Velopharyngeal insufficiency, speech, and language impairment in craniofacial microsomia: a scoping review

This review provides a comprehensive overview of the literature on velopharyngeal insufficiency, associated anomalies, and speech/language impairment in patients with craniofacial microsomia (CFM). A systematic search of the literature was conducted to identify records on VPI and speech impairment in CFM from their inception until September 2022 within the databases Embase, PubMed, MEDLINE, Ovid, CINAHL EBSCO, Web of Science, Cochrane, and Google Scholar. Seventeen articles were included, analysing 1,253 patients. Velopharyngeal insufficiency results in hypernasality can lead to speech impairment. The reported prevalence of both velopharyngeal insufficiency and hypernasality ranged between 12.5% and 55%, while the reported prevalence of speech impairment in patients with CFM varied between 35.4% and 74%. Language problems were reported in 37% to 50% of patients. Speech therapy was documented in 45.5% to 59.6% of patients, while surgical treatment for velopharyngeal insufficiency consisted of pharyngeal flap surgery or pharyngoplasty and was reported in 31.6% to 100%. Cleft lip and/or palate was reported in 10% to 100% of patients with CFM; these patients were found to have worse speech results than those without cleft lip and/or palate. No consensus was found on patient characteristics associated with an increased risk of velopharyngeal insufficiency and speech/language impairment. Although velopharyngeal insufficiency is a less commonly reported characteristic of CFM than other malformations, it can cause speech impairment, which may contribute to delayed language development in patients with CFM. Therefore, timely recognition and treatment of speech impairment is essential.

Comorbidity and Severity in Childhood Apraxia of Speech: A Retrospective Chart Review

PURPOSE

The purpose of this study was to investigate comorbidity prevalence and patterns in childhood apraxia of speech (CAS) and their relationship to severity.

METHOD

In this retroactive cross-sectional study, medical records for 375 children with CAS (M age = 4;9 [years;months], SD = 2;9) were examined for comorbid conditions. The total number of comorbid conditions and the number of communication-related comorbidities were regressed on CAS severity as rated by speech-language pathologists during diagnosis. The relationship between CAS severity and the presence of four common comorbid conditions was also examined using ordinal or multinomial regressions.

RESULTS

Overall, 83 children were classified with mild CAS; 35, with moderate CAS; and 257, with severe CAS. Only one child had no comorbidities. The average number of comorbid conditions was 8.4 (SD = 3.4), and the average number of communication-related comorbidities was 5.6 (SD = 2.2). Over 95% of children had comorbid expressive language impairment. Children with comorbid intellectual disability (78.1%), receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia) were significantly more likely to have severe CAS than children without these comorbidities. However, children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism.

CONCLUSIONS

Comorbidity appears to be the rule, rather than the exception, for children with CAS. Comorbid intellectual disability, receptive language impairment, and nonspeech apraxia confer additional risk for more severe forms of CAS. Findings are limited by being from a convenience sample of participants but inform future models of comorbidity.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22096622.

Safety of an operculoinsulectomy in the language-dominant hemisphere for refractory epilepsy

BACKGROUND

Operculoinsular cortectomy is increasingly recognized as a therapeutic avenue for perisylvian refractory epilepsy. However, most neurosurgeons are reluctant to perform this type of procedure because of feared neurological complications, especially in the language-dominant hemisphere, as the insula is involved in speech and language processes. The goal of this retrospective study is to quantify the incidence and types of speech and language deficits associated with operculoinsulectomies in the dominant hemisphere for language, and to identify factors associated with these complications.

METHODS

Clinical, imaging, and surgical data of all patients who had an operculoinsulectomy for refractory epilepsy at our center between 1998 and 2018 were reviewed. Language lateralization was determined by functional magnetic resonance imaging (fMRI) and/or Wada test. Speech and language assessments were carried out by neurosurgeons, neurologists, neuropsychologists and/or speech language pathologists, before surgery, during the first week after surgery, and at least 6 months after surgery.

RESULTS

Amongst 44 operculoinsulectomies, 13 were performed in the language-dominant hemisphere. 46% of these patients presented with transient aphasia post-surgery. However, a few months later, the patients' performances on language assessments were not statistically different from before surgery, thus suggesting a complete recovery of speech and language functions.

CONCLUSION

Temporary aphasias after operculoinsulectomy for refractory epilepsy in the language-dominant hemisphere are frequent, but eventually subside. Potential mechanisms underlying this recovery are discussed.

Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study

OBJECTIVES/HYPOTHESIS

To investigate the impact of specific treatment-related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients.

STUDY DESIGN

Retrospective Cohort.

METHODS

Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider-rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression.

RESULTS

Fifty-three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT-HN.

CONCLUSIONS

In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes

BACKGROUND

Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings.

METHODS

Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome.

RESULTS

Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time.

CONCLUSIONS

Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.

Network analysis of autistic disease comorbidities in Chinese children based on ICD-10 codes

BACKGROUND

Autism is a lifelong disability associated with several comorbidities that confound diagnosis and treatment. A better understanding of these comorbidities would facilitate diagnosis and improve treatments. Our aim was to improve the detection of comorbid diseases associated with autism.

METHODS

We used an FP-growth algorithm to retrospectively infer disease associations using 1488 patients with autism treated at the Guangzhou Women and Children's Medical Center. The disease network was established using Cytoscape 3.7. The rules were internally validated by 10-fold cross-validation. All rules were further verified using the Columbia Open Health Data (COHD) and by literature search.

RESULTS

We found 148 comorbid diseases including intellectual disability, developmental speech disorder, and epilepsy. The network comprised of 76 nodes and 178 directed links. 158 links were confirmed by literature search and 105 links were validated by COHD. Furthermore, we identified 14 links not previously reported.

CONCLUSION

We demonstrate that the FP-growth algorithm can detect comorbid disease patterns, including novel ones, in patients with autism.

The Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Scale: Normative Data

The Parent's Evaluation of Aural/Oral Performance of Children (PEACH) was developed to evaluate the effectiveness of amplification for infants and children with hearing impairment by a systematic use of parents' observations. The PEACH was administered to 180 parents (one parent of each of 90 children with normal hearing that ranged in age from 0.25 to 46 months, and 90 children with hearing impairment that ranged in age from 4 months to 19 years). The internal consistency reliability was 0.88, and the test-retest correlation was 0.93. Normative data are presented to enable performance of children with hearing impairment to be related to their normally hearing peers and/or other children with similar degrees of hearing loss. Ninety and ninety-five percent critical differences are presented to facilitate evaluation of differences between scores obtained under different conditions for the same individual. The PEACH can be used with infants as young as one month old and with school-aged children who have hearing loss ranging from mild to profound degree. La Escala de Evaluación de los Padres sobre el Desempeño Auditivo/Oral Infantil (PEACH) fue desarrollada para evaluar la efectividad en la amplificación de infantes y niños con trastornos auditivos, haciendo uso sistemático de las observaciones de los padres. Se administró el PEACH a 180 padres (un progenitor por cada 90 niños con audición normal en edades entre 0.25 y 46 meses, y por cada 90 niños con hipoacusia en edades entre los 4 meses y los 19 años). La confiabilidad en la consistencia interna fue 0.88, y la correlación test-retest fue 0.93. Se presentan los datos normativos para establecer la relación entre niños con hipoacusia y niños normo-oyentes, y/o con otros niños con grados similares de hipoacusia. Se presentan diferencias críticas del noventa y noventa y cinco por ciento para facilitar la evaluación de diferencias entre los puntajes obtenidos bajo diferentes condiciones en el mismo individuo. El PEACH puede utilizarse en niños desde un mes de edad hasta la edad escolar, con grados de hipoacusia de grado leve a profundo.

Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study

Anxiety and depression are common emotional problems in children and adolescents. This study used a long-term tracking large database to investigate whether the proportion of children who were diagnosed with speech and language impairments were later diagnosed with anxiety or depression were significantly greater than that of matched group of the same age and gender without speech and language impairments. More than 4300 eligible children with speech and language impairments and matched controls were identified and assessed for anxiety and depression. The risk of anxiety and depressive disorders in children with speech and language impairments were examined with Cox regression analyses and adjusting for covariables (gender, age, and comorbidities). The results showed that speech and language impairments were positively associated with anxiety disorders (adjusted hazard ratio [AHR] 2.87, 95% confidence interval [CI] 2.20-3.76) and depressive disorders (AHR 2.51, 95% CI 1.52-4.13). The number of boys with speech and language impairments was more than twofold that of girls, but boys did not different from girls in the risk of anxiety disorders (AHR 0.95, 95% CI 0.75-1.20) and depressive disorders (AHR 0.72, 95% CI 0.47-1.11). Infantile autism and intellectual disabilities were positively associated with anxiety (AHR 1.54, 95% CI 1.07-2.21; AHR 1.47, 95% CI 1.09-1.98), and the latter was positively associated with depression (AHR 1.83, 95% CI 1.06-3.17). In addition to speech and language impairments interventions, our findings supported the necessity of identification and interventions in anxiety and depressive disorders among children with speech and language impairments from elementary school until youth.

Validation of a case definition for speech and language disorders: In community-dwelling older adults in Alberta

OBJECTIVE

To validate a case definition for speech and language disorders in community-dwelling older adults and to determine the prevalence of speech and language disorders in a primary care population.

DESIGN

This is a combined case definition validation and cross-sectional prevalence study. Chart review was considered the reference standard and was used to estimate prevalence. This study used de-identified electronic medical record data from participating SAPCReN-CPCSSN (Southern Alberta Primary Care Research Network-Canadian Primary Care Sentinel Surveillance Network) primary care clinics.

SETTING

Southern Alberta.

PARTICIPANTS

Men and women aged 55 years and older who had visited a SAPCReN-CPCSSN physician or nurse practitioner at least once in the 2 years before the beginning of the study.

MAIN OUTCOME MEASURES

Validation analysis included estimation of sensitivity, specificity, positive predictive value, and negative predictive value. Prevalence was the other main outcome measure.

RESULTS

The prevalence of speech and language disorders within the sample of 1384 patients was 1.2%. The case definition had a favourable specificity (99.9%, 95% CI 99.6% to 100.0%), positive predictive value (75.6%, 95% CI 25.4% to 96.6%), and negative predictive value (99.0%, 95% CI 98.8% to 99.2%). Sensitivity was not sufficient for validity (18.8%, 95% CI 4.05% to 45.6%).

CONCLUSION

The case definition did not meet an acceptable standard for validity and thus cannot be used for future epidemiologic research. However, owing to the case definition's high positive predictive value, it might be useful for clinical purposes and for cohort studies. Finally, while the case definition did not prove valid, this study has provided a conservative estimate of prevalence (1.2%) given the case definition's high specificity.

Assessment of Neurocognitive Impairment and Speech Functioning Before Head and Neck Cancer Treatment

Importance

Head and neck cancer (HNC) and its treatment may negatively alter neurocognitive and speech functioning. However, the prevalence of neurocognitive impairment among patients with HNC before treatment is poorly studied, and the association between neurocognitive and speech functioning is unknown, which hampers good interpretability of the effect of HNC treatment on neurocognitive and speech function.

Objectives

To document neurocognitive functioning in patients with HNC before treatment and to investigate the association between neurocognitive and speech functioning.

Design, Setting, and Participants

Prospective cohort study of newly diagnosed patients with HNC before treatment using a large sample obtained in a nationwide, multicenter setting (Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer [NET-QUBIC] project).

Main Outcome and Measures

Objective neuropsychological measures of delayed recall, letter fluency, and executive functioning, as well as patient-reported outcome measures on neurocognitive speech and functioning, were collected before treatment.

Results

In total, 254 patients with HNC participated (71.7% male), with a mean (SD) age of 62 (10) years. The response rate ranged from 81.9% (208 of 254) to 84.6% (215 of 254). Objective neurocognitive measures indicated that 4.7% (10 of 212) to 15.0% (32 of 214) of patients were initially seen with moderate to severe cognitive impairment. Mild to moderate impairment was found in 12.3% (26 of 212) to 26.2% (56 of 214) of patients. The most altered domains were delayed recall and letter fluency. Seven percent (15 of 208) of the patients reported high levels of everyday neurocognitive failure, and 42.6% (89 of 209) reported speech problems. Objective neurocognitive function was not significantly associated with patient-reported neurocognitive or speech functioning, but the results from patient-reported outcome measures were significantly correlated.

Conclusions and Relevance

Results of this study demonstrate a high prevalence of impaired speech functioning among patients with HNC before treatment, which is in line with previous findings. A novel finding is that neurocognitive impairment is also highly prevalent as objectively measured and as self-perceived. Understanding the reason why patients with HNC are initially seen with neurocognitive impairment before the start of treatment is important because this impairment may complicate patient-clinician interaction and alter treatment adherence and because treatment itself may further worsen cognitive functioning. In addition, low self-perceived neurocognitive and speech functioning before treatment may decrease a patient's confidence in communicative participation and perceived quality of life. Disentangling the associations between objective and patient-reported neurocognitive and speech functions is an important area for future research.

Estimates of the Prevalence of Speech and Motor Speech Disorders in Youth With 22q11.2 Deletion Syndrome

Purpose Speech sound disorders and velopharyngeal dysfunction are frequent features of 22q11.2 deletion syndrome (22q). We report the first estimate of the prevalence of motor speech disorders (MSDs) in youth with 22q. Method Seventeen children and adolescents with 22q completed an assessment protocol that included a conversational speech sample. Data reduction included phonetic transcription, perceptual speech ratings, prosody-voice coding, and acoustic analyses. Data analyses included 3 motor speech measures and a cross-classification analytic. Prevalence estimates of speech and MSDs in youth with 22q were compared with estimates in speakers with other complex neurodevelopmental disorders: Down syndrome, fragile X syndrome, and galactosemia. Results Results indicated that 58.8% of the participants with 22q met criteria for speech delay, and 82.4% of the participants met criteria for MSDs, including 29.4% with speech motor delay, 29.4% with childhood dysarthria, 11.8% with childhood apraxia of speech, and 11.8% with concurrent childhood dysarthria and childhood apraxia of speech. MSDs were not significantly associated with velopharyngeal dysfunction. Conclusions In summary, 82.4% of the participants with 22q met criteria for 1 of 4 MSDs, predominantly speech motor delay and childhood dysarthria. Cross-validation of the present findings would support viewing MSDs as a core phenotypic feature of 22q.

The impact of speech and language problems in kindergarten on academic learning and special education status in grade three

PURPOSE

This study addressed the implications of experiencing early speech-language pathologies (SLPs) in kindergarten on special education needs (SEN) and academic outcomes in grade three.

METHOD

Early Development Instrument (EDI) kindergarten data on development and the presence or absence of SLPs were matched with grade three school-system standardised tests of reading, writing and maths, and SEN classification in Ontario, Canada for 59 015 students. Children were classified as having a Persistent speech language pathology (SLP), Remittent SLP, Latent SEN or as a typically developing Control.

RESULT

Even though 72.3% of children's SLPs remitted by grade three, kindergarten SLPs conveyed higher likelihood of having an SEN, and of lower achievement levels in grade three. The degree of impact varied between Persistent and Remittent groups. Children in the Latent group had lower scores in kindergarten on all five EDI domains than Control children.

CONCLUSION

These population level results provide strong evidence to indicate that all children who present with an SLP in kindergarten face further academic challenges, even if their SLP resolves over time. Findings have implications for early intervention and treatment for children with early SLPs.

Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay

The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders (CND) can inform research in the biobehavioural origins and treatment of CND. The goal of this research was to use measures and analytics in a diagnostic classification system to estimate the prevalence of speech and motor speech disorders in convenience samples of speakers with one of eight types of CND. Audio-recorded conversational speech samples from 346 participants with one of eight types of CND were obtained from a database of participants recruited for genetic and behavioural studies of speech sound disorders (i.e., excluding dysfluency) during the past three decades. Data reduction methods for the speech samples included narrow phonetic transcription, prosody-voice coding, and acoustic analyses. Standardized measures were used to cross-classify participants' speech and motor speech status. Compared to the 17.8% prevalence of four types of motor speech disorders reported in a study of 415 participants with idiopathic Speech Delay (SD), 47.7% of the present participants with CND met criteria for one of four motor speech disorders, including Speech Motor Delay (25.1%), Childhood Dysarthria (13.3%), Childhood Apraxia of Speech (4.3%), and concurrent Childhood Dysarthria and Childhood Apraxia of Speech (4.9%). Findings are interpreted to indicate a substantial prevalence of speech disorders, and notably, a substantial prevalence of motor speech disorders in persons with some types of CND. We suggest that diagnostic classification information from standardized motor speech assessment protocols can contribute to research in the pathobiologies of CND. Abbreviations: 16p: 16p11.2 deletion and duplication syndrome; 22q: 22q11.2 deletion syndrome; ASD: Autism Spectrum Disorder; CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; CND: Complex Neurodevelopmental Disorder; DS: Down syndrome; FXS: Fragile X syndrome; GAL: Galactosemia; IID: Idiopathic Intellectual Disability; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; NSA: Normal(ized) Speech Acquisition; PEPPER: Programs to Examine Phonetic and Phonologic Evaluation Records; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SDCSS: Speech Disorders Classification System Summary; SE: Speech Errors; SMD: Speech Motor Delay; SSD: Speech Sound Disorders; TBI: Traumatic Brain Injury.

Introduction: Motor Speech Disorders in Idiopathic Speech Delay and in Complex Neurodevelopmental Disorders: Introduction

This introduction to a special issue of Clinical Linguistics & Phonetics includes an overview of the contents of each of the six articles. Each of the articles use the finalized version of the Speech Disorders Classification System (SDCS).

Estimates of the prevalence of speech and motor speech disorders in adolescents with Down syndrome

Although there is substantial rationale for a motor component in the speech of persons with Down syndrome (DS), there presently are no published estimates of the prevalence of subtypes of motor speech disorders in DS. The goal of this research is to provide initial estimates of the prevalence of types of speech disorders and motor speech disorders in adolescents with DS. Conversational speech samples from a convenience sample of 45 adolescents with DS, ages 10 to 20 years old, were analysed using perceptual and acoustic methods and measures in the Speech Disorders Classification System (SDCS). The SDCS cross-classified participants into five mutually exclusive speech classifications and five mutually exclusive motor speech classifications. For participants meeting criteria for Childhood Dysarthria or for Childhood Dysarthria concurrent with Childhood Apraxia of Speech, the SDCS provided information on participants' percentile status on five subtypes of dysarthria. A total of 97.8% of participants met SDCS criteria for Speech Disorders and 97.8% met criteria for Motor Speech Disorders, including Childhood Dysarthria (37.8%), Speech Motor Delay (26.7%), Childhood Dysarthria and Childhood Apraxia of Speech (22.2%), and Childhood Apraxia of Speech (11.1%). Ataxia was the most prevalent dysarthria subtype. Nearly all participants with DS in the present sample had some type of speech and motor speech disorder, with implications for theory, assessment, prediction, and treatment. Specific to treatment, the present findings are interpreted as support for motor speech disorders as a primary explanatory construct to guide the selection and sequencing of treatment targets for persons with DS. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; NSA: Normal(ized) Speech Acquisition; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SE: Speech Errors; SMD: Speech Motor Delay.

Hotspots of small strokes in glioma surgery: an overlooked risk?

BACKGROUND

Small deep infarcts constitute a well-known risk of motor and speech deficit in insulo-opercular glioma surgery. However, the risk of cognitive deterioration in relation to stroke occurrence in so-called silent areas is poorly known. In this paper, we propose to build a distribution map of small deep infarcts in glioma surgery, and to analyze patients' cognitive outcome in relation to stroke occurrence.

METHODS

We retrospectively studied a consecutive series of patients operated on for a diffuse glioma between June 2011and June 2017. Patients with lower-grade glioma were cognitively assessed, both before and 4 months after surgery. Areas of decreased apparent diffusion coefficient (ADC) on the immediate postoperative MRI were segmented. All images were registered in the MNI reference by ANTS algorithm, allowing to build a distribution map of the strokes. Stroke occurrence was correlated with the postoperative changes in semantic fluency score in the lower-grade glioma cohort.

RESULTS

One hundred fifteen patients were included. Areas of reduced ADC were observed in 27 out of 54 (50%) patients with a lower-grade glioma, and 25 out of 61 (41%) patients with a glioblastoma. Median volume was 1.6 cc. The distribution map revealed five clusters of deep strokes, corresponding respectively to callosal, prefrontal, insulo-opercular, parietal, and temporal tumor locations. No motor nor speech long-term deficits were caused by these strokes. Cognitive evaluations at 4 months showed that the presence of small infarcts correlated with a slight decrease of semantic fluency scores.

CONCLUSION

Deep small infarcts are commonly found after glioma surgery, but their actual impact in terms of patients' quality of life remains to be demonstrated. Further studies are needed to better evaluate the cognitive consequences-if any-for each of the described hotspots and to identify risk factors other than the surgery-induced damage of microvessels.

Initial studies of the phenotype and persistence of speech motor delay (SMD)

Speech Motor Delay (SMD) is a recently proposed childhood motor speech disorder characterized by imprecise and unstable speech, prosody, and voice that does not meet criteria for either Childhood Dysarthria or Childhood Apraxia of Speech. The goals of the present research were to obtain information on the phenotype of SMD and initial information on the persistence of SMD in children receiving treatment for idiopathic Speech Delay (SD). Five questions about the phenotype and persistence of SMD were posed using a database of audio-recordings and participant records and longitudinal data from audio-recordings of children with early SMD treated for SD. Three phenotype questions examined associations between participant risk factors and prevalence of SMD, and described the most frequent speech, prosody, and voice signs of early SMD. To provide initial estimates of the persistence of SMD, two questions examined associations between the persistence of SMD and participant risk factors using the audio-recordings of 14 participants with SMD treated for idiopathic SD. Phenotype findings indicated that SMD is characterized by across-the-board delays in the spatiotemporal precision and stability of speech, prosody, and voice production. Persistence findings indicated that although most participants normalized early SMD by 6 years of age, SMD persisted until at least late adolescence in 21.4% of participants. Findings are interpreted to support the construct validity of SMD and the potential for research using additional assessment modalities to explicate its genomic and neuromotor causal pathways. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; PSI: Precision-Stability Index; SD: Speech Delay; SMD: Speech Motor Delay; SSD: Speech Sound Disorders.

Acquired Velopharyngeal Dysfunction: Survey, Literature Review, and Clinical Recommendations

PURPOSE

The aim of this study was to describe the clinical assessment recommendations for acquired velopharyngeal dysfunction (AVPD) and, through a literature review and online survey, summarize current practice patterns for evaluation and treatment pathway determination for this target population.

