Language and Literacy Together: Supporting Grammatical Development in Dual Language Learners With Risk for Language and Learning Difficulties

Purpose Early Interventions in Reading (Vaughn et al., 2006), the only literacy intervention with demonstrated effectiveness for U.S. dual language learners, was enhanced to support the development of oral language (vocabulary, grammar, and narrative) and literacy, which we refer to as "Language and Literacy Together." The primary focus of this study is to understand the extent to which grammatical skills of bilinguals with risk for language and/or reading difficulties improve in the Language and Literacy Together intervention. Method Fifteen first-grade dual language learners with risk for language and/or reading difficulties participated in an enhanced version of Early Interventions in Reading in Spanish. Children completed pre- and postintervention evaluations in Spanish and English, including grammatical testing from the Bilingual English Spanish Oral Screener (Peña et al., 2008) and narrative evaluation Test of Narrative Language story prompts (Gillam & Pearson, 2004; Gillam et al., n.d.). Data from six comparison participants with typical language skills who completed pre- and posttesting demonstrate the stability of the measures. Results The intervention group made gains in English and Spanish as evidenced by significant increases in their cloze and sentence repetition accuracy on the Bilingual English Spanish Oral Screener Morphosyntax subtest. They increased productivity on their narratives in Spanish and English as indexed by mean length of utterance in words but did not make gains in their overall grammaticality. Conclusions Structured intervention that includes an emphasis on grammatical elements in the context of a broader intervention can lead to change in the production of morphosyntax evident in both elicited constructions and narrative productivity as measured by mean length of utterance in words. Additional work is needed to determine if and how cross-linguistic transfer might be achieved for these learners.

Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants

Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.

Resection of highly language-eloquent brain lesions based purely on rTMS language mapping without awake surgery

BACKGROUND

The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping.

METHODS

Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed.

RESULTS

No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection.

CONCLUSIONS

The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.

Factors Affecting Early Services for Children Who Are Hard of Hearing

PURPOSE

To describe factors affecting early intervention (EI) for children who are hard of hearing, we analyzed (a) service setting(s) and the relationship of setting to families' frequency of participation, and (b) provider preparation, caseload composition, and experience in relation to comfort with skills that support spoken language for children who are deaf and hard of hearing (CDHH).

METHOD

Participants included 122 EI professionals who completed an online questionnaire annually and 131 parents who participated in annual telephone interviews.

RESULTS

Most families received EI in the home. Family participation in this setting was significantly higher than in services provided elsewhere. EI professionals were primarily teachers of CDHH or speech-language pathologists. Caseload composition was correlated moderately to strongly with most provider comfort levels. Level of preparation to support spoken language weakly to moderately correlated with provider comfort with 18 specific skills.

CONCLUSIONS

Results suggest family involvement is highest when EI is home-based, which supports the need for EI in the home whenever possible. Access to hands-on experience with this population, reflected in a high percentage of CDHH on providers' current caseloads, contributed to professional comfort. Specialized preparation made a modest contribution to comfort level.

Embedded Instruction Improves Vocabulary Learning During Automated Storybook Reading Among High-Risk Preschoolers

PURPOSE

We investigated a small-group intervention designed to teach vocabulary and comprehension skills to preschoolers who were at risk for language and reading disabilities. These language skills are important and reliable predictors of later academic achievement.

METHOD

Preschoolers heard prerecorded stories 3 times per week over the course of a school year. A cluster randomized design was used to evaluate the effects of hearing storybooks with and without embedded vocabulary and comprehension lessons. A total of 32 classrooms were randomly assigned to experimental and comparison conditions. Approximately 6 children per classroom demonstrating low vocabulary knowledge, totaling 195 children, were enrolled.

RESULTS

Preschoolers in the comparison condition did not learn novel, challenging vocabulary words to which they were exposed in story contexts, whereas preschoolers receiving embedded lessons demonstrated significant learning gains, although vocabulary learning diminished over the course of the school year. Modest gains in comprehension skills did not differ between the two groups.

CONCLUSION

The Story Friends curriculum appears to be highly feasible for delivery in early childhood educational settings and effective at teaching challenging vocabulary to high-risk preschoolers.

Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy

OBJECTIVES

Patients with temporal lobe epilepsy (TLE) experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to "collateral damage" to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes.

METHODS

Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, nonrandomized, nonblinded, parallel-group design.

