial recognition procedure that reduced spoken response demands. Results confirmed that individuals with Down syndrome do show impaired verbal short-term memory performance for their level of receptive vocabulary. The findings also indicated that this deficit is specific to memory for verbal information and is not primarily caused by auditory or speech-production difficulties.

Narrative discourse in young children with histories of early corrective heart surgery

Narrative attainment was assessed in a group of 76 four-year-old children at risk for brain injury because of histories of early corrective heart surgery. Elicited personal experience narratives were coded for narrative components, evaluative devices, and information adequacy and were contrasted with narratives produced by a comparison group of typically developing 4-year-olds. The production of autonomous narrative discourse was identified as an area of special vulnerability for children with this medical history. Despite considerable heterogeneity in narrative performance, children with early corrective heart surgery produced fewer narrative components than typically developing children. Results suggest that the elaboration of events and contextual information, the expression of subjective evaluation and causality, and clarity and explicitness of information reporting may constitute special challenges for this population of children. Implications of these findings for clinical assessment and possible risks for socioemotional relationships and academic achievement are discussed.

Height distribution in children with Tourette syndrome

Tourette syndrome is characterized by motor and vocal tics, frequently accompanied by attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, coprolalia, aggressive or self-injurious behavior, and learning disabilities. We investigated the height distribution and clinical characteristics of 38 consecutive patients with Tourette syndrome. Seventeen patients with Tourette syndrome (44.7%) were in the lower height quartile versus 25% from a control group of 44 patients with ADHD (P <.05). The mean standard deviation score differential (patient height - [target height]) was -1.12 +/- 0.82 for patients in the first quartile (group A) compared with 0.42 +/- 0.63 in taller patients with Tourette syndrome (group B) (P < .001). The mean birthweight of boys in group A versus group B was 3023 +/- 351 g and 3363 +/- 486 g, respectively (P <.02); birthweight correlated with standard deviation score (r=.43). Current weight relative to height was normal. Conduct disorder and/or self-injurious behavior were more common in group A patients (P < .05). Relative short stature appears common in Tourette syndrome, and its presence with other features may implicate a neurotransmitter system that interacts with neuroendocrine pathways, controlling height.

Fiery tongues and mystical motivations: glossolalia in a forensic population is associated with mania and sexual/religious delusions

Comparisons are made between a nonrandom sample of 18 glossolalists and 130 non-glossolalists admitted to a maximum-security forensic hospital. The glossolalic mentally disordered offender exhibited a predominance of diagnoses in the manic spectrum, and was typically psychotic. The delusions, hallucinations, and crimes were predominately of a religious and sexual nature. Glossolalist perpetrators tended to be female. We review the extant research on glossolalia in both normal and clinical samples. and integrate our findings, the first study of glossolalia in a forensic setting.

Influences of preclinical dementia and impending death on the magnitude of age-related cognitive deficits

The authors examined the influence of preclinical dementia and impending death on the cross-sectional relationship between age and performance in tasks assessing episodic memory, visuospatial skill, and verbal fluency. Increasing age was associated with a general decrease in cognitive performance. In addition, those who were to be diagnosed with dementia or had died by a 3-year follow-up, were older, and performed at a lower level than the remaining sample across all cognitive tasks at baseline. Nevertheless, removal of the preclinical dementia and impending death groups from the original sample affected the cross-sectional age-cognition relations relatively little. This pattern of findings suggests that the biological aging process exerts negative influences on cognitive functioning beyond those resulting from disease and mortality.

Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation

OBJECTIVE

RADPLAT (concurrent selective supradose intraarterial cisplatin and external-beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech.

METHODS

Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT were compared with 16 treated with systemic chemoradiation 1 month after treatment.

RESULTS

RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures, and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals. Speech function was comparable except for RADPLAT's significantly worse /s, z/ productions.

CONCLUSIONS

Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function.