Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection.

OBJECTIVE: The aim of this study was to explore the relation of language functional MRI (fMRI)-guided tractography with postsurgical naming decline in people with temporal lobe epilepsy (TLE). METHODS: Twenty patients with unilateral TLE (9 left) were studied with auditory and picture naming functional MRI tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole-brain fibre tractography. Clinical naming performance was assessed preoperatively, 4 months, and 12 months following temporal lobe resection. Volumes of white matter language tracts in both hemispheres as well as tract volume laterality indices were explored as moderators of postoperative naming decline using Pearson correlations and multiple linear regression with other clinical variables. RESULTS: Larger volumes of white matter language tracts derived from auditory and picture naming maxima in the hemisphere of subsequent surgery as well as stronger lateralization of picture naming tract volumes to the side of surgery correlated with greater language decline, which was independent of fMRI lateralization status. Multiple regression for picture naming tract volumes was associated with a significant decline of naming function with 100% sensitivity and 93% specificity at both short-term and long-term follow-up. INTERPRETATION: Naming fMRI-guided white matter language tract volumes relate to postoperative naming decline after temporal lobe resection in people with TLE. This can assist stratification of surgical outcome and minimize risk of postoperative language deficits in TLE.

Processamento fonológico e leitura em crianças com dificuldade de aprendizagem em escolas bilíngues português-inglês: relatos de casos / Phonological processing and reading in children with learning difficulties in Portuguese-English bilingual schools: case reports / Procesamiento y lectura fonológica en niños con dificultades de aprendizaje en escuelas bilingües portugués-inglés: reporte de casos

Introdução: Há influência positiva no desenvolvimento da linguagem, quando ocorre a exposição a um novo idioma. No entanto, quando se considera esse contexto em crianças com dificuldade de aprendizagem, o deficit apresentado na primeira língua pode ser transferido para o aprendizado da segunda. Objetivo: O objetivo do presente estudo é caracterizar o desempenho em processamento fonológico e leitura em três crianças com dificuldade de aprendizagem em escolas bilíngues português-inglês. Método: Os dados gerais sobre o desenvolvimento e desempenho nas habilidades de consciência fonológica, memória de trabalho fonológica, acesso ao léxico mental e leitura em três crianças de 8 a 9 anos de idade, cursando 2º e 3º ano do ensino fundamental foram descritos; todos com, ao menos, dois anos de exposição à escola bilíngue, especialmente na alfabetização. Na avaliação, foram aplicados os protocolos CONFIAS, Memória de Trabalho Fonológica, TENA, RAN e Protocolo de Avaliação da Compreensão Leitora de Textos Expositivos. Resultado: as crianças apresentaram desempenho aquém do esperado nas habilidades do processamento fonológico, na fluência da leitura oral, bem como na compreensão leitora. Conclusão: esses resultados podem contribuir tanto para a compreensão de aspectos da linguagem escrita na atuação do fonoaudiólogo com crianças bilíngues, quanto para as implicações clínicas e educacionais, haja vista a escassez de estudos nessa área, no Brasil.

