The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Visual impairment could worsen sleep/wake disorders and cognitive decline.

OBJECTIVE

To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site.

METHOD

HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations.

RESULT

Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= -0.16; p < 0.001) and on average 7-years later (β= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations.

CONCLUSION

Self-reported visual impairment was independently associated with worse cognitive function and decline.

Variation in Vowel Duration Among Southern African American English Speakers

PURPOSE

Atypical duration of speech segments can signal a speech disorder. In this study, we examined variation in vowel duration in African American English (AAE) relative to White American English (WAE) speakers living in the same dialect region in the South to characterize the nature of systematic variation between the 2 groups. The goal was to establish whether segmental durations in minority populations differ from the well-established patterns in mainstream populations.

METHOD

Participants were 32 AAE and 32 WAE speakers differing in age who, in their childhood, attended either segregated (older speakers) or integrated (younger speakers) public schools. Speech materials consisted of 14 vowels produced in hVd-frame.

RESULTS

AAE vowels were significantly longer than WAE vowels. Vowel duration did not differ as a function of age. The temporal tense-lax contrast was minimized for AAE relative to WAE. Vowels produced by females were significantly longer than vowels produced by males for both AAE and WAE.

CONCLUSIONS

African American speakers should be expected to produce longer vowels relative to White speakers in a common geographic area. These longer durations are not deviant but represent a typical feature of AAE. This finding has clinical importance in guiding assessments of speech disorders in AAE speakers.

Public attitudes toward-and identification of-cluttering and stuttering in Norway and Puerto Rico

PURPOSE

The study sought to compare public attitudes toward cluttering versus stuttering in Norway and Puerto Rico and to compare respondents' identification of persons known with these fluency disorders.

METHOD

After reading lay definitions of cluttering and stuttering, three samples of adults from Norway and three from Puerto Rico rated their attitudes toward cluttering and/or stuttering on modified versions of the POSHA-Cl (for cluttering) and POSHA-S (for stuttering). They also identified children and adults whom they knew who either or both manifested cluttering or stuttering.

RESULTS

Attitudes toward cluttering were essentially unaffected by rating either cluttering only or combined cluttering and stuttering on the same questionnaire in both countries. The same was also true of stuttering. Attitudes were very similar toward both disorders although slightly less positive for cluttering. Norwegian attitudes toward both disorders were generally more positive than Puerto Rican attitudes. The average respondent identified slightly more than one fluency disorder, a higher percentage for stuttering than cluttering and higher for adults than children. Cluttering-stuttering was rarely identified.

CONCLUSION

Given a lay definition, this study confirmed that adults from diverse cultures hold attitudes toward cluttering that are similar to-but somewhat less positive than-their attitudes toward stuttering. It also confirmed that adults can identify cluttering among people they know, although less commonly than stuttering. Design controls in this study assured that consideration of stuttering did not affect either the attitudes or identification results for cluttering.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) describe the effects-or lack thereof-of considerations of stuttering on attitudes toward cluttering; (b) describe differences in public identification of children and adults who either clutter or stutter; (c) describe differences between attitudes toward cluttering and stuttering in Norway and Puerto Rico.

Variability in the language input to children enhances learning in a treatment context

PURPOSE

Artificial language learning studies have demonstrated that learners exposed to many different nonword combinations representing a grammatical form demonstrate rapid learning of that form without explicit instruction. However, learners presented with few exemplars, even when they are repeated frequently, fail to learn the underlying grammar. This study translated this experimental finding in a therapeutic context.

METHOD

Eighteen preschool children with language impairment received conversational recast treatment for morpheme errors. Over a 6-week period, half heard 12 unique verbs twice each during recasts (low-variability condition), and half heard 24 unique verbs (high-variability condition). Children's use of trained and untrained morphemes on generalization probes as well as spontaneous use of trained morphemes was tracked throughout treatment.

RESULTS

The high-variability condition only produced significant change in children's use of trained morphemes, but not untrained morphemes. Data from individual children confirmed that more children in the high- than the low-variability condition showed a strong treatment effect. Children in the high-variability condition also produced significantly more unique utterances containing their trained morpheme than children in the low-variability condition.

CONCLUSION

The results support the use of highly variable input in a therapeutic context to facilitate grammatical morpheme learning.

