The relationship between lingual and hypoglossal nerve function and quality of life in head and neck cancer.

Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient-perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ-H&N35 standardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health-related QoL outcomes.

Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer.

Primary treatment of oropharyngeal cancer often involves surgical resection and reconstruction of the affected area. However, during base of tongue reconstruction the lingual nerve is often severed on one or both sides, affecting sensation in the preserved tissue of the anterior tongue. The loss of specific tongue sensations could negatively affect a person's oral function and quality of life. The aim of this study was to explore the effects of different types of lingual nerve intervention on sensory function for patients with base of tongue cancer as compared to healthy, age-matched adults. Subjects included 30 patients who had undergone primary oropharyngeal reconstruction with a radial forearm free-flap and 30 matched controls. Sensations tested were temperature, two-point discrimination, light touch, taste, oral stereognosis and texture on the anterior two-thirds of the tongue. Results indicated that type of surgical nerve repair may not have a significant impact on overall sensory outcomes, providing mixed results for either nerve repair technique. Sensations for the nonoperated tongue side and operated side with lingual nerve intact were comparable to matched controls, with mixed outcomes for nerve repair. The poorest sensory outcomes were observed in patients with the lingual nerve severed, while all patients with lingual nerve intervention exhibited deteriorated taste sensation on the affected tongue side. Overall, patients in this study who had undergone oropharyngeal reconstruction with lingual nerve intervention exhibited decreased levels of sensation on the operated tongue side, with minimal differences between types of lingual nerve repair.

Motor sequence learning in children with recovered and persistent developmental stuttering: preliminary findings.

PURPOSE: Previous studies have associated developmental stuttering with difficulty learning new motor skills. We investigated non-speech motor sequence learning in children with persistent developmental stuttering (CWS), children who have recovered from developmental stuttering (CRS) and typically developing controls (CON). METHODS: Over the course of two days, participants completed the Multi-Finger Sequencing Task, consisting of repeated trials of a10-element sequence, interspersed with trials of random sequences of the same length. We evaluated motor sequence learning using accuracy and response synchrony, a timing measure for evaluation of sequencing timing. We examined error types as well as recognition and recall of the repeated sequences. RESULTS: CWS demonstrated lower performance accuracy than CON and CRS on the first day of the finger tapping experiment but improved to the performance level of CON and CRS on the second day. Response synchrony showed no overall difference among CWS, CRS and CON. Learning scores of repeated sequences did not differ from learning scores of random sequences in CWS, CRS and CON. CON and CRS demonstrated an adaptive strategy to response errors, whereas CWS maintained a high percentage of corrected errors for both days. CONCLUSIONS: Our study examined non-speech sequence learning across CWS, CRS and CON. Our preliminary findings support the idea that developmental stuttering is not associated with sequence learning per se but rather with general fine motor performance difficulties.

The effects of hemispatial and asymmetrically focused attention on dichotic listening with normal and learning-disabled children.

The effects of hemispatial and focused attention were examined with 50 normal and learning-disabled children to determine the extent of these two attentional strategies influenced perceptual laterality as reflected by the dichotic listening right-ear advantage (REA). Twenty-five normal children (8 females, 17 males, mean age 9.10 yr) matched with 25 learning-disabled children (8 females, 17 males, mean age 10.1 yr) were administered a dichotic consonant-vowel (CV) and consonant-vowel-consonant (CVC) syllable task. The two types of stimuli were compared across focused attention (free report, focused left, focused right) and hemispatial (central, left hemispace, right hemispace) conditions implemented independently and in systematic combinations. A four-factorial analysis of variance (groups x stimuli x conditions x ears) resulted in a significant REA for normal children across all attentional conditions whereas learning-disabled did not produce a consistent REA across all attentional conditions, and in several instances, produced equivalent left and right hemisphere processing. Right hemispatial orientation increased the magnitude of the REA (i.e., left hemisphere processing) for both groups, whereas left hemispatial orientation increased the magnitude of the left ear report (i.e., right hemisphere processing) only in learning-disabled subjects. Focused attention to the right ear also increased left hemisphere efficiency for both groups of children; however, focused attention to the left ear produced symmetrical functioning by learning-disabled subjects. Congruent combinations of focused attention and hemispatial orientation were not found to enhance the REA beyond its magnitude when each strategy was assessed independently. When focused attention and hemispatial conditions were employed in opposing directions, normal children were more susceptible to the "rightward" direction regardless of the strategy whereas learning-disabled subjects were more susceptible to the "verbal" nature of the strategy. Higher overall processing performance was exhibited for CVC stimuli when compared to CV stimuli. These findings lend support to the hypothesis that hemispatial and asymmetrically focused attention strategies interact with structural mechanisms in producing the observed REA in dichotic listening and do so differentially for normal and learning-disabled children.