Introduction: There is a positive influence on language development when there is exposure to a new language. However, when considering this context in children with learning difficulties, the deficits presented in the first language can be transferred to the learning of the second. Objective: The aim of the present study was to characterize the performance in phonological processing and reading in three children with learning difficulties from Brazilian-English bilingual schools. Method: General data on the development and performance in phonological awareness skills, phonological working memory, access to mental lexicon and reading in three children aged 8 to 9 years, attending the 2nd and 3rd year of elementary school were described; all with at least two years of exposure to bilingual school, especially in literacy. In the evaluation, the protocols CONFIAS, Phonological Working Memory, TENA, RAN and Protocol for Assessment of Reading Comprehension of Expository Texts were applied. Results: The children performed below expectations in terms of phonological processing skills, difficulties in oral reading fluency, as well as in reading comprehension. Conclusion: These results can contribute to the understanding of aspects of written language in the performance of speech therapists with bilingual children, regarding clinical and educational implications, given the scarcity of studies in this area in Brazil.;Introducción: Existe una influencia positiva en el desarrollo del lenguaje cuando hay exposición a un nuevo idioma. Sin embargo, al considerar este contexto en niños con dificultades de aprendizaje, los déficits presentados en el primer idioma se pueden trasladar al aprendizaje del segundo. Objetivo: El objetivo del presente estudio fue caracterizar el desempeño en procesamiento fonológico y lectura en tres niños con dificultades de aprendizaje de escuelas bilingües brasileño-inglés. Método: Se describieron datos generales sobre el desarrollo y desempeño en las habilidades de conciencia fonológica, memoria de trabajo fonológica, acceso al léxico mental y lectura en tres niños de 8 a 9 años de 2º y 3º de primaria; todos con al menos dos años de exposición a la escuela bilingüe, especialmente en alfabetización. En la evaluación se aplicaron los protocolos CONFIAS, Memoria Fonológica de Trabajo, TENA, RAN y Protocolo de Evaluación de la Comprensión Lectora de Textos Expositivos. Resultados: Los niños se desempeñaron por debajo de las expectativas en términos de habilidades de procesamiento fonológico, dificultades en la fluidez de la lectura oral, así como en la comprensión lectora. Conclusión: Estos resultados pueden contribuir a la comprensión de aspectos del lenguaje escrito en el desempeño de logopedas con niños bilingües, en cuanto a implicaciones clínicas y educativas, dada la escasez de estudios en esta área en Brasil.

Introduction: There is a positive influence on language development when there is exposure to a new language. However, when considering this context in children with learning difficulties, the deficits presented in the first language can be transferred to the learning of the second. Objective: The aim of the present study was to characterize the performance in phonological processing and reading in three children with learning difficulties from Brazilian-English bilingual schools. Method: General data on the development and performance in phonological awareness skills, phonological working memory, access to mental lexicon and reading in three children aged 8 to 9 years, attending the 2nd and 3rd year of elementary school were described; all with at least two years of exposure to bilingual school, especially in literacy. In the evaluation, the protocols CONFIAS, Phonological Working Memory, TENA, RAN and Protocol for Assessment of Reading Comprehension of Expository Texts were applied. Results: The children performed below expectations in terms of phonological processing skills, difficulties in oral reading fluency, as well as in reading comprehension. Conclusion: These results can contribute to the understanding of aspects of written language in the performance of speech therapists with bilingual children, regarding clinical and educational implications, given the scarcity of studies in this area in Brazil.;Introducción: Existe una influencia positiva en el desarrollo del lenguaje cuando hay exposición a un nuevo idioma. Sin embargo, al considerar este contexto en niños con dificultades de aprendizaje, los déficits presentados en el primer idioma se pueden trasladar al aprendizaje del segundo. Objetivo: El objetivo del presente estudio fue caracterizar el desempeño en procesamiento fonológico y lectura en tres niños con dificultades de aprendizaje de escuelas bilingües brasileño-inglés. Método: Se describieron datos generales sobre el desarrollo y desempeño en las habilidades de conciencia fonológica, memoria de trabajo fonológica, acceso al léxico mental y lectura en tres niños de 8 a 9 años de 2º y 3º de primaria; todos con al menos dos años de exposición a la escuela bilingüe, especialmente en alfabetización. En la evaluación se aplicaron los protocolos CONFIAS, Memoria Fonológica de Trabajo, TENA, RAN y Protocolo de Evaluación de la Comprensión Lectora de Textos Expositivos. Resultados: Los niños se desempeñaron por debajo de las expectativas en términos de habilidades de procesamiento fonológico, dificultades en la fluidez de la lectura oral, así como en la comprensión lectora. Conclusión: Estos resultados pueden contribuir a la comprensión de aspectos del lenguaje escrito en el desempeño de logopedas con niños bilingües, en cuanto a implicaciones clínicas y educativas, dada la escasez de estudios en esta área en Brasil.

'Moderate global aphasia': A generalized decline of language processing caused by glioma surgery but not stroke.

Unlike stroke, neurosurgical removal of left-hemisphere gliomas acts upon a reorganized language network and involves brain areas rarely damaged by stroke. We addressed whether this causes the profiles of neurosurgery- and stroke-induced language impairments to be distinct. K-means clustering of language assessment data (neurosurgery cohort: N = 88, stroke cohort: N = 95) identified similar profiles in both cohorts. But critically, a cluster of individuals with specific phonological deficits was only evident in the stroke but not in the neurosurgery cohort. Thus, phonological deficits are less clearly distinguished from other language deficits after glioma surgery compared to stroke. Furthermore, the correlations between language production and comprehension scores at different linguistic levels were more extensive in the neurosurgery than in the stroke cohort. Our findings suggest that neurosurgery-induced language impairments do not correspond to those caused by stroke, but rather manifest as a 'moderate global aphasia' - a generalized decline of language processing abilities.