Resourcing speech-language pathologists to work with multilingual children

Speech-language pathologists play important roles in supporting people to be competent communicators in the languages of their communities. However, with over 7000 languages spoken throughout the world and the majority of the global population being multilingual, there is often a mismatch between the languages spoken by children and families and their speech-language pathologists. This paper provides insights into service provision for multilingual children within an English-dominant country by viewing Australia's multilingual population as a microcosm of ethnolinguistic minorities. Recent population studies of Australian pre-school children show that their most common languages other than English are: Arabic, Cantonese, Vietnamese, Italian, Mandarin, Spanish, and Greek. Although 20.2% of services by Speech Pathology Australia members are offered in languages other than English, there is a mismatch between the language of the services and the languages of children within similar geographical communities. Australian speech-language pathologists typically use informal or English-based assessments and intervention tools with multilingual children. Thus, there is a need for accessible culturally and linguistically appropriate resources for working with multilingual children. Recent international collaborations have resulted in practical strategies to support speech-language pathologists during assessment, intervention, and collaboration with families, communities, and other professionals. The International Expert Panel on Multilingual Children's Speech was assembled to prepare a position paper to address issues faced by speech-language pathologists when working with multilingual populations. The Multilingual Children's Speech website ( http://www.csu.edu.au/research/multilingual-speech ) addresses one of the aims of the position paper by providing free resources and information for speech-language pathologists about more than 45 languages. These international collaborations have been framed around the World Health Organization's International Classification of Functioning, Disability and Health (ICF-CY) and have been established with the goal of supporting multilingual children to participate in society.

Speech-language pathologists' assessment and intervention practices with multilingual children

Within predominantly English-speaking countries such as the US, UK, Canada, New Zealand, and Australia, there are a significant number of people who speak languages other than English. This study aimed to examine Australian speech-language pathologists' (SLPs) perspectives and experiences of multilingualism, including their assessment and intervention practices, and service delivery methods when working with children who speak languages other than English. A questionnaire was completed by 128 SLPs who attended an SLP seminar about cultural and linguistic diversity. Approximately one half of the SLPs (48.4%) reported that they had at least minimal competence in a language(s) other than English; but only 12 (9.4%) reported that they were proficient in another language. The SLPs spoke a total of 28 languages other than English, the most common being French, Italian, German, Spanish, Mandarin, and Auslan (Australian sign language). Participants reported that they had, in the past 12 months, worked with a mean of 59.2 (range 1-100) children from multilingual backgrounds. These children were reported to speak between two and five languages each; the most common being: Vietnamese, Arabic, Cantonese, Mandarin, Australian Indigenous languages, Tagalog, Greek, and other Chinese languages. There was limited overlap between the languages spoken by the SLPs and the children on the SLPs' caseloads. Many of the SLPs assessed children's speech (50.5%) and/or language (34.2%) without assistance from others (including interpreters). English was the primary language used during assessments and intervention. The majority of SLPs always used informal speech (76.7%) and language (78.2%) assessments and, if standardized tests were used, typically they were in English. The SLPs sought additional information about the children's languages and cultural backgrounds, but indicated that they had limited resources to discriminate between speech and language difference vs disorder.

Maximizing health literacy and client recall in a developing context: speech-language therapist and client perspectives

BACKGROUND

In the field of speech-language therapy, limited research has been conducted with regards to health literacy and client recall. However, speech-language therapists frequently provide a considerable amount of information for clients to understand, apply and review in order to manage their (or their child's) health.

AIMS

This study aimed to investigate (1) issues around clients' health literacy and recall of information; and (2) how these issues can be overcome in speech-language therapy in a developing context.

METHOD & PROCEDURES

An exploratory study was undertaken with specific focus on speech-language therapists and their clients who had previously received treatment for dysphagia, voice disorders (including laryngectomies), and cleft lip and/or palate management. They were recruited at public tertiary hospitals and primary healthcare clinics in Cape Town, South Africa. Data were gathered through focus group discussions and qualitatively analysed using a content-driven immersion/crystallization style.

OUTCOMES & RESULTS

Five themes and 13 subthemes were identified. Speech-language therapists currently use mostly low-technology strategies to manage issues of health literacy and client recall, and frequently view poor outcomes as being related to clients themselves and a lack of compliance.

CONCLUSIONS & IMPLICATIONS

An understanding of context, intercultural health literacy and client-provider concordance are important factors that should inform the clinical practice of speech-language therapy. There is a need to develop effective strategies for information provision and review post-consultation. Speech-language therapists have an important mediating role in cross-cultural communication.

Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe

PURPOSE

This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe.

METHODS

We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed.

RESULTS

Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02).

CONCLUSIONS

In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.

Child maltreatment: a global issue

PURPOSE

This article explains why children with speech and language impairments are at increased risk for having experienced abuse, neglect, and trauma and how maltreatment may vary across cultures.

METHOD

International literature on maltreatment is reviewed in order to provide frameworks for identifying what constitutes maltreatment across cultures; how cultural variations in discipline practices impact maltreatment; and professionals' roles in treatment when they encounter children who have experienced abuse, neglect, or trauma.

CONCLUSION

Speech-language pathologists and audiologists are required to document and report any instance of suspected child abuse. To intervene effectively with children and families from diverse cultures who experience maltreatment, professionals must understand when a practice causes harm and be able to modify childrearing practices in culturally acceptable ways.

Speech and language therapy service delivery for bilingual children: A survey of three cities in Great Britain

BACKGROUND

Speech and language therapy (SLT) managers are expected to ensure that there are appropriate services available for bilingual and multilingual clients in order to ensure an equitable service to all clients. However, there is a paucity of data available to inform service planning.