RESULTS

Performance declines were significantly greater for the patients with dominant TLE who were undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<0.0001, η2=0.57, and F=11.2, p<0.001, η2=0.39, respectively), and for the patients with nondominant TLE undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<0.02, η2=0.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p<0.001, Fisher's exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant) TLE patients declined on face recognition.

SIGNIFICANCE

Preliminary results suggest (1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.

A potential protective effect in multilingual patients with semantic dementia: two case reports of patients speaking Taiwanese and Japanese

PURPOSE

Several reports have suggested that multilingualism has a protective effect against semantic dementia. Here, we provide further evidence for this effect.

CASE REPORTS FIRST

The patient was a 75-year-old right-handed Taiwanese woman who had retired after working as a tailor. She was able to speak Taiwanese, Japanese and Mandarin Chinese fluently until 5 years ago. She gradually developed symptoms of profound anomia and difficulty with word-finding. Her mother tongue was Taiwanese and she had learned Japanese as her first symbolized language. She had used Mandarin Chinese for most of her life, but depended on Japanese to read and write (such as reading a newspaper and keeping accounts). However, she could now speak only very simple Taiwanese and Japanese, and could recognize only simple Japanese characters. SECOND: The patient was a 62-year-old right-handed man who had worked as an ironworker. He could speak Taiwanese and Mandarin Chinese fluently until 5 years ago. His mother tongue was Taiwanese. After 5 years of language deterioration, he was unable to communicate with his family members or recognize any characters, including numbers. SPECT RESULTS: Brain perfusion ECD SPECT (Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography) showed less perfusion in the multilingual patient (Case #1) than in the bilingual patient (Case #2). Neuropsychological tests also demonstrated a slower rate of degeneration in the multilingual patient.

CONCLUSION

We speculate that reading and writing in Japanese had a greater impact on the semantic system in Case #1. Thus, this patient showed relatively less degeneration or functional inactivity, as shown by perfusion in the frontal lobe, and this might be due to the persistent activation involved in multilingualism.

Tea drinking and cognitive function in oldest-old Chinese

OBJECTIVE

We examined the longitudinal association between tea drinking frequency and cognitive function in a large sample of oldest-old Chinese.

DESIGN

population-based longitudinal cohort study.

SETTING

The Chinese Longitudinal Healthy Longevity Survey (CLHLS).

PARTICIPANTS

7139 participants aged 80 to 115 (mean age 91.4 years) who provided complete data at baseline (year 1998).

MEASUREMENTS

Current frequency of tea drinking and past frequency at age 60 were ascertained at baseline, and baseline and follow-up cognitive assessments were performed in the years 1998 (n=7139), 2000 (n=4081), 2002 (n=2288) and 2005 (n=913) respectively. Verbal fluency test was used as measure of cognitive function.

RESULTS

Tea drinking was associated at baseline with higher mean (SD) verbal fluency scores: daily=10.7 (6.6), occasional=9.2 (5.8), non-drinker=9.0 (5.5). In linear mixed effects model that adjusted for age, gender, years of schooling, physical exercise and activities score, the regression coefficient for daily drinking (at age 60) and occasional drinking was 0.72 (P<0.0001) and 0.41(P=0.01) respectively. Tea drinkers had higher verbal fluency scores throughout the follow-up period but concurrently had a steeper slope of cognitive decline as compared with non-drinkers (coefficient for the interaction term Time*Daily drinking= -0.12, P=0.02; "Time" was defined as the time interval from baseline to follow-up assessments in years). Similar results were found for current tea drinking status at study baseline year (1998) as predictor variable.

CONCLUSION

Regular tea drinking is associated with better cognitive function in oldest-old Chinese.

Localizing and Lateralizing Language in Patients with Brain Tumors: Feasibility of Routine Preoperative Functional MR Imaging in 81 Consecutive Patients1

PURPOSE

To prospectively assess the feasibility of standardized presurgical functional magnetic resonance (MR) imaging for localizing the Broca and Wernicke areas and for lateralizing language function.

MATERIALS AND METHODS

The study was approved by the responsible ethics commission, and patients gave written informed consent. Eighty-one patients (36 female and 45 male patients; age range, 7-75 years) with different brain tumors underwent blood oxygen level-dependent functional MR imaging at 1.5 T with two paradigms: sentence generation (SG) and word generation (WG). Functional MR imaging measurements, data processing, and evaluation were fully standardized by using dedicated software. Four regions of interest were evaluated in each patient: the Broca and Wernicke areas and their anatomic homologues in the right hemisphere. Statistics were calculated.