Terapias para la comunicación en personas con esclerosis múltiple / Therapies for communication in people with multiple sclerosis

People with Multiple Sclerosis (MS) can present a variety of communication disorders that affect their roles and social participation, affecting their quality of life and that of their environment. An early approach to these people and their communication difficulties could improve/compensate/facilitate communication, minimizing the effects on their daily life. Purpose: To contribute with recommendations for communication therapy in people with MS. Method: narrative literature review related to the topic. Results: There are few investigations focused on the intervention of communication in people with MS, those found are works in small populations, with evaluations at the beginning and at the end of therapy. The most promising studies are those that show specific effects on speech, through the LSVT LOUD, which not only improves communicative effectiveness, but has also shown improvements in dysphagia (eating disorder). significant to consider interventions with the environment and aimed at the quality of life of the affected individuals and families. Conclusions: The different presentations that MS has and its individual characteristics in each person, makes it difficult to have specific evidence on the most effective types of therapy. Despite this, it is possible to use therapies focused on different communication symptoms and adapt them under certain considerations to address communication in people with MS. (AU)

Early Vocal Development in Tuberous Sclerosis Complex.

BACKGROUND: Our goal was to assess for the first time early vocalizations as precursors to speech in audio-video recordings of infants with tuberous sclerosis complex (TSC). METHODS: We randomly selected 40 infants with TSC from the TSC Autism Center of Excellence Research Network dataset. Using human observers, we analyzed 74 audio-video recordings within a flexible software-based coding environment. During the recordings, infants were engaged in developmental testing. We determined syllables per minute (volubility), the number of consonant-vowel combinations, such as 'ba' (canonical babbling), and the canonical babbling ratio (canonical syllables/total syllables) and compared the data with two groups of typically developing (TD) infants. One comparison group's data had come from a laboratory setting, while the other's had come from all-day Language Environment Analysis recordings at home. RESULTS: Compared with TD infants in laboratory and all-day Language Environment Analysis recordings, entry into the canonical babbling stage was delayed in the majority of infants with TSC, and the canonical babbling ratio was low (TD mean = 0.346, SE = 0.19; TSC mean = 0.117, SE = 0.023). Volubility level in infants with TSC was less than half that of TD infants (TD mean = 9.82, SE = 5.78; TSC mean = 3.99, SE = 2.16). CONCLUSIONS: Entry into the canonical stage and other precursors of speech development were delayed in infants with TSC and may signal poor language and developmental outcomes. Future studies are planned to assess prediction of language and developmental outcomes using these measures in a larger sample and in more precisely comparable recording circumstances.

STN-DBS affects language processing differentially in Parkinson's disease: Multiple-case MEG study.

OBJECTIVES: In this study, we investigated the effects of bilateral and unilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) in PD patients on neural responses associated with two aspects of spoken language processing: semantics of action-related verbs and morphosyntactic processing. MATERIALS AND METHODS: Using a passive unattended paradigm to present spoken linguistic stimuli, we recorded magnetoencephalographic (MEG) responses in three PD patients in four DBS conditions: left unilateral STN-DBS, right unilateral STN-DBS, bilateral STN-DBS, and no STN-DBS. To ensure that any observed effects of DBS on the neuromagnetic responses could be attributed to the linguistic context per se and were not merely induced by the electrical stimulation, we assessed the effects of STN-DBS on linguistic contrasts within each stimulation condition. Hence, we contrasted the processing of action vs. abstract verbs as well as the processing of correct vs. incorrect morphosyntactic inflections within each DBS condition. RESULTS: The results revealed that, compared to the DBS-off state, both bilateral and right unilateral stimulation of the STN yielded significant dissociations in the processing of action and abstract verbs, with greater neuromagnetic responses for action verbs compared to abstract verbs. For morphosyntax processing, only left unilateral stimulation yielded significant dissociations (relative to the DBS-off state), with greater neuromagnetic responses to the incorrect inflections compared to the correct inflections. CONCLUSION: The results reflect differential effects of unilateral and bilateral STN-DBS on neuromagnetic responses associated with the processing of spoken language. They suggest that different specific aspects of linguistic information processing in PD are affected differently by STN-DBS.