AIMS

To identify the level to which SLT services in three UK cities meet the recommendations of The Royal College of Speech and Language Therapists (RCSLT) Good Practice Guidelines. Socio-demographic information is provided about the number of children from ethnic minorities in the population and the proportion of (bilingual) children from ethnic minorities on the speech and language therapy caseload. Based on this information, it is estimated whether there is proportionate representation of bilingual children on SLT caseloads, and whether services are in place to meet the needs of those clients.

METHODS & PROCEDURES

Population statistics were gathered from Census data and data were gleaned from Local Education Authorities. The study used a combination of interview and postal questionnaires to SLTs, with particular emphasis on the issues that may affect service provision.

OUTCOMES & RESULTS

As in previous studies, it was difficult to find reliable data. However, two of the three cities studied appeared to be offering a proportionate service to both monolingual and bilingual children in terms of the relative numbers of children on caseloads. Only one city was confident that their SLT service was fully meeting the RCSLT Good Practice Guidelines on bilingualism, although all three cities were aware of them and appeared to be making an effort at varying levels to address the principles of those guidelines.

CONCLUSIONS

There is a need for a change in how data on linguistic diversity in society are collected and disseminated, both at a national level and within SLT services, so that informed decisions can influence the future of quality services to minority groups.

Speech language pathology services in Kivalliq Region of Nunavut, Canada

OBJECTIVES

To provide a review of Speech Language Pathology services in the Kivalliq Region of Nunavut, Canada, since its inception. Referral sources, reasons for referral and discharge will also be shown for seven of the communities in the Kivalliq Region.

STUDY DESIGN

A quantitative and qualitative survey of the services received for the 26-month time period from January 2001 to February 28th, 2003.

METHODS

A record review of Speech Language Pathology services was conducted. Referral sources in each community, the rate of referrals, reasons for discharge and changes in abilities of three clients were examined.

RESULTS

The rate of referrals increased as the service became more familiar. Small increases in client abilities were noted over the specified time period.

CONCLUSION

Speech Language Pathology services are being utilized more effectively as the referral sources become more familiar with the program.

A noncontrastive model for assessment of phonology

The contrastive/noncontrastive model developed by Seymour and Seymour (1977) can be applied to the development of a dialect-sensitive phonological assessment that uses a single scoring and test format, regardless of a child's dialect. Through extensive field research, stimulus items were found that respect the phonotactics of African American English (AAE) (i.e., no targets are final consonants or final consonant clusters), yet are sufficiently demanding to show development in the age range from 4 to 9 years. Consonant clusters of varying levels of phonological difficulty are shown to discriminate between typically developing and phonologically impaired children of different dialect groups, Mainstream American English (MAE) and non-MAE. Implications for further diagnosis and remediation are presented.

Perceptions of the impact of speech, language, swallowing, and hearing difficulties on quality of life of a group of South African persons with multiple sclerosis

The present study investigated perceptions of speech, language, swallowing, and hearing difficulties and the relative impact of these problems on quality of life (QOL) in a group of South African persons with multiple sclerosis (MS). A questionnaire was used to elicit information regarding the difficulties experienced and the perceptions of their influence on QOL. Of the 30 respondents, 56.7% experienced speech problems and 63.3% reported language difficulties, with 62% of those feeling that these speech and language difficulties impacted on QOL. Fifty percent reported swallowing problems with 53% of those perceiving an influence on QOL. Twenty-three percent of participants experienced hearing problems with 44% expressing the view that their QOL was influenced. These findings are discussed with regard to their implications for the education and counselling of individuals with MS and their families, incorporation of speech-language pathologists and audiologists into management teams, and further research.

Attitudes toward speech disorders: sampling the views of Cantonese-speaking Americans

Speech-language pathologists who serve clients from cultural backgrounds that are not familiar to them may encounter culturally influenced attitudinal differences. A questionnaire with statements about 4 speech disorders (dysfluency, cleft pallet, speech of the deaf, and misarticulations) was given to a focus group of Chinese Americans and a comparison group of non-Chinese Americans. The focus group was much more likely to believe that persons with speech disorders could improve their own speech by "trying hard," was somewhat more likely to say that people who use deaf speech and people with cleft palates might be "emotionally disturbed," and generally more likely to view deaf speech as a limitation. The comparison group was more pessimistic about stuttering children's acceptance by their peers than was the focus group. The two subject groups agreed about other items, such as the likelihood that older children with articulation problems are "less intelligent" than their peers.

Cross-linguistic study of lateral misarticulation using electropalatography

This paper reports on some preliminary aspects of a collaborative cross-linguistic study of normal and disordered Japanese and British English speech. The investigation compares lateralised productions of parallel s which are abnormal in the two languages. EPG and acoustic recordings were made of four Japanese and four British subjects. The EPG patterns were classified according to certain criteria, such as the presence or absence of complete constriction between the tongue and the hard palate, and the area and location of this contact. Findings revealed that lateralised articulations varied between individual speakers, but that Japanese and English productions were broadly similar. Acoustically, misarticulations in both languages were characterised by a lower frequency of peak energy than would be expected in normal productions.