RESULTS

The SG and WG paradigms were successfully completed by all (100%) and 70 (86%) patients, respectively. Success rates in localizing and lateralizing language were 96% for the Broca and Wernicke areas with the SG paradigm, 81% for the Broca area and 80% for the Wernicke area with the WG paradigm, and 98% for both areas when the SG and WG paradigms were used in combination. Functional localizations were consistent for SG and WG paradigms in the inferior frontal gyrus (Broca area) and the superior temporal, supramarginal, and angular gyri (Wernicke area). Surgery was not performed in seven patients (9%) and was modified in two patients (2%) because of functional MR imaging findings.

CONCLUSION

Functional MR imaging proved to be feasible during routine diagnostic neuroimaging for localizing and lateralizing language function preoperatively.

Pre-Surgical Language Mapping with Functional Magnetic Resonance Imaging

Patients with lesions in or near eloquent cortex typically undergo one of several invasive techniques to prevent loss of function following surgery. One of the most promising potential clinical applications of functional magnetic resonance imaging (fMRI) is to map these functions as part of the pre-surgical work-up to identify patients at-risk, guide the surgical entry, or tailor the surgical procedure to prevent deficits. While motor and sensory mapping are relatively straightforward, language mapping is far more complex. The language system is variable in location across individuals and in many cases may reorganize partially or completely to the contralateral hemisphere. In addition, multiple regions of the brain contribute to language functioning including essential regions that must not be removed in surgery, and contributory regions that may result in transient or insignificant impairments post-surgery. Despite these challenges, an increasing number of studies have supported the use of fMRI for pre-surgical language mapping in a variety of disorders. This article reviews the literature from three disorders for which patients benefit from preoperative language mapping: epilepsy, brain tumors, and arteriovenous malformations. Each disorder presents unique challenges to language mapping. Specific case studies are presented highlighting the both the potential benefits of preclinical fMRI for language mapping as well as the potential risks and pitfalls.

Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping

OBJECTIVE

Intraoperative speech mapping has evolved into the "gold standard" for neurosurgical removal of lesions near the language cortex. The integration of neuronavigation into a multimodal protocol can improve the reliability of this type of operation, but most systems require rigid fixation of the patient's head throughout the operation. This article describes and evaluates a new noninvasively attached sensor-based reference tool, which can replace rigid pin fixation of the patient's head during awake craniotomies.

METHODS

The attachment technique and the resulting application accuracy were investigated under clinical conditions in 13 patients undergoing awake craniotomy with intraoperative mapping of cortical language sites.

RESULTS

Spatial information was used for updating the image guidance by continuously adjusting the image planes relative to the position of the patient's head. The mean registration error achieved with this technique was 1.53 +/- 0.51 mm (fiducial registration error +/- standard deviation). The system's median application accuracy between dura opening and closure ranged from 0.83 to 1.85 mm (position error).

CONCLUSION

The use of a reference sensor can replace uncomfortable pin fixation of the patient's head during navigation-supported awake craniotomies. Application accuracy is not affected by repositioning of the patient or by unavoidable head movements. Thus, this technique enables full exploitation of the benefits of navigation in a multimodal operative protocol without the need to rigidly fix the patient's head.

Facilitating Literacy Development in Young Children with Hearing Loss

Historically, children with hearing loss (HL) are often poor readers. In this article, the authors present two divergent groups of children with HL who have better than average literacy outcomes, children with Pervasive Exposure to Sign Language (PESL) and children who are Auditory-Verbal Communicators (AVCs). Outside-in and inside-in factors contributing to literacy development in the two groups of children are discussed with an emergent literacy perspective. Effective intervention strategies that can be used with all children with HL are highlighted.

Translational research on early language development: Current challenges and future directions

There is a pressing need for the early and accurate identification of young children at risk for language and other developmental disabilities and the provision of timely, age-appropriate intervention, as mandated by Part C of the Individuals with Disabilities Education Act. Research has shown that early intervention is effective for many language impaired children in different etiological groups, and can reduce the functional impact of persistent disorders on children and their families. Yet, the accurate identification of infants and toddlers at risk for language impairment remains elusive, especially for late-talking children without obvious genetic or neurological conditions. In this paper, the need for translational research on basic processes in early language development in typical and atypical populations and the contextual factors that affect them are discussed, along with current challenges and future directions for its successful implementation. Implications of this research for clinical evidence-based practice are also considered.