METHOD

An online survey to query current assessment procedures and treatment pathway recommendations for AVPD was developed. Following survey results, a literature review was completed to determine evidence-based recommendations for assessment procedures and intervention recommendations based on assessment findings. Literature search terms included the following: acquired velopharyngeal dysfunction, hypernasality, non-cleft velopharyngeal dysfunction, velopharyngeal dysfunction, velopharyngeal dysfunction AND iatrogenic, velopharyngeal dysfunction AND neurogenic, velopharyngeal dysfunction AND assessment OR evaluation, velopharyngeal dysfunction AND treatment OR intervention, velopharyngeal dysfunction AND practice patterns OR clinical guidelines, velopharyngeal insufficiency. Inclusion criteria were limited to practice patterns/recommendations for assessment and/or treatment recommendations for AVPD, English language articles published between 2000 and 2017, and peer-reviewed journals. Studies regarding solely congenital or cleft palate velopharyngeal dysfunction and intervention outcome studies were excluded. Forty articles met inclusionary criteria.

RESULTS

The online survey results indicated lack of consensus for AVPD assessment and treatment recommendation protocols, with 93% of respondents indicating the need for a clinical guide for developing treatment recommendations. The majority of recommendations were filtered into an algorithm for clinical decision making.

CONCLUSIONS

Clinical uncertainty among speech-language pathologists surveyed and the paucity of published clinical guidelines for assessing individuals with AVPD indicate the need for additional clinical research for this disorder, one that is heterogeneous and distinct from those with congenital velopharyngeal dysfunction. The proposed evidence-based clinical worksheet may assist in determining management for patients with AVPD and may serve as a starting place for validation of a clinical guideline.

Cerebral palsy in Moldova: subtypes, severity and associated impairments

BACKGROUND

Moldova is ranked as one of the countries in Europe with the lowest income per capita and with a relatively high infant and maternal mortality rate. Information on neurodisabilities in general is limited, and regarding cerebral palsy (CP) in particular, it is completely lacking. The aim of this study was therefore to make a crude estimate of the prevalence of CP and to describe subtypes and the severity of motor impairments and associated problems in this country.

METHODS

Children with CP born 2009-2010, attending the National Hospital Institute of Mother and Child, the reference hospital for ~ 75% of children in Moldova with neurological disabilities, were identified from medical records.

RESULTS

Among 207 children with CP (estimated prevalence 3.4 per 1000 live births), 185 (mean age 7.3 years; 36% girls) had detailed information. Thirty seven (20%) children had spastic unilateral, 113 (61%) spastic bilateral, 22 (12%) dyskinetic and 9 (5%) children had ataxic CP. The subtype was unclassified in four children. Among all children, 93 (51%) had epilepsy, 109 (59%) intellectual disability, 42 (23%) severe vision and 10 (5%) hearing impairments while 84 (45%) children had severe speech impairments. Fifty-two (28%) children were born prematurely, and 46 (25%) had Apgar scores below 7 at five minutes.

CONCLUSION

Compared to other European studies, the distribution of CP subtypes was different in Moldova. Moreover, the estimated prevalence, the proportions with severe motor and associated impairments and of children born at term were higher in Moldova while the proportion with low Apgar did not differ. The findings may suggest different etiological pathways causing CP in Moldova than in other European countries. A national register is warranted for quality assurance and improvement.

The identification of speech and language problems in elementary school: Diagnosis and co-occurring needs

BACKGROUND

Oral language skills are the foundation for success at school and in employment. A significant minority of children experience difficulties in the acquisition of oral language resulting in speech and language needs (SLN). There are disjunctures between clinical studies using standardised assessment and educational studies. The current study examines teacher reported SLN alongside assessments of language and cognitive skills to explore children's profiles of needs, developmental trajectories and risk factors.

PROCEDURE

Data from the UK Millennium Cohort Study were used to examine teacher identification of SLN at seven (n = 8658) and 11 years (n = 7275).

RESULTS

There were high levels of co-occurrence between SLN and other special educational needs at seven and 11 years, with SLN being less common at 11. Vocabulary levels and parental concerns at three and five and educational attainment at seven were highly predictive of SLN at seven, slightly less so at 11. However, a significant proportion of parents of children who scored in the bottom 2nd centile on vocabulary measures did not report their child as experiencing a language problem. Gender and disadvantage were also predictive of SLN but were mediated by the cognitive and behavioural variables.

IMPLICATIONS

These results raise questions about whether children's language needs at age 11 are recognised in schools. The extent of co-occurrence challenges the way diagnostic categories should be used and supports the value of profiling of dimensions of need.

Frequency of speech disruptions in Parkinson's Disease and developmental stuttering: A comparison among speech tasks

OBJECTIVE

To analyze the frequency of speech disruptions across different speech tasks, comparing the performance of individuals with Parkinson's Disease (PD) and DS.

METHOD

Participants were 20 people with PD, 20 people with DS and 40 fluent individuals. Speech samples were recorded during monologue speech, choral and solo oral reading. Transcriptions of 200 fluent syllables were performed to identify stuttering-like disfluencies (SLDs) and other disfluencies (ODs).

RESULTS

People with PD presented significantly less speech disruptions when compared to people with DS, but significantly more speech disruptions than the control group. Stuttering-like disfluencies ocurred more frequently during monologue speech and solo oral reading for both PD and DS, whereas the control group did not present difference between these tasks.

CONCLUSION

The stuttering pattern presented by people with PD is different from what is usually described as being neurogenic stuttering.

Deep phenotyping of speech and language skills in individuals with 16p11.2 deletion

Recurrent deletions of a ~600-kb region of 16p11.2 have been associated with a highly penetrant form of childhood apraxia of speech (CAS). Yet prior findings have been based on a small, potentially biased sample using retrospectively collected data. We examine the prevalence of CAS in a larger cohort of individuals with 16p11.2 deletion using a prospectively designed assessment battery. The broader speech and language phenotype associated with carrying this deletion was also examined. 55 participants with 16p11.2 deletion (47 children, 8 adults) underwent deep phenotyping to test for the presence of CAS and other speech and language diagnoses. Standardized tests of oral motor functioning, speech production, language, and non-verbal IQ were conducted. The majority of children (77%) and half of adults (50%) met criteria for CAS. Other speech outcomes were observed including articulation or phonological errors (i.e., phonetic and cognitive-linguistic errors, respectively), dysarthria (i.e., neuromuscular speech disorder), minimal verbal output, and even typical speech in some. Receptive and expressive language impairment was present in 73% and 70% of children, respectively. Co-occurring neurodevelopmental conditions (e.g., autism) and non-verbal IQ did not correlate with the presence of CAS. Findings indicate that CAS is highly prevalent in children with 16p11.2 deletion with symptoms persisting into adulthood for many. Yet CAS occurs in the context of a broader speech and language profile and other neurobehavioral deficits. Further research will elucidate specific genetic and neural pathways leading to speech and language deficits in individuals with 16p11.2 deletions, resulting in more targeted speech therapies addressing etiological pathways.

The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS

OBJECTIVE

This study aimed to determine the diagnostic utility of clinician speech ratings and patient self-report for detecting early bulbar changes associated with amyotrophic lateral sclerosis (ALS), compared to instrumentation-based speech measures.

METHODS

Thirty-six individuals with ALS and 17 healthy control participants were included. Patients' awareness of early bulbar motor involvement was assessed using self-reported scores on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Clinicians' detection of early bulbar motor involvement was assessed through perceptual speech ratings by two experienced speech-language pathologists. Participants with ALS were grouped as 'bulbar pre-symptomatic' or 'bulbar symptomatic' based on self-report and clinician ratings, and compared to healthy controls on six instrumentation-based speech measures. ROC analysis was used to compare the sensitivity and specificity of perceptual and instrumentation-based measures for detecting bulbar changes in pre-symptomatic individuals.

RESULTS

Early bulbar changes that were documented using instrumentation-based measures were undetected by both patients and clinicians. ROC analyses indicated that instrumentation-based measures outperformed clinicians' scaled severity ratings, and that percent pause time was the best measure for differentiating healthy controls from bulbar pre-symptomatic individuals with ALS.