Intraoperative Corticocortical Evoked Potentials for Language Monitoring in Epilepsy Surgery.

OBJECTIVE: To evaluate the applicability of corticocortical evoked potentials (CCEP) for intraoperative monitoring of the language network in epilepsy surgery under general anesthesia. To investigate the clinical relevance on language functions of intraoperative changes of CCEP recorded under these conditions. METHODS: CCEP monitoring was performed in 14 epileptic patients (6 females, 4 children) during resections in the left perisylvian region under general anesthesia. Electrode strips were placed on the anterior language area (AL) and posterior language area (PL), identified by structural and functional magnetic resonance imaging. Single-pulse electric stimulations were delivered to pairs of adjacent contacts in a bipolar fashion. During resection, we monitored the integrity of the dorsal language pathway by stimulating either AL by recording CCEP from PL or vice versa, depending on stability and reproducibility of CCEP. We evaluated the first negative (N1) component of CCEP before, during, and after resection. RESULTS: All procedures were successfully completed without adverse events. The best response was obtained from AL during stimulation of PL in 8 patients and from PL during stimulation of AL in 6 patients. None of 12 patients with a postresection N1 amplitude decrease of 0%-15% from baseline presented postoperative language impairment. Decreases of 28% and 24%, respectively, of the N1 amplitude were observed in 2 patients who developed transient postoperative speech disturbances. CONCLUSIONS: The application of CCEP monitoring is possible and safe in epilepsy surgery under general anesthesia. Putative AL and PL can be identified using noninvasive presurgical neuroimaging. Decrease of N1 amplitude >15% from baseline may predict postoperative language deficits.

Case of right hemispatial neglect and transcortical sensory aphasia following left occipitotemporoparietal glioblastoma resection.

The neurobehavioral syndrome of hemispatial neglect, which can result from insults such as stroke, brain tumor, or head injury, has most frequently been described as occurring for the left-side of hemispace following lesions to the right hemisphere. While right hemispatial neglect/inattention may occur following left hemisphere lesions as well, it has received limited attention in the scientific literature. The present case describes an inpatient neuropsychological evaluation with a 67-year-old, African American man presenting with right hemispatial neglect following resection of a large glioblastoma in the left occipitotemporoparietal region. The evaluation included a clinical interview, neurobehavioral status examination, and a battery of neuropsychological tests. Results documented consistent evidence of right hemispatial neglect across the administered tests, which could not be attributed to an established right visual field cut. Neuropsychological testing also revealed nearly global deficits in complex visuoperception, posterior/receptive language, memory, and complex attention/executive functioning abilities, while basic attention remained intact. Further remarkable findings of this case included color anomia and transcortical sensory aphasia. Findings from the case are discussed in the context of the preexisting literature on hemispatial neglect and the theoretical specialization of the parietal lobe for spatial attention/awareness.

Amyotrophic lateral sclerosis, dysarthria, and language disorders - type of research and approaches in different areas: an integrative literature review / Esclerose lateral amiotrófica, disartria e alterações de linguagem: tipo de pesquisa e abordagens em diferentes áreas - revisão integrativa da literatura

ABSTRACT Purpose: to identify the knowledge produced in national and international researches on speech and language disorders in Amyotrophic Lateral Sclerosis, regarding the type of research and approach in different areas. Methods: an integrative review performed on databases, using the following descriptors: Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement and Speech Disorders. The inclusion criteria covered articles that addressed motor speech and language disorders from 2013 to 2018, excluding duplications, and categorizing valid articles for analysis. Results: 83 articles were selected, after screening the titles and abstracts. A large scientific production from different countries and areas, mainly Speech Therapy and Neurology, was found. Most of them was clinical research (65.06%), with a main focus on speech motor disorders (42.16%), speech and language motor disorders, cognition and behavior (27.71%), and language disorders (12.06%). Conclusion: researches found were mostly clinical and aimed at determining the diagnosis of disorders in different areas of knowledge. With regard to communication, few studies have been found in Brazil, and international studies addressed high technology. The results confirmed the heterogeneous nature of the disease, which shows, in addition to motor impairment of speech, cognitive, behavioral and language impairments.