Brain stimulation reveals critical auditory naming cortex

One challenge in dominant temporal lobe epilepsy surgery is to remove sufficient epileptogenic tissue without compromising post-operative language functioning. Pre-resection electrical stimulation mapping enables identification of language areas that can be spared from resection, and also provides a unique opportunity to investigate brain-language relationships. Visual object naming is the gold standard for identifying 'essential' language cortex; however, sparing visual naming (VN) sites has not reliably prevented post-operative language decline. In addition to visual object naming, we included a more 'ecologically valid' auditory description naming task in our pre-resection cortical mapping protocol. Of the seven patients who had auditory naming (AN) sites removed, six declined post-operatively, whereas of the 12 patients who did not have AN sites removed, only 3 declined post-operatively (P = 0.02), suggesting an association between AN site removal and post-operative naming decline. Interestingly, although VN sites were preserved in all patients, AN site removal resulted in decline in both auditory and VN tasks. These findings not only have potentially critical clinical significance, but also argue for modality specificity, with considerable integration within the semantic system.

Hearing impairment: a population study of age at diagnosis, severity, and language outcomes at 7-8 years

BACKGROUND

Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection.

AIMS

To study impact of age of diagnosis and severity of HI in a population cohort of 7-8 year old children.

METHODS

Eighty eight 7-8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models.

RESULTS

Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI.

CONCLUSIONS

More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7-8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.

New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations

Despite a better understanding of the organization of the cortical network underlying the semantic system, very few data are currently available regarding its anatomo-functional connectivity. Here, we report on a series of 17 patients operated on under local anaesthesia for a cerebral low-grade glioma located within the dominant hemisphere. Prior to and during resection, intraoperative electrical stimulation was used to map sensorimotor and language structures so that permanent neurological deficits could be avoided. In a number of cases, cortical and subcortical stimulation caused semantic paraphasias. Using postoperative MRI, we correlated these functional findings with the anatomical locations of the sites where semantic errors were elicited by stimulation, especially at the subcortical level, with the aim of studying the connectivity underlying the semantic system. In temporal gliomas, cortical sites involved in semantic processing were found around the posterior part of the superior temporal sulcus, with subcortical pathways reproducibly located under the depth of this sulcus. In insular gliomas, although stimulation elicited no semantic disturbances at the cortical level, such semantic paraphasias were generated at the level of the anterior floor of the external capsule. In frontal tumours, cortical regions implicated in semantics were detected in the lateral orbitofrontal region and dorsolateral prefrontal cortex, with subcortical fibres located under the inferior frontal sulcus. All these eloquent structures were systematically preserved, thereby avoiding permanent postoperative deficits. Our results provide arguments in favour of the existence of a main ventral subcortical pathway underlying the semantic system, within the dominant hemisphere, joining the two essential cortical epicentres of this network: the posterior and superior temporal areas, and the orbitofrontal and dorsolateral prefontal regions. Such a ventral stream might anatomically partly correspond to the inferior fronto-occipital fasciculus.

Successful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping

Despite recent literature advocating the surgical removal of symptomatic Cavernous Angiomas (CA), even in critical brain areas, very few observations of insular CA surgery have been described, particularly in the left hemisphere. We report the case of a successful resection of a CA located in the dominant insula, using both neuronavigation and intra-operative functional mapping. This 33-year-old right-handed man harbored a left insular CA, revealed by generalized seizures following a bleed confirmed on MRI. The preoperative examination was normal. A stereotactic-guided surgery was performed under local anesthesia, with intra-operative functional mapping using direct cortico-subcortical electrical stimulation in the awake patient--allowing the surgeon to achieve total resection of both CA and pericavernomatous gliosis, as shown on repeated postoperative MRIs. There was no postsurgical deficit, nor any seizure without treatment (follow-up: 4.5 years). The diagnosis of CA was confirmed by histological examination. Taking account of the risk of morbidity due to the natural history of CA, particularly in eloquent brain regions, we suggest to routinely consider the possibility of a surgical treatment in cases of symptomatic (left dominant) insular CA, using combined intra-operative anatomical and physiological localization methods.

[What is the current role of a Wada test in the pre-surgical work-up of pharmacologically intractable epilepsy in adults?]