Verbal and nonverbal auditory processing among left- and right-handed good readers and reading-disabled children.

Cerebral lateralization of left- and right-handed good readers and left- and right-handed reading disabled was examined with a sample of 60 children who ranged in age from 7-13 years via a dichotic selective attention task (free recall, directed left, directed right) using consonant-vowel (CV) and tonal stimuli. Several ANOVAs were conducted to evaluate gender, reader group, handedness, and stimuli effects of left- and right-ear reports across dichotic conditions. Results indicated males outperformed females across stimuli and conditions regardless of handedness and all subjects recalled more tonal stimuli than CV stimuli. More importantly, the expected REA (left hemisphere processing) was found for CV stimuli only by right-handed good readers across all three dichotic conditions. The left-handed good readers and left-handed reading-disabled children were left ear (LE) dominant in free recall and in the directed left condition, but were right ear (RE) dominant in the directed right condition. Conversely, right-handed reading-disabled children produced a REA during free recall and directed right conditions, but were LE dominant in the directed left condition. In contrast, a significant LEA (right hemisphere processing) was found for tonal stimuli across all dichotic conditions for all four groups. These findings lend support to the hypothesis that attentional factors have a greater influence on auditory processing of verbal than nonverbal stimuli for various groups of children and also suggest reversed or bilateralized processing abilities for language in strongly left-handed children with sinistral relatives.

Cued dichotic listening with right-handed, left-handed, bilingual and learning-disabled children.

This study used cued dichotic listening to investigate differences in language lateralization among right-handed (control), left-handed, bilingual, and learning-disabled children. A sample of 60 subjects ranging in age from 7-13 yr were administered a CVC dichotic paradigm with three experimental conditions (free recall, directed left, directed right). A three-factor ANOVA design conducted on the data revealed that control, bilingual, and learning-disabled children produced the expected REA suggestive of left hemisphere dominance for language processing whereas left-handed children produced an LEA suggestive of right hemisphere superiority for language processing. The cued attention data derived from groups as well as from individual subjects suggested that in comparison with control children, left-handed children were greatly susceptible to attentional manipulation similar to learning-disabled children only in the opposite hemisphere. Bilingual children were found to have a REA much like control children although recall accuracy was depressed. Further, lambda (lambda) analyses conducted on individual subjects indicated that the magnitude and degree of perceptual asymmetry varied widely among individuals of various anomaly groups. These findings lend support to the hypothesis that attentional factors play a larger role in unilateral processing for some anomalous groups of children (i.e. left-handers and learning-disabled) while not affecting others (i.e. controls and bilinguals).

Vocalization and breathing during the first year of life.

Vocalization and breathing were studied in 40 healthy infants, including five boys and five girls each at ages 5 weeks, 2.5 months, 6.5 months, and 12 months. Breathing was monitored through the use of a variable inductance plethysmograph that enabled estimates of the volume changes of the rib cage, abdomen, and lung, as well as estimates of selected temporal features of the breathing cycle. Four vocalization types were studied intensively. These included cries, whimpers, grunts, and syllable utterances. Breathing behavior was highly variable across the four vocalization types, demonstrating the degrees of freedom of performance available to the infant to accomplish the aeromechanical drive required. Such behavior was influenced by body length, body position, and age, but not by vocalization type and sex. The protocol established is a useful tool for observing the natural course of the emergence of vocalization and breathing during the first year of life.

Vocalization and breathing during the second and third years of life.

Vocalization and breathing were studied in 40 healthy young children, including 5 boys and 5 girls at each, of ages of 18, 24, 30, and 36 months. A variable inductance plethysmograph was used to obtain estimates of volume changes of the rib cage, abdomen, and lung, as well as estimates of selected temporal features of the breathing cycle. Results indicated that breathing behavior was influenced by height and age, but not by vocalization type or sex. Such behavior was found to be highly variable, demonstrating that these young children had multiple degrees of freedom of performance available to accomplish the aeromechanical drive required.