RESUMO Objetivo: identificar o conhecimento produzido em pesquisas nacionais e internacionais das alterações de fala e de linguagem na Esclerose Lateral Amiotrófica, quanto tipo de pesquisa e abordagens em diferentes áreas. Métodos: revisão integrativa realizada em bases de dados, utilizando-se os descritores Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement e Speech Disorders. Os critérios de inclusão abrangeram artigos que abordassem alterações motoras de fala e de linguagem de 2013 a 2018, excluindo-se duplicações, categorizando-se os válidos para análise. Resultados: selecionou-se 83 artigos, após triagem dos títulos e resumos. Foi encontrada grande produção científica de diferentes países e áreas, principalmente Fonoaudiologia e Neurologia, na maioria pesquisas clínicas (65,06%), com foco principal em alterações motoras da fala (42,16%), alterações motoras de fala e linguagem, cognição e comportamento (27,71%) e alterações de linguagem (12,06%). Conclusão: as pesquisas encontradas foram, na maioria, clínicas e com objetivo determinar diagnóstico das alterações em diferentes áreas do conhecimento. No que se refere à comunicação, foram encontrados poucos estudos no Brasil e os internacionais voltavam-se à alta tecnologia. Os resultados confirmaram o caráter heterogêneo doença, que evidencia, além de comprometimento motor da fala, prejuízo cognitivo, comportamental e de linguagem.

Relationship between symptoms of attention-deficit/hyperactivity disorder and speech-language-hearing aspects / Relação entre sintomas do transtorno de déficit de atenção/hiperatividade e aspectos fonoaudiológicos

ABSTRACT Purpose: to investigate the association of symptoms of inattention and hyperactivity with language development and cognitive, environmental, socioeconomic, and quality of life aspects in children with attention-deficit/hyperactivity disorder. Methods: an observational, analytical, cross-sectional study with a sex-stratified sample of 38 children 7 to 12 years old, diagnosed with attention-deficit/hyperactivity disorder. The assessments approached sociodemographic and environmental aspects, the quality of life, language comprehension, rapid automatic naming, phonological working memory, vocabulary, reading and writing processes and metalinguistic skills. Descriptive and bivariate analyses were conducted at the 5% significance level. Results: there was a statistically significant association between the profile of attention-deficit/hyperactivity disorder and behavioral aspects. There was no significant association of the forms of manifestation of attention-deficit/hyperactivity disorder with the quality of life, oral language, written language and phonological processing skills. Conclusion: children with hyperactive profiles had a better performance, whereas children with combined and predominantly inattentive profiles had similar performances. Although no statistically significant associations were found between attention-deficit/hyperactivity disorder and most of the variables analyzed in this research, it contributes to the discussion of the speech-language-hearing diagnosis.

RESUMO Objetivo: investigar a associação de sintomas de desatenção e hiperatividade com o desenvolvimento de linguagem, aspectos cognitivos, ambientais, socioeconômicos e de qualidade de vida, em crianças com Transtorno do Déficit de Atenção e Hiperatividade. Métodos: estudo observacional, analítico, transversal, com amostra estratificada por sexo e composta por 38 crianças de sete a doze anos de idade, com diagnóstico de Transtorno do Déficit de Atenção e Hiperatividade. Foram avaliados aspectos sociodemográficos e ambientais, qualidade de vida, compreensão da linguagem, nomeação automática rápida, memória de trabalho fonológica, vocabulário, processos de leitura, escrita e habilidades metalinguísticas. Foram realizadas análises descritiva e bivariada, adotando nível de significância de 5%. Resultados: houve associação com significância estatística entre perfil do Transtorno do Déficit de Atenção e Hiperatividade e aspectos comportamentais. Não houve associação significante das formas de apresentação do Transtorno do Déficit de Atenção e Hiperatividade com qualidade de vida, linguagem oral, linguagem escrita e habilidades de processamento fonológico. Conclusão: verificou-se melhor desempenho das crianças com perfil hiperativo e desempenho semelhante entre os perfis combinado e predominantemente desatento. Embora não tenham sido encontradas associações estatisticamente significantes entre Transtorno do Déficit de Atenção e Hiperatividade e a maioria das variáveis analisadas nesta pesquisa, ela contribui para a discussão do diagnóstico fonoaudiológico.