Juhn Wada developed a test while in Montreal designed to definitively confirm hemispheric lateralization of speech in candidates for surgical treatment of epilepsy. By unilateral intra-carotid administration of a bolus of a general anesthetic, classically sodium amobarbital, function can be tested in the non-injected hemisphere, while the injected side is dysfunctional. The test has been expanded to test memory functions in the hemisphere (temporal lobe) contralateral to expected surgery (memory reserve) in the hope of contra-indicating surgery that may result in global amnestic syndromes (patient HM). Conversely, risk of material-specific memory loss following surgery can be assessed by testing memory in the hemisphere/temporal lobe to be operated ("functional adequacy"). Memory dysfunction, when concordant with EEG seizure onset and chosen side of temporal lobe surgery has also been shown to correlate with favourable post-operative seizure outcome. Nevertheless, the test remains invasive, requiring an angiogramme. Non-invasive alternatives such as fMRI and PET and their reported reliability compared to a Wada test are discussed. A world-wide shortage of amobarbital has led to the use of some other anesthetic agents. Overall, the indications for the test and the manner in which it is performed vary greatly from one institution to the next. It is used almost systematically in some institutions and very rarely in others. Future perspectives are discussed.

Magnetocephalography: a noninvasive alternative to the Wada procedure

Object. In this study the authors evaluated the sensitivity and selectivity of a noninvasive language mapping procedure based on magnetoencephalography (MEG), for determining hemispheric dominance for language functions.

Methods. Magnetic activation profiles of the brain were obtained from 100 surgical candidates (age range 8–56 years) with medically intractable seizure disorder by using a whole-head MEG system within the context of a word recognition task. The degree of language-specific activity was indexed according to the number of consecutive sources (modeled as single, moving current dipoles) in perisylvian brain areas. Only activity sources that were observed with a high degree of spatial and temporal overlap in two split-half data sets were used to compute the MEG laterality index. Independently, all patients underwent Wada testing for the determination of hemispheric dominance for language.

Independent clinical judgments based on MEG and Wada data showed a high degree of concordance (87%). Magnetoencephalography laterality judgments had an overall sensitivity of 98%, but a lower selectivity of 83%, which was due to the fact that MEG detected more activity in the nondominant hemisphere than was predicted based on the Wada test. A number of objective criteria were derived based on this large patient series to ensure data quality and bolster the clinical usefulness of MEG for language mapping.

Conclusions. Although the availability of MEG is still limited across epilepsy surgery centers, this study method may be substituted for the Wada procedure in assessing hemispheric dominance for language in select cases.

[Memory evaluation using functional magnetic resonance: applications in preoperative patients and in Alzheimer s disease]

The assessment of memory functions related to medial temporal lobe has become one of the most important issues on current neuropsychology. On this communication, we review the results which our research group has achieved using two functional magnetic resonance Image procedures to assess memory function: Hometown walking task and an encoding/retrieval task using complex images. Nine patients with tumoural temporal lesions performed the hometown walking task. The results of these patients showed either a bilateral or contralesional representation of memory function. These results confirm those obtained by Jokeit, Okujava y Woermann (2001), and they seem to prove that this protocol is useful to determine the preservation of memory function in the non damaged hemisphere. On the other hand, the images encoding/retrieval task has been run by two groups of four patients diagnosed as Alzheimer disease and mild cognitive impairment, and another group of five patients who participated as a control group. According to our hypothesis, the results have shown a lower activation at the left parahippocampal gyrus in mild cognitive impairment and Alzheimer disease patients than controls, just as a lower bilateral activation in the same structure for the Alzheimer group than the control group. As a whole, our results show how important may become functional magnetic resonance image for neuropsychological assessment of memory, and as a diagnostic tool for CNS diseases.

Valedictory--why pediatric otorhinolaryngology is important

The importance of the care given by the pediatric otolaryngologist to the individual child encompasses the traditional purposes of medicine. This field has its special focus on interventions that preserve, restore and/or otherwise improve hearing, speech, voice, gustation, olfaction, deglutition, respiration, appearances, etc. The value-added dimension of pediatric otolaryngology is of essential importance because it enhances communication-language--through the vehicles of hearing, voice, and speech. This critical role is manifest in two ways. The first relates to the economic bases of society. Comparison of the consequences of communications disorders in three different countries ranging, currently, from one very highly dependent upon communication skills (The Netherlands), to one highly dependent upon communication skills (the United States), to a developing nation less dependent upon communication skills (the Philippines) is presented. All three nations are adversely affected economically and socially by communication disorders. It is estimated that the United States loses between 2.5 and 3% of its gross domestic product from the economic sequel of communication disorders. It also appears that communication disorders contribute to crime, since the prevalence of communication disorders is many times greater in populations of juvenile delinquents than in the general population. Communication disorders may act synergistically with diminished economic and social resources and other factors in the causes of violent behavior and crime.