From the big bang to the brain.

Current research on the capacities of the infant has lead to a better understanding of developmental processes underlying cognition and motor skill acquisition. ASHA's Eighth Annual Research Symposium on Infant-Toddler Development, in November 1998, included a presentation on developmental cognitive science by Dr. Andrew Meltzoff and a presentation on motor skill acquisition by Dr. Esther Thelen. The theoretical constructs and data presented served to broaden our current perspectives on infant abilities. The data reported by Meltzoff and Thelen challenged several long-standing theories of infant cognition and motor development. Alternative theoretical models were used to describe skill acquisition during the first several years of life. Our response will include a brief summary of each investigator's presentation, discuss their findings with respect to research in the area of infant speech physiology and production, and provide possible future directions and challenges for individuals conducting developmental research.

Establishing a reliable protocol to measure tongue sensation.

The relationship between tongue sensation and tongue function for speech, mastication and deglutition are growing areas of interest among rehabilitative professionals. To determine the potential effect that sensation has on function, it is imperative that, first, reliable and valid measures of tongue sensation be established. The aim of this study was to develop a protocol to test tongue sensation across a spectrum of sensory functions that included two-point discrimination, light-touch discrimination, thermal sensation, texture recognition, oral stereognosis and taste recognition. Materials tested within each domain respectively included: (i) the MacKinnon-Dellon Disk-criminator, paperclip and caliper; (ii) the Semmes-Weinstein monofilament and cotton wisp; (iii) dental mirrors and glass test tubes; (iv) spheres of textured acrylic resin on rods; (v) acrylic resin forms with differing shapes on rods and (vi) salty, sweet, sour, bitter and neutral solutions. Materials were tested on 40 healthy subjects between the ages of 20 and 55. The results from this study indicated that thermal, texture and taste sensations appear robust for accuracy and discrimination. Two-point discrimination and light touch seem to be influenced by location of stimulation on the tongue and force applied, whereas stereognosis was influenced by stimulus complexity. The results of this study indicate that clinicians may choose instruments as practical as paperclips and test tubes for testing two-point discrimination and thermal sensation, respectively. For the other sensations, it may be important to use more sophisticated instrumentation to control variables of force, surface area stimulated and assessing sensations in graded steps.

The effect of stimulus type and directed attention on dichotic listening with children.

This research investigated the effect of stimulus type and directed attention on dichotic listening performance with children. A sample of 12 (5 male, 7 female; mean age 10.5 years) high academically performing children were administered four types of dichotic stimuli (words, digits, CV syllables, and melodies) in three experimental conditions (free recall, directed left, and directed right) to examine perceptual asymmetry as reflected by the right-ear advantage (REA). While the expected REA for words and CV syllables and the expected LEA for melodies were found under free recall, the directed conditions produced varied results depending on the nature of the stimuli. Directed condition had no effect on recall of CV syllables but had a dramatic effect on recall of digits. Word stimuli and directed condition interacted to produce inconsistent perceptual asymmetry while directed condition reduced overall recall for melodies. The findings lend support to the hypothesis that perceptual asymmetries can be strongly influenced by the type of stimulus material used and the effect of attentional strategy employed.

Factorial structure of the Waterloo Handedness Questionnaire for control and learning-disabled adults.

This study examined the factorial structure of the 32-item version of the Waterloo Handedness Questionnaire (Steenhuis & Bryden, 1989) with a sample of control (n = 325) and learning-disabled (LD) (n = 147) subjects. On the basis of Principal Components Analyses, we have replicated the work of Steenhuis and Bryden (1989) who suggested that hand preference factors for control subjects are multifactorial in nature and are related more to "skilled" and "less skilled" activities rather than on distal/proximal musculature. Further, we have found that the factor structure for hand preference in LD adults is somewhat different than of normally achieving adults. The primary difference occurred within Factor 2. Unlike control subjects, whose Factor 2 items were classified as "less skilled" and preference was less lateralized, items loading on this factor for LD subjects were classified as "skilled" and showed strongly lateralized responses for both left and right handers. Presumably, LD adults show a less marked distinction between "skilled" and "less skilled" unimanual motor activities than control subjects suggesting different degrees of manual laterality between the groups.