Fisher Grading Scale and Cognitive Deficits ­ Literature Review

Subarachnoid hemorrhage (SAH) accounts for 5 to 10% of all types of stroke, with rupture of brain aneurysms being related to deficits in memory, executive functions, and language. Changes in brain functions appear to be related to the presence of blood in the subarachnoid space, and the Fisher Scale (FS) correlates the amount of blood identified on computed tomography (CT). This paper presents a literature review of the association of FS with cognitive deficits secondary to aneurysmal subarachnoid hemorrhage (aSAH), using PubMed. The attempt to correlate the amount of blood identified in the CT with the development of cognitive alterations presents conflicting data. It was evidenced that some of the studies did not perform cognitive tests, or did not show differences between the scores of FS due to sample difficulty. The FS, even with its limitations and imperfections, seems to be a safe and easily reproducible way to predict neurological, cognitive or neuropsychological deficits, in view of its routine use when analyzing patients with aSAH.

Tumor de sistema nervoso central e o paciente pediátrico: alterações fonoaudiológicas / Central nervous system tumor and the pediatric patient: speech-language alterations / Tumor del sistema nervioso central y el paciente pediátrico: trastornosdelhabla y ellenguaje

Introdução: Os tumores do sistema nervoso central (SNC) constituem a segunda neoplasia mais frequente na criança. Os distúrbios tratados pela equipe de fonoaudiologia mais observados em pacientes com tumores são: disfagia, disfonia, alterações de linguagem, transtorno da articulação temporomandibular, disacusia, disartria e paralisia facial. A detecção precoce de alterações fonoaudiológicas em pacientes com tumores pediátricos, na fase do diagnóstico ou início do tratamento, é essencial para um manejo terapêutico mais adequado. Objetivo: descrever as alterações fonoaudiológicas de pacientes pediátricos com diagnóstico de tumor de sistema nervoso central em atendimento durante internação hospitalar. Método: Estudo retrospectivo, com coleta realizada através da pesquisa de dados extraídos de prontuário eletrônico, com dados dos pacientes internados de março de 2016 a agosto de 2018. Para avaliar a associação entre as variáveis categóricas, o teste Qui-quadrado de Pearson foi aplicado. O nível de significância adotado foi de 5% (p<0,05). Resultados: Verificou-se maior relevância nos dados relacionados aos distúrbios de deglutição e motricidade orofacial. Observou-se significância estatística na variável local da lesão - em fossa posterior -, com presença de alterações fonoaudiológicas. Conclusão: A amostra de pacientes oncológicos pediátricos demonstrou alterações fonoaudiológicas, principalmente nas áreas de disfagia e de motricidade orofacial.

Introduction: Central nervous system (CNS) tumors are the second most frequent neoplasm in children. The disorders treated by the speech therapy team most observed in patients with tumors are: dysphagia, dysphonia, language disorders, temporomandibular joint disorder, dysacusis, dysarthria and facial paralysis. Early detection of speech-language pathology changes in patients with pediatric tumors, at the stage of diagnosis or initiation of treatment, is essential for a more appropriate therapeutic management. Objective: to describe speech disorders in pediatric patients diagnosed with a tumor of the central nervous system in care during hospitalization. Method: Retrospective study, with collection performed through the research of data extracted from electronic medical records, with data of patients hospitalized from March 2016 to August 2018. To evaluate the association between categorical variables, Pearson's Chi-square test was applied. The level of significance adopted was 5% (p <0.05). Results: There was greater relevance in the data related to swallowing disorders and orofacial motricity. Statistical significance was observed in the local variable of the lesion - in the posterior fossa -, with the presence of speech-language disorders. Conclusion: The sample of pediatric cancer patients demonstrated speechlanguage disorders, especially in the areas of dysphagia and orofacial motricity.