CONCLUSIONS

Findings suggested that instrumentation-based measures of speech may be necessary for early detection of bulbar changes due to ALS.

Factors contributing to the longitudinal development of social participation in individuals with cerebral palsy

AIMS

We aimed to determine factors associated with the longitudinal development of social participation in a Dutch population of individuals with Cerebral Palsy (CP) aged 1-24 years.

METHODS AND PROCEDURES

For this multicentre prospective longitudinal study, 424 individuals with CP aged 1-24 years were recruited from various rehabilitation centers in The Netherlands. Social participation was measured with the Vineland Adaptive Behavior Scales. We assessed associations with age, intellectual impairment, level of gross motor function, gender, type of CP, manual ability, epilepsy, hearing-, visual-, speech impairment and pain, internalizing- and externalizing behavioral problems, type of education and parental level of education. Each individual was measured 3 or 4 times. The time between measurements was 1 or 2 years.

OUTCOMES AND RESULTS

Epilepsy and speech impairment were each independently associated with the longitudinal development of social participation. The effects were rather small and did not change with age. Also, a trend was found that children attending special education develop less favorably in social participation.

CONCLUSIONS AND IMPLICATIONS

Our results might provide parents and caregivers with starting points to further develop tailored support for individuals with epilepsy, with speech impairment and/or attending special education at risk for suboptimal social participation.

Development of Orofacial Praxis of Children from 4 to 8 Years of Age

Orofacial praxis is the ability to plan and execute movements or sequences of voluntary movements, meaningful or not, using the muscles of the pharyngo-buccofacial system or the orofacial region. An original test was developed, the Orofacial Praxis Test, consisting of 36 gestures, 24 single and 12 complex, elicited through verbal and imitative request. The test was administered to 93 normally developing Italian children ages 4 to 8 yr. to assess development of orofacial praxis. Analysis showed a progressive development of the orofacial praxic ability by type of gesture and examiner's request: (1) the imitation modality is more facilitating than a verbal request modality, especially for children ages 4 or 5 years; (2) a consistent mastery of sequences of gestures and oroverbal movements is in place by age 6 years. The analysis of the orofacial region may be helpful in identifying persistent speech difficulties and developmental coordination disorders.

Family and Community Predictors of Comorbid Language, Socioemotional and Behavior Problems at School Entry

Objectives

To identify the prevalence and family and community-level predictors of comorbid speech-language difficulties and socioemotional and behavioral (SEB) difficulties across a population of children at school entry.

Methods

The School Entry Health Questionnaire is a parent survey of children’s health and wellbeing, completed by all children starting school in Victoria, Australia (N = 53256). It includes parental report of speech-language difficulties, the Strengths and Difficulties Questionnaire (behavior), and numerous family and community variables. Following univariate analysis, family and community risk characteristics were entered into a multinomial logistic regression model to identify the associated relative risk of comorbid speech/language and SEB needs. The influence of experiencing multiple risk factors was also examined.

Results

20.4% (n = 10,868) began school with either speech-language or SEB difficulties, with 3.1% (n = 1670) experiencing comorbid needs. Five factors predicted comorbidity: the child having witnessed violence; a history of parent mental illness; living in more deprived communities; and the educational attainment of each parent (independently). The relative risk of comorbidity was 6.1 (95% Confidence Interval: 3.9, 9.7) when a child experienced four or more risk factors, compared to those with no risk factors.

Conclusions

The risk of comorbidity in early childhood is associated with a range of family and community factors, and elevated by the presence of multiple factors. Children growing up in families experiencing multiple, complex needs are therefore at heightened risk of the early development of difficulties likely to impact upon schooling. Early identification of these children offers opportunities for appropriate and timely health and education intervention.

Quantitative Three-Dimensional Ultrasound Imaging of Partially Resected Tongues

OBJECTIVE: We sought to assess the impact of partial lateral glossectomies on tongue function and speech.

STUDY DESIGN AND SETTING: Tongue shapes of 12 patients with lateral tumors of the tongue were recorded with three-dimensional ultrasound before their surgery and two months after. Twelve normal participants served as controls. Speech acceptability was also assessed.

RESULTS: Principal component analyses demonstrated that the flap reconstructions led to a stiffening of the operated side of the tongue. A concavity index and an asymmetry index demonstrated that the glossectomy patients exhibited decreased midsagittal grooving and increased lingual asymmetry. The change in midsagittal grooving correlated moderately with the decrease in speech acceptability.

CONCLUSION: A lateral partial glossectomy affects the tongue's intrinsic deformation, in particular midsagittal grooving and symmetry. This can have a detrimental effect for speech.

SIGNIFICANCE: A lateral resection affects the tongue's symmetry and midsagittal groove. The change in midsagittal grooving correlates with a decrease in speech acceptability.

Teachers' screening estimations of speech-language impairments in primary school children in Nepal

BACKGROUND

The prevalence of speech-language impairments in children have been estimated for several languages, primarily in developed countries. However, prevalence data is lacking for developing countries, such as Nepal.

AIMS

(1) To obtain teacher estimates of incidence and overall prevalence of speech-language impairments and its subtypes as a function of gender, age and grade level; and (2) to validate the screening instrument on Nepalese children.

METHODOLOGY

The adapted teachers' screening instrument, namely adapted Teachers' Speech and Language Referral Checklist (a-TSLRC), was administered in 2776 (690 and 2086) primary school children aged 5;00-11;11 years (mean = 8;11 years). The screening was conducted at four different points in time, i.e. Incidences I and II, and each incidence consisted of a testing and a retesting phase. Prior to this, teachers were trained in forum meetings, and an information sheet containing an overview of speech-language impairments, and guidelines/criteria for marking the occurrence of speech-language impairments in the TSLRC were disseminated.

OUTCOMES & RESULTS

Overall prevalence of speech-language impairments in children was estimated as 8.11%. Specifically, overall speech problems were estimated as 4.68%, and language problems as 8.0%. Additionally, the prevalence by subtypes of speech-language impairments as categorized in the TSLRC were reported to be 2.95% for an articulation/phonological problems, 2.09% for stuttering, 3.42% for a voice problems, 4.97% for a receptive language problems and 7.74% for an expressive language problems. The internal consistency among items was sufficient and a good intra-rater reliability was obtained.

CONCLUSIONS & IMPLICATIONS

The study indicates that the overall results of speech-language impairments in children via the adapted in-Nepalese criterion-referenced instrument are supported by international studies. In addition, justifiable reliability and validity was obtained. Therefore, based on these overall evidence, this instrument can be useful for the screening of speech-language impairments in primary school children in Nepal.

Analysis of Postsurgical Health-Related Quality of Life and Quality of Voice of Patients With Laryngeal Carcinoma

This study aims to analyze the postsurgical health-related quality of life (HRQOL) and quality of voice (QOV) of patients with laryngeal carcinoma with an expectation of improving the treatment and HRQOL of these patients. Based on the collection of information of patients with laryngeal carcinoma regarding clinical characteristics (age, TNM stage, with or without laryngeal preservation and/or neck dissection, with or without postoperative irradiation and/or chemotherapy, etc.), QOV using Voice Handicap Index (VIH) scale and HRQOL using EORTC QLQ-C30 and EORTCQLQ-H&N35 scales, the differences of postsurgical HRQOL related to their clinical characteristics were analyzed using univariate nonparametric tests, the main factors impacting the postsurgical HRQOL were analyzed using regression analyses (generalized linear models) and the correlation between QOV and HRQOL analyzed using spearman correlation analysis. A total of 92 patients were enrolled in this study, on whom the use of EORTC QLQ-C30, EORTC QLQ-H&N35 and VHI scales revealed that: the differences of HRQOL were significant among patients with different ages, TNM stages, and treatment modalities; the main factors impacting the postsurgical HRQOL were pain, speech disorder, and dry mouth; and QOV was significantly correlated with HRQOL. For the patients with laryngeal carcinoma included in our study, the quality of life after open surgeries were impacted by many factors predominated by pain, speech disorder, and dry mouth. It is suggested that doctors in China do more efforts on the patients' postoperative pain and xerostomia management and speech rehabilitation with the hope of improving the patients' quality of life.