Temporal lobe stimulation reveals anatomic distinction between auditory naming processes

BACKGROUND

Language errors induced by cortical stimulation can provide insight into function(s) supported by the area stimulated. The authors observed that some stimulation-induced errors during auditory description naming were characterized by tip-of-the-tongue responses or paraphasic errors, suggesting expressive difficulty, whereas others were qualitatively different, suggesting receptive difficulty. They hypothesized that these two response types reflected disruption at different stages of auditory verbal processing and that these "subprocesses" might be supported by anatomically distinct cortical areas.

OBJECTIVE

To explore the topographic distribution of error types in auditory verbal processing.

METHODS

Twenty-one patients requiring left temporal lobe surgery underwent preresection language mapping using direct cortical stimulation. Auditory naming was tested at temporal sites extending from 1 cm from the anterior tip to the parietal operculum. Errors were dichotomized as either "expressive" or "receptive." The topographic distribution of error types was explored.

RESULTS

Sites associated with the two error types were topographically distinct from one another. Most receptive sites were located in the middle portion of the superior temporal gyrus (STG), whereas most expressive sites fell outside this region, scattered along lateral temporal and temporoparietal cortex.

CONCLUSIONS

Results raise clinical questions regarding the inclusion of the STG in temporal lobe epilepsy surgery and suggest that more detailed cortical mapping might enable better prediction of postoperative language decline. From a theoretical perspective, results carry implications regarding the understanding of structure-function relations underlying temporal lobe mediation of auditory language processing.

Intrasubject reproducibility of presurgical language lateralization and mapping using fMRI

BACKGROUND

fMRI is becoming a standard tool for the presurgical lateralization and mapping of brain areas involved in language processing. However, its within-subject reproducibility has yet to be fully explored.

OBJECTIVE

To evaluate within-test and test-retest reliability of language fMRI in consecutive patients undergoing evaluation for epilepsy surgery.

METHODS

Thirty-four unselected patients were investigated once (within-test reliability) and 12 patients twice (test-retest reliability). The imaging series consisted of an alternating 25-second synonym judgment condition with a 25-second letter-matching condition repeated 15 times. Reproducibility of activation maps of the first and second half of session 1 or activation maps of sessions 1 and 2 was evaluated by comparing one global and three regional lateralization indexes (Broca's area, remaining prefrontal cortex, temporoparietal area) and on a voxel-by-voxel basis (intraclass correlation coefficient, percentage overlap, correlation of t-values).

RESULTS

Global and regional language lateralization was achieved with high reliability within and across sessions. Reproducibility was evenly distributed across both hemispheres but not within each hemisphere. Frontal activations were more reliable than temporoparietal ones. Depending on the statistical threshold chosen, the voxel-by-voxel analysis revealed a mean overlap of activations derived from the first and second investigation of up to 48.9%.

CONCLUSION

Language fMRI proved sufficiently reliable for the determination of global and regional lateralization of language representation in individual unselected patients with epilepsy.

Prospective preliminary analysis of the development of autism and epilepsy in children with infantile spasms

The objective of this study was to compare the efficacy of corticotropin (ACTH) versus vigabatrin in treating infantile spasms and to determine which medication has a more favorable long-term outcome in terms of cognitive function, evolution of epilepsy, and incidence of autism. Patients with infantile spasms were included in the study if they were 3 to 16 months old, had hypsarrhythmia, and had no previous treatment with vigabatrin or corticosteroids. Patient evaluation included electroencephalographic and psychometric measures before and after treatment. Patients were stratified based on etiology (idiopathic or symptomatic) and sex and then randomized between the ACTH and vigabatrin treatment groups. Each of the treatment groups received either ACTH or vigabatrin for 2 weeks. At the end of 2 weeks of treatment, patients were considered responders if spasms and hypsarrhythmia resolved. Nonresponders were crossed over and treated with the alternate drug. Nine patients were included in the study. Three patients received ACTH, one of whom was a responder. Six patients received vigabatrin, three of whom were responders. The five nonresponders received both therapies. All patients had some degree of developmental plateau or regression before the initiation of treatment. Four patients with idiopathic infantile spasms showed improved cognitive function following treatment. The remaining five patients remained significantly delayed. Five patients with symptomatic infantile spasms had epilepsy following treatment; three of them were in the autistic spectrum. The small number of infants in this pilot study is insufficient to determine which of the two drugs is more effective. However, the following trends were identified: vigabatrin may be more effective for patients with symptomatic infantile spasms; patients with idiopathic infantile spasms tend to have a better cognitive outcome; and patients with symptomatic infantile spasms tend to develop both epilepsy and autism.