Introducción: Los tumores del sistema nervioso central (SNC) son la segunda neoplasia maligna más frecuente em niños. Los trastornos tratados por el equipo de terapia del habla más observados en pacientes con tumores son: disfagia, disfonía, transtornos del lenguaje, trastorno de la articulación temporomandibular, disacusis, disartria y parálisis facial. La detección temprana de los câmbios em la patologia del habla y el linguaje en pacientes con tumores pediátricos, em la etapa de diagnóstico o inicio del tratamiento, es esencial para un manejo terapéutico más adecuado. Objetivo: describir los transtornos del habla y el lenguaje de los pacientes pediátricos diagnosticados con tumor del sistema nervioso central em la atención durante la hospitalización. Método: Estudio retrospectivo, com recopilación realizada a través de la investigación de datos extraídos de registros médicos electrónicos, com datos de pacientes hospitalizados de marzo de 2016 a agosto de 2018. Para evaluar la asociación entre variables categóricas, se aplico la prueba de Chi-cuadrado de Pearson. El nivel de significancia adoptado fue del 5% (p<0,05). Resultados: Hubo mayor relevância em los datos relacionados com los trastornos de la deglución y la motricidad orofacial. Se observo importancia estadística em la variable local de la lesión, em la fosa posterior, com la presencia de alteraciones de la patologia del habla y el lenguaje. Conclusión: La muestra de pacientes com cáncer pediátrico demostró la presencia de transtornos del habla y el lenguaje, especialmente em las áreas de disfagia y motricidad orofacial.

Language after childhood hemispherectomy: A systematic review.

OBJECTIVE: To conduct a systematic review on language outcomes after left and right hemispherectomy in childhood, a surgical procedure that involves removing or disconnecting a cerebral hemisphere. METHODS: We searched MEDLINE, Embase, and PsycInfo for articles published between January 1, 1988, and May 16, 2019. We included (1) all types of observational studies; (2) studies in which hemispherectomy was performed before age 18 years; and (3) studies with standardized scores measuring receptive vocabulary, expressive vocabulary, sentence comprehension, and/or sentence production. We calculated mean z scores after left and right hemispherectomy in the whole group and within etiology-specific subgroups. RESULTS: Our search identified 1,096 studies, of which 17 were eligible. The cohort added up to 205 individuals (62% left hemispherectomy) assessed 1 to 15 years after surgery. In the left surgery group, all language skills were impaired (z scores <-1.5) except sentence comprehension. In the right surgery group, language performance was in the borderline range (z scores ∼ -1.5). Children with cortical dysplasia showed the worst outcomes irrespective of surgery side (z scores <-2.5). Individuals with left vascular etiology and right-sided Rasmussen syndrome showed the best outcomes. CONCLUSION: Evidence based on the largest patient cohort to date (205 participants) suggests that the risk of language impairment after hemispherectomy is high, with few exceptions. Etiology plays a major role in postsurgical plasticity. We recommend specialist evaluation of language skills soon after surgery to identify intervention targets. Large-scale studies examining outcomes in consecutive cases are still needed.

Microstructural Injury to Left-Sided Perisylvian White Matter Predicts Language Decline After Brain Radiation Therapy.

PURPOSE: Our purpose was to investigate the association between imaging biomarkers of radiation-induced white matter (WM) injury within perisylvian regions and longitudinal language decline in patients with brain tumors. METHODS AND MATERIALS: Patients with primary brain tumors (n = 44) on a prospective trial underwent brain magnetic resonance imaging, diffusion-weighted imaging, and language assessments of naming (Boston Naming Test [BNT]) and fluency (Delis-Kaplan Executive Function System Category Fluency [DKEFS-CF]) at baseline and 3, 6, and 12 months after fractionated radiation therapy (RT). Reliable change indices of language function (0-6 months), accounting for practice effects (RCI-PE), evaluated decline. Bilateral perisylvian WM regions (superficial WM subadjacent to Broca's area and the superior temporal gyrus [STG], inferior longitudinal fasciculus [ILF], inferior fronto-occipital fasciculus [IFOF], and arcuate fasciculus) were autosegmented. We quantified volume and diffusion measures of WM microstructure: fractional anisotropy (FA; lower values indicate disruption) and mean diffusivity (MD; higher values indicate injury). Linear mixed-effects models assessed mean dose as predictor of imaging biomarker change and imaging biomarkers as longitudinal predictors of language scores. RESULTS: DKEFS-CF scores declined at 6 months post-RT (RCI-PE, -0.483; P = .01), whereas BNT scores improved (RCI-PE, 0.262; P = .04). Higher mean dose to left and right regions was predictive of decreased volume (left-STG, P = .02; right-ILF and IFOF, P = .03), decreased FA (left-WM tracts, all P < .01; right-STG and IFOF, P < .02), and increased MD of left-WM tracts (all P < .03). Volume loss within left-Broca's area (P = .01), left-ILF (P = .01), left-IFOF (P = .01), and left-arcuate fasciculus (P = .04) was associated with lower BNT scores. Lower FA correlated with poorer DKEFS-CF and BNT scores within left-ILF (P = .02, not significant), left-IFOF (P = .02, .04), and left-arcuate fasciculus (P = .01, .01), respectively. Poorer DKEFS-CF scores correlated with increased MD values within the left-arcuate fasciculus (P = .03). Right-sided biomarkers did not correlate with language scores. CONCLUSIONS: Patients with primary brain tumors experience language fluency decline post-RT. Poorer fluency and naming function may be explained by microstructural injury to left-sided perisylvian WM, representing potential dose-avoidance targets for language preservation.