Gender and geographic differences in the prevalence of reportable childhood speech and language disability in Taiwan

Speech and language disability (SLD) is not uncommon in children. However, data at the national level are limited, and geographic differences are seldom evaluated. Starting from 1980, the local governments in Taiwan has begun to certify disabled residents for providing various services and report cases to the central government according to the law, and the central government maintains a registry of reported cases, which provides a unique opportunity for studying SLD at the national level. Using the registry data from 2004 to 2010, we calculated the prevalence of SLD by age, gender, and geographic area and assessed the changes over time. Because the government discourages the certification under 3 years of age, we excluded cases under 3 years old from the analyses. We found that from 2004 to 2010 the registered cases between 3 and 17 years old increased from 1418 to 1637 per year, and the prevalence generally increased every year in all age groups except in 12-14 years of age. In each year there were more boy cases than girl cases, and the prevalence rate ratio increased from 1.50 to 1.83 (p < 0.05 in all years), with an increasing trend over time (p < 0.01). A higher prevalence was observed in the rural areas over the years, and the prevalence rate ratio increased from 1.35 to 1.71 (p < 0.05 in all years), with an increasing trend over time (p < 0.01). Further studies identifying the risk factors contributed to the increases might help the prevention of SLD in the future.

Learning trajectories of children with special health care needs across the severity spectrum

OBJECTIVE

A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years.

METHODS

The Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children which commenced in May 2004. Data were analyzed from the LSAC kindergarten cohort (n = 4,983), as well as a subsample of 720 children for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development at school entry that includes SHCN.

RESULTS

Latent class analysis was utilized to establish 3 academic trajectories from 4-5 to 10-11 years: high (24.3%), average (49.8%), and low (23.6%). Descriptive statistics revealed a trend for both children with established and emerging SHCN to fall into weaker performing learning pathways. Multinomial logistic regression focusing on those children with emerging SHCN confirmed this pattern of results, even after adjustment for covariates (relative risk 3.06, 95% confidence interval 1.03-9.10). Children who additionally had low socioeconomic standing were particularly at risk.

CONCLUSIONS

Even children with less complex SCHN are at risk for academic failure. Early identification, together with integrated health and educational support, may promote stronger pathways of educational attainment for these children. Achieving these better outcomes will require the involvement of both educational and health practitioners.

[Verbal fluency among healthy elderly: a study of three complex verbal fluency tasks under healthy older people and patients with neurocognitive disorder or onset dementia of the Alzheimer type]

The aim of this study is to provide normative data for a phonological alternating task (FAT), a semantic alternating task (SAT) and an excluded letter task (ELT). The tasks were administered to 146 Flemish-speaking, cognitively healthy elderly. Data from 102 were used and were classified according to the significant variables. Subsequently, these tasks were administered to seven patients diagnosed with mild neurocognitive impairment (mild cognitive impairment, MCI) and seven patients with onset dementia of the Alzheimer type (DAT). Results of the standard study show that the level of education is a significant variable for all complex VFT and age for the SAT and the ELT, while age related deterioration is highest for the ELT. The error rate is highest for the ELT and lowest for the SAT. Analysis of the time duration shows that data should be collected for at least 2 min. The patients scored significantly lower than the normgroup of healthy adults. The error rate is highest for the SAT and lowest for the ELT.

Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE

The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints.

METHOD

This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions.

RESULTS

Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment.

CONCLUSIONS

The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

The developmental health of children of parents with intellectual disabilities: cross sectional study

In a representative population-based sample of 46,025 families caring for a young child, parental intellectual disability (identified in 588 families) was associated with increased risk of child developmental delay, child speech and language problems, child behaviour problems and frequent child accidents and injuries. Parental intellectual disability was also associated with increased risk of exposure to a wide range of environmental adversities such as poverty, poor housing and social isolation. Adjusting for between-group differences in exposure to low socio-economic position reduced the risk of adverse child outcomes by over 50% on each of the four measures of child developmental health. In the final fully adjusted model parental intellectual disability was associated with increased risk of child developmental delay and child speech and language problems. However, there were no significant associations between parental intellectual disability and child behaviour problems or frequent accidents and injuries.

Trends in the prevalence of childhood disability: analysis of data from the national disability registry of Taiwan, 2000-2011

Childhood disability is not uncommon, but data at the national level are limited, especially those on the changes in the prevalence over time. On the basis of the Disabled Welfare Act, Taiwan began to certify disabled residents and provide various services in 1980. All the cases receiving services are registered, and the registry provides a rare opportunity for studying childhood disability at the national level. Using the data from 2000 to 2011, we calculated the age-specific prevalence of all disability combined and assessed the changes over time. We also calculated the prevalence rate and the proportion in all disabilities combined for each disability category and assessed the trends. As certification before 3 years old is generally discouraged by the government, we limited analyses to children between 3 and 17 years old. We found that the registered cases ranged from 49,242 to 61,717 from 2000 to 2011 and that intellectual disability (ID), had been the leading category all through the years. The proportion of autism spectrum disorders (ASD) had been increasing rapidly and become the third leading disability in 2011. The prevalence of all disabilities combined increased constantly from 9.98/1000 to 15.41/1000 (p<0.01), and increases were generally observed every year in all age groups (p<0.01). The increase could largely be attributable to the increases in ID and ASD, while the increasing trends were also significant in "multiple disabilities," "speech or language impairment," and "other disabilities listed by the Department of Health" (p<0.01 for all the five categories). An increase with age in the prevalence of all disabilities combined could be observed all through the years (p<0.01 in all calendar years). We concluded that the prevalence of childhood disability has been increasing in Taiwan, with ID contributing the most cases and ASD as an emerging problem. However, the increase of prevalence cannot be attributed entirely to the increase in the occurrence of cases, and an increase in the proportion of cases registered was an more important factor, which may be in turn attributable to a better service of the related agencies, lower discrimination against the patients, higher awareness of the disorder, and more willingness of the guardians to register.

[Six-month outcome of 795 patients admitted to Annecy hospital emergency department for mild traumatic brain injury]

INTRODUCTION

Mild traumatic brain injuries (mTBI) are common, but their outcomes are not very well known. A prospective study was conducted in Annecy hospital, France (CHRA), to assess the incidence of disorders 6 months after the injury and to identify risk factors for persistent disorders.

METHOD

All patients admitted to the emergency department after a mild brain injury between February 2006 and July 2007 were included. They were contacted by telephone 6 months later to detect (by questionnaire) the presence of persistent disorders. Patients reporting disorders were referred to the l ocal brain injury centre for a follow-up check-up.

RESULTS

Ninety three of the 795 patients contacted reported disorders: memory disorders (80%), sleep disorders (79%), headaches (65%), irritability (64%), speech disorders (64%) and concentration disorders (62%). Disorders at 6 months were independently associated with age, female gender, presence of headache at the initial examination and CT scan performed in the emergency department.

DISCUSSION

The disorders reported in this study were consistent with the results of previous studies. As these disorders are usually nonspecific, a case-control study or an exposed-unexposed study would be necessary to determine whether or not these disorders are linked to mTBI.

Hearing and speech impairment at age 4 and risk of later non-affective psychosis

BACKGROUND

Schizophrenia often becomes manifest in late adolescence and young adulthood but deviations in physical and behavioural development may already be present in childhood. We investigated the relationship between hearing impairment (measured with audiometry) and speech impairment (broadly defined) at age 4 years and adult risk of non-affective psychosis.