[Perioperative cortical stimulation of language fields under local anesthesia in preparation to excision of tumors of the dominant hemisphere]

OBJECTIVES

The aim of this study is to demonstrate the accuracy of direct cortical stimulation of language areas preparatory to the removal of infiltrating tumors of dominant hemisphere.

MATERIAL AND METHODS

From June 1998 to March 2000 we included in our study 15 patients, aged from 30 to 75 years, harboring gliomas (14 high grades and 1 low grade) close to language-specific cortex. All patients had slight inaugural phasic troubles. They underwent craniotomy under local anesthesia for cortical stimulation language mapping, in conjunction with electrocorticography to identify the after-discharge threshold. Stimulation mapping covered the entire macroscopically tumor involved area, extending up to 3 cm away from the margins of the lesion, without searching to identify systematically the language areas. Therefore, the lesion was removed as completely as possible, respecting a security margin of at least 1 cm from the recognized language sites.

RESULTS

We identified from 1 to 6 language sites for 14 of our patients, in different locations. A radical removal was achieved for all high grade gliomas, while the low grade was only partially removed. A patient died on the 16th postoperative day from pulmonary embolism; 2 patients deteriorated from peri- or immediate postoperative complications; 9 showed a transient neurological worsening that receded by the 2nd postoperative month, while 3 did not present any postoperative aggravation. At a follow-up of 1 month to 2 years (mean 8 months), 6 patients died and the 9 survivors maintain a good life quality.

CONCLUSIONS

Cortical stimulation for language mapping is an accurate technique that allows the surgical morbidity of lesions in proximity to language areas to decrease and become comparable to the surgical morbidity for lesions in non eloquent areas.

[Identification of language disorders in children. A contribution to the prevention of illiteracy]

Early identification of disorders of oral and written language development is essential for effective action before the vicious circle of educational failure and established psychosocial consequences. There has been growing awareness among health and education professionals that the means of recognizing, treating and teaching children with specific oral and written language disorders are inadequate. There is still a limited number of diagnostic tools that have not been fully evaluated. Nevertheless, considerable effort has been made in recent years to develop instruments for early detection and precise diagnostic evaluation. Developments in cognitive neuropsychology provide new approaches for the management of these disorders.

The burden of otitis media

Otitis media is the most frequent reason that children go to the doctor for illness. In developing countries, where children have limited access to medical care, suppurative complications of otitis media (OM) are frequent and permanent hearing loss results. In developed countries, the most common morbidity of OM is conductive hearing loss due to middle ear effusion. Infants with severe and recurrent OM and persistent middle ear effusion are at risk for problems in behavior and development of speech, language and cognitive abilities. Parent stress is frequent. The cost of otitis media is large (>$5 billion in the United States). Selection and spread of multi-drug resistant bacterial pathogens arising from extensive use of antimicrobial agents for OM is a problem for management of all diseases due to the pathogens. The incidence and severity of OM may diminish with introduction of new bacterial and viral vaccines.

Precursors to speech in infancy: the prediction of speech and language disorders

During the canonical stage of infant babbling, infants produce well-formed syllables, often in reduplicated sequences such as "bababa." Although nearly all infants with normal hearing begin the canonical stage by 10 months of age, a few are delayed, and these infants may be of special interest. Recent studies indicate that late onset of canonical babbling may be a predictor of disorders. A simple screening procedure that focuses on canonical babbling was used to evaluate over 3400 infants at risk who were about 10 months of age. Among infants who showed late onset of canonical babbling, fewer than half had been previously diagnosed as having a significant medical problem that might have accounted for the delay. A follow-up study indicated that infants with delayed canonical babbling had smaller production vocabularies at 18, 24, and 30 months than did infants in the control group. The results suggest that late onset of canonical babbling, a factor that can be monitored effectively through an interview with a parent, can predict delay in the onset of speech production.

Secondary prevention of paediatric language disability: a comparison of parents and nurses as screening agents

The purpose of this investigation was to compare the ability of nurses and parents to detect speech and language disability. The methodology included development and validation of a parent questionnaire to detect speech and language disability in 398 3-year-old English-speaking children. The parent questionnaire and a standard developmental screen administered by child health nurses were compared with a gold standard (a speech and language assessment). International criteria for screening tools were applied. The tools were comparable in performance. A simple parent questionnaire, completed without professional assistance, was a viable alternative to professional screening. Parents' education and parity had no influence on their ability to detect language disorders. Although size of sibship had no association with the occurrence of speech and language disability, third-born children were more likely to have a speech and language disability than any other birth order.

Program evaluation findings of an intensive early intervention program

An intensive early intervention program was evaluated through determining child gains made by 44 children with special needs in cognition, gross-motor, fine-motor, receptive language, and expressive language domains. Gains were examined for the total group and two subgroups based upon their delays at pretesting. Analyses comparing actual to predicted posttest scores for the total group did not reveal statistically significant gains in any domains. Findings by subgroup revealed that in cognition, gross-motor, and fine-motor domains, the group with less severe impairments made more progress. Results were interpreted in light of constraints imposed by the measurement tools and discussed in terms of policy implications and the limitations involved in conducting quality program evaluation in early intervention.

Parent questionnaire for screening early language development in children with cleft palate

This study investigated the efficacy of a parent questionnaire as a component for screening early language development of children 16 to 30 months of age with cleft lip and palate. Thirty nonsyndromic children with cleft lip and palate and 30 children without clefts received the MacArthur Communicative Development Inventory: Toddler (CDI: Toddler), administered by a pediatrician. In addition, a speech-language screening was performed by a speech-language pathologist. Results of the two assessments indicated that the CDI:Toddler was a valid screener of language development when compared with a comprehensive speech-language screening. Language and speech characteristics of the subject populations are discussed. In particular, differences between the cleft and noncleft groups demonstrated evidence of delays in expressive language development in the children with cleft lip and palate.

Otological and habilitative management of children with Down syndrome

It has been well-established that children with Down syndrome experience a high incidence of persistent conductive hearing loss because of their predisposition to stenosis of the external auditory canal (EAC), cerumen impaction, serous otitis media (SOM), and cholesteatoma. Because this hearing problem may be a primary cause of the spoken communication skills in these children being far below their cognitive ability, assertive management is required. The authors present an aggressive multi-discipline treatment model that is instituted during the first year of life in an infant with Down syndrome. Reconstruction of the EAC, amplification technology, and speech/language intervention that emphasizes auditory-verbal (A/V) therapy are discussed. In a pilot study, we compared the language development of six infants with Down syndrome who received aggressive treatment during their first year of life (group A) to six infants who did not (group B). The results showed age-appropriate oral language development for the infants in group A.

[Screening of language disorders in the preschool period]

Between five and 20% of preschool age children have language problems. These can be related to the child's hearing, socioeconomic status, intellectual development, or a psychiatric disorder. Even when it is difficult to recommend a formal screening program, family physicians can interpret delays in speech and language as "indicators" of underlying disorders.

Chronic pediatric tracheotomy: assessment and implications for habilitation of voice, speech and language in young children

The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.

The behaviour, development, and health of the young child: implications for care

Children with recurrent physical illnesses such as infections of the ears and chest are more likely than average to have developmental and behavioural disorders as well. Specialist skills are needed for the assessment and management of these disorders; the belief that "the child will grow out of it" is rarely correct. Any reorganisation of the child health services should take account of the need for children with developmental and behavioural disorders to be treated within the community by doctors and other health workers with the appropriate skills.

In vivo language intervention: unanticipated general effects

After observing the lack of generalization of language trained in highly structured training sessions using established behavior modification techniques, "incidental teaching" procedures were developed to change the use of specified language behaviors in the natural environment. This paper reports an analysis of the general changes in the language, other than that specifically targeted by the incidental teaching procedures, used by disadvantaged preschool children. The daily language samples of disadvantaged children involved in a previously reported experiment to increase compound sentence usage were reexamined and compared to comparable records of other disadvantaged children and of middle-class children of college parents in order to assess possible general effects of the intervention program. Whereas the language that both groups of comparison children used changed little across the preschool year, the amount of talking by the children in the experimental program increased markedly. Their use of more elaborate vocabulary and more elaborate sentences also increased in direct proportion to the increases in overall language use, such that both language use and language elaboration in the experimental group of children changed from a pattern simlar to the comparison group of disadvantaged children to a pattern similar to the comparison group of middleclass children. It is argued that some general features of the incidental teaching procedure--differentially attending to child overtures and responding relative to the child's selected topic (reinforcer)--contributed to the increase in overall language use beyond the specific language behavior targeted, and that this increase in the probability of children's talking itself resulted in the substantial increases in elaboration seen in the children's spontaneous language. Because, at least in children with fairly well-developed language repertoires, language use is contextually controlled, talking more involves talking in more varied and complex contexts, which inevitably produces the use of more elaborate language.