METHOD

We performed a population-based, case–control study in Sweden with 105 cases of schizophrenia or other non-affective psychoses and 213 controls matched for sex, date and place of birth. Information on hearing and speech impairment at age 4, along with potential confounding factors, was retrieved from Well Baby Clinic (WBC) records.

RESULTS

Hearing impairment [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.6–23.2] and speech impairment (OR 2.6, 95% CI 1.4–4.9) at age 4 were associated with an increased risk of non-affective psychotic illness. These associations were mutually independent and not explained by parental psychiatric history, occupational class or obstetric complications.

CONCLUSIONS

These results support the hypothesis that psychosis has a developmental aspect with presentation of antecedent markers early in childhood, long before the disease becomes manifest. Our findings add to the growing evidence that early hearing impairment and speech impairment are risk indicators for later non-affective psychosis and possibly represent aetiological clues and potentially modifiable risk factors. Notably, speech impairment and language impairment are both detectable with inexpensive, easily accessible screening.

[Language disorders. Diagnosis and treatment]

AIMS

The study reviews language disorders in children. Taking their normal development as the starting point, the work puts forward a differential diagnosis based on the symptoms presented in the moment the patient visited the physician. It also suggests an approach for children with language disorders from the neuropaediatric point of view while also updating the management of some of its forms.

DEVELOPMENT

The acquisition of language is one of the key milestones in the development of children. A child's social and intellectual development is affected by delayed acquisition of language and this can give rise to a ongoing effect involving isolation and regression, which tends towards poor academic achievement and, eventually, leads to the development of learning and social problems. There are studies that evidence a close relationship in children between the development of spoken language and written language, as well as the importance of acquiring language as the basis for writing skills. These problems cause a great deal of anxiety in parents.

CONCLUSIONS

Knowledge of the problem allows the specialist to detect these children early on in the preschool stage and to ensure they receive the right attention. If treated in time, language learning can be modified to a significant degree, thereby avoiding the complications that affect its development. The specialist working with children must recognise these problems and channel them towards the most suitable therapy.

Dysfluencies in the speech of adults with intellectual disabilities and reported speech difficulties

BACKGROUND

In individuals with an intellectual disability, speech dysfluencies are more common than in the general population. In clinical practice, these fluency disorders are generally diagnosed and treated as stuttering rather than cluttering.

PURPOSE

To characterise the type of dysfluencies in adults with intellectual disabilities and reported speech difficulties with an emphasis on manifestations of stuttering and cluttering, which distinction is to help optimise treatment aimed at improving fluency and intelligibility.

METHOD

The dysfluencies in the spontaneous speech of 28 adults (18-40 years; 16 men) with mild and moderate intellectual disabilities (IQs 40-70), who were characterised as poorly intelligible by their caregivers, were analysed using the speech norms for typically developing adults and children. The speakers were subsequently assigned to different diagnostic categories by relating their resulting dysfluency profiles to mean articulatory rate and articulatory rate variability.

RESULTS

Twenty-two (75%) of the participants showed clinically significant dysfluencies, of which 21% were classified as cluttering, 29% as cluttering-stuttering and 25% as clear cluttering at normal articulatory rate. The characteristic pattern of stuttering did not occur.

CONCLUSION

The dysfluencies in the speech of adults with intellectual disabilities and poor intelligibility show patterns that are specific for this population. Together, the results suggest that in this specific group of dysfluent speakers interventions should be aimed at cluttering rather than stuttering.

LEARNING OUTCOMES

The reader will be able to (1) describe patterns of dysfluencies in the speech of adults with intellectual disabilities that are specific for this group of people, (2) explain that a high rate of dysfluencies in speech is potentially a major determiner of poor intelligibility in adults with ID and (3) describe suggestions for intervention focusing on cluttering rather than stuttering in dysfluent speakers with ID.

Subclinical declines in the verbal fluency and motor regulation of patients with AVIM (asymptomatic ventriculomegaly with features of idiopathic NPH on MRI): a case-controlled study

OBJECTIVE

We previously reported that, on brain MRI, iNPH features were observed in approximately 1% of asymptomatic elderly community dwellers. This phenomenon is designated asymptomatic ventriculomegaly with features of iNPH on MRI (AVIM). The aim of the present study was to clarify whether a subclinical decline in the neuropsychological function is present in patients with AVIM.

METHODS

We examined eight subjects with AVIM, six subjects with possible iNPH and 21 elderly controls. Neuropsychological tests were used, including the mini-mental state examination (MMSE), the Hasegawa dementia scale-revised (HDS-R), the frontal assessment battery (FAB), the trail making test A&B and semantic and letter verbal fluency tests.

RESULTS

When comparing the individuals with AVIM with the control subjects, significant differences were found in the scores achieved on the semantic verbal fluency tests and Luria's motor series (fist-edge-palm), a subtest of the FAB.

CONCLUSION

The present study suggests that individuals with AVIM demonstrate a slight subclinical decline in the cognitive function and motor regulation, which may represent a prodromal stage of iNPH.

Characterizing intonation deficit in motor speech disorders: an autosegmental-metrical analysis of spontaneous speech in hypokinetic dysarthria, ataxic dysarthria, and foreign accent syndrome

PURPOSE

The autosegmental-metrical (AM) framework represents an established methodology for intonational analysis in unimpaired speaker populations but has found little application in describing intonation in motor speech disorders (MSDs). This study compared the intonation patterns of unimpaired participants (CON) and those with Parkinson's disease (PD), ataxic dysarthria (AT), and foreign accent syndrome (FAS) to evaluate the approach's potential for distinguishing types of MSDs from each other and from unimpaired speech.

METHOD

Spontaneous speech from 8 PD, 8 AT, 4 FAS, and 10 CON speakers were analyzed in relation to inventory and prevalence of pitch patterns, accentuation, and phrasing. Acoustic-phonetic baseline measures (maximum-phonation-duration, speech rate, and F0-variability) were also performed.

RESULTS

The analyses yielded differences between MSD and CON groups and between the clinical groups in regard to prevalence, accentuation, and phrasing. AT and FAS speakers used more rising and high pitch accents than PD and CON speakers. The AT group used the highest number of pitch accents per phrase, and all 3 MSD groups produced significantly shorter phrases than the CON group.

CONCLUSIONS

The study succeeded in differentiating MSDs on the basis of intonational performances by using the AM approach, thus, demonstrating its potential for charting intonational profiles in clinical populations.

Paediatric speech-language pathology service delivery: an exploratory survey of Australian parents

Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E(3)BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents' wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E(3)BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.

Stuttering, disability and the higher education sector in Australia

The aim of this study was to ascertain the extent to which Australian public universities and their associated disability liaison services offer web-based information for current or prospective students who stutter. The disability pages of the websites of all 39 public universities in Australia were visited and the information about disability services assessed according to 12 criteria developed by the authors. Results indicate that there is a dearth of information on Australian university websites available for students or prospective students who stutter. Only 13% of the sites reported any form of alternative teaching and assessment procedures for speech-impaired students and only 51% of 39 disability liaison officers responded when contacted by email. Such a student could not make an informed choice to enrol in a university based upon the information on disability services available on public Australian university websites.

[Language disorders and cognitive functions in persons with schizophrenic disorders]

AIM

The aim of this study is to evaluate the relationship between clinical and neuropsychological measures of language disorders as well as characteristics of the mental condition of patients diagnosed as having schizophrenic disorders.

METHOD

There were 45 persons with schizophrenic disorder (acc. ICD-10) examined with The Positive and Negative Syndrome Scale (PANSS), the side effect rating scale (UKU), Wisconsin Cards Storting Test (WCST), verbal fluency task, Ruff's Test, "Similarities" --WAIS-R subtest, 10 graphics of The Thematic Apperception Test (TAT). Patient's speech was evaluated independently by two diagnosticians using Thought, Language and Communication Scale (TLCS).

RESULTS

Time since the onset of illness and the number of hospitalisations were associated with total TLCS scores and with most of the WCST indicators. Total amount and most of the particular language disorders correlated positively with total PANSS scores. Total amount of language disorders was connected with the number of trials, which were necessary to complete the first category and also with the global scores obtained in "Similarities". There were also many correlations between particular language phenomenons and results of several neuropsychological tests.

CONCLUSIONS

Correlation between psychopathological evaluation of language disorders according to TLCS and evaluation of the schizophrenic syndrome score is found to be significant. The psychopathological rating of general and particular language disorders shows significant correlations with some indicators of executive function, verbal and nonverbal fluency and the ability for abstract thinking.

Children with developmental and behavioural concerns in Singapore

INTRODUCTION

Childhood developmental and behavioural disorders (CDABD) have been increasingly recognised in recent years. This study evaluated the profiles and outcomes of children referred for developmental and behavioural concerns to a tertiary child developmental centre in Singapore. This is the first such regional database.

METHODS

Baseline information, obtained through a questionnaire, together with history at first consultation, provided information for referral, demographic and presentation profiles. Clinical formulations were then made. Definitive developmental and medical diagnoses, as well as outcomes based on clinical assessment and standardised testing, were recorded at one year post first consultation.

RESULTS

Out of 1,304 referrals between January 1, 2003 and December 1, 2004, 45% were 2-4 years old and 74% were boys. The waiting time from referral to first consultation exceeded four months in 52% of children. Following clinical evaluation, 7% were found to be developmentally appropriate. The single most common presenting concern was speech and language (S&L) delay (29%). The most common clinical developmental diagnosis was autism spectrum disorder (ASD) (30%), followed by isolated S&L disorder, global developmental delay (GDD) and cognitive impairment (CI). Recommendations included S&L therapy (57%), occupational therapy (50%) and psychological/behavioural services (40%). At one year, ASD remained the most common definitive developmental diagnosis (31%), followed by S&L disorder, CI and GDD. Most were children with high-prevalence, low-moderate severity disorders who could potentially achieve fair-good prognosis with early intervention.

CONCLUSION

Better appreciation of the profile and outcome of children with CDABD in Singapore could enable better resource planning for diagnosis and intervention.

APOE E4 status predicts age-related cognitive decline in the ninth decade: longitudinal follow-up of the Lothian Birth Cohort 1921

Carriers of the APOE E4 allele have an increased risk of developing Alzheimer's disease. However, it is less clear whether APOE E4 status may also be involved in non-pathological cognitive ageing. The present study investigated the associations between APOE genotypes and cognitive change over 8 years in older community-dwelling individuals. APOE genotype was determined in 501 participants of the Lothian Birth Cohort 1921, whose intelligence had been measured in childhood in the Scottish Mental Survey 1932. A polymorphic variant of TOMM40 (rs10524523) was included to differentiate between the effects of the APOE E3 and E4 allelic variants. Cognitive performance on the domains of verbal memory, abstract reasoning and verbal fluency was assessed at mean age 79 years (n=501), and again at mean ages of 83 (n=284) and 87 (n=187). Using linear mixed models adjusted for demographic variables, vascular risk factors and IQ at age 11 years, possession of the APOE E4 allele was associated with a higher relative rate of cognitive decline over the subsequent 8 years for verbal memory and abstract reasoning. Individuals with the long allelic variant of TOMM40, which is linked to APOE E4, showed similar results. Verbal fluency was not affected by APOE E4 status. APOE E2 status was not associated with change in cognitive performance over 8 years. In non-demented older individuals, possession of the APOE E4 allele predicted a higher rate of cognitive decline on tests of verbal memory and abstract reasoning between 79 and 87 years. Thus, possession of the APOE E4 allele may not only predispose to Alzheimer's disease, but also appears to be a risk factor for non-pathological decline in verbal memory and abstract reasoning in the ninth decade of life.

Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai

OBJECTIVES

This study was to analyze the association of hyposalivation with oral function, nutritional status and oral health in community-dwelling elderly Thai.

METHOD

The subjects were 612 elderly people (mean age = 68.8, SD 5.9 years). Oral function (tasting, speaking, swallowing and chewing) and Mini Nutritional Assessment (MNA) were evaluated. Oral examination investigated teeth and periodontal status. Both unstimulated and stimulated whole saliva were collected for 5 minutes.

RESULTS

Among all subjects, 14.4 % were classified within the hyposalivation. Hyposalivation was associated with gender, systemic disease, medication, and smoking. Subjects within the hyposalivation group had a higher number of decayed teeth and a higher prevalence of periodontitis than the normal salivation group (p < 0.05). The hyposalivation group also had a lower number of teeth present and a lower mean MNA score than the normal salivation group (p < 0.05). Logistic regression analysis showed that hyposalivation in both dentate and edentulous subjects was significantly associated with tasting, speaking, swallowing and chewing.

CONCLUSION

This study suggested that hyposalivation is a risk factor not only for dental caries and periodontal disease but also for taste disturbances, speaking problems, swallowing problems, poor chewing ability and malnutrition. Monitoring salivary flow is an important measure in the care of older people.

Literacy outcomes of children with early childhood speech sound disorders: impact of endophenotypes

PURPOSE

To demonstrate that early childhood speech sound disorders (SSD) and later school-age reading, written expression, and spelling skills are influenced by shared endophenotypes that may be in part genetic.

METHOD

Children with SSD and their siblings were assessed at early childhood (ages 4-6 years) and followed at school age (7-12 years). The relationship of shared endophenotypes with early childhood SSD and school-age outcomes and the shared genetic influences on these outcomes were examined.

RESULTS

Structural equation modeling demonstrated that oral motor skills, phonological awareness, phonological memory, vocabulary, and speeded naming have varying influences on reading decoding, spelling, spoken language, and written expression at school age. Genetic linkage studies demonstrated linkage for reading, spelling, and written expression measures to regions on chromosomes 1, 3, 6, and 15 that were previously linked to oral motor skills, articulation, phonological memory, and vocabulary at early childhood testing.

CONCLUSIONS

Endophenotypes predict school-age literacy outcomes over and above that predicted by clinical diagnoses of SSD or language impairment. Findings suggest that these shared endophenotypes and common genetic influences affect early childhood SSD and later school-age reading, spelling, spoken language, and written expression skills.

Speech disorders in students in Belo Horizonte

PURPOSE

To describe speech disorders in students from 1st to 4th grades, and to investigate possible associations between these disorders and stomatognathic system and auditory processing disorders.

METHODS

Cross-sectional study with stratified random sample composed of 288 students, calculated based on an universe of 1,189 children enrolled in public schools from the area covered by a health center in Belo Horizonte. The median age was 8.9 years, and 49.7% were male. Assessment used a stomatognathic system protocol adapted from the Myofunctional Evaluation Guidelines, the Phonology task of the ABFW - Child Language Test, and a simplified auditory processing evaluation. Data were statistically analyzed.

RESULTS

From the subjects studied, 31.9% had speech disorder. From these, 18% presented phonetic deviation, 9.7% phonological deviation, and 4.2% phonetic and phonological deviation. Linguistic variation was observed in 38.5% of the children. There was a higher proportion of children with phonetic deviation in 1st grade, and a higher proportion of children younger than 8 years old with both phonetic and phonological deviations. Phonetic deviation was associated to stomatognathic system disorder, and phonological deviation was associated to auditory processing disorder.

CONCLUSION

The prevalence of speech disorders in 1st to 4th grade students is considered high. Moreover, these disorders are associated to other Speech-Language Pathology and Audiology alterations, which suggest that one disorder may be a consequence of the other, indicating the need for early diagnosis and intervention.