High-level language outcomes three and twelve months after awake surgery in low grade glioma and cavernoma patients.

OBJECTIVE: Knowledge about the long-term outcome of high-level language ability in awake surgery patients with low-grade gliomas or cavernomas in language eloquent regions is limited, particularly regarding subtle changes in high-level language abilities. PATIENTS AND METHODS: The study group consisted of 27 patients with LGG or cavernoma which involved language eloquent regions in the left hemisphere. A comprehensive assessment battery was used to target subtle changes in overall high-level language ability as well as in language sub skills. Assessments were made preoperatively and at 3 and 12 months postoperatively. RESULTS: The results showed that overall high-level language ability had not decreased significantly at group level at 3 or 12 months postoperatively. The proportion of patients with a decline of 5 percent or more at follow up 3 and 12 months were 13% and 9% respectively. There was a marked decline in semantic fluency (animals and verbs) at 3 and 12 months postoperatively. Phonemic fluency, while not significantly reduced at three months, improved markedly in the interval between 3 and 12 months. At 12 months, the only significant decline relative to preoperative scores were seen in semantic fluency for animals and verbs. Verbal cognitive speed did not decline significantly postoperatively but approximately 40% of the patients had a decline of 5% or more at 12 months. CONCLUSIONS: Overall high-level language ability was not significantly affected postoperatively at 3 and 12 months in LGG and cavernoma awake surgery patients. Semantic word fluency had deteriorated postoperatively at 3 and 12 months follow-up. Taken together our results indicate a decline in processing speed of verbal material postoperatively in the patient group.

Memory and language impairments are associated with anxiety disorder severity in childhood

Abstract Introduction Children with anxiety disorders have been suggested to possess deficits in verbal fluency, shifting and attention, with inconsistent results regarding working memory and its subcomponents. This study extends previous findings by analyzing the performance of children with anxiety disorders in a wide range of neuropsychological functions. Methods We evaluated 54 children with a primary diagnosis of an anxiety disorder according to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) using subtests of a neuropsychological battery. The severity of anxiety disorders was assessed using the Pediatric Anxiety Rating Scale (PARS). We calculated the frequency of neuropsychological impairments (-1.5 standard deviation of the normative sample). Comparisons between groups were performed based on the severity of anxiety symptoms, as well as in the presence of one vs. more diagnoses of anxiety disorder. Results We found higher impairment in visuospatial working memory (23.1%), semantic memory (27.8%), oral language (35.4%) and word writing (44.4%) in anxious children. Moreover, children with higher anxiety severity presented lower performance in visuospatial working memory, inferential processing, word reading, writing comprehension, copied writing, and semantic verbal fluency (d = 0.49 to 0.96 [Cohen's d]). The higher the number of anxiety diagnoses, the lower the performance in episodic memory and oral and written language (d = 0.56 to 0.77). Conclusion Our data suggested the presence of memory (visuospatial working memory and semantic memory) and language deficits (oral and writing) in some children with an anxiety disorder. Severity and number of anxiety diagnoses were associated with lower performance in memory and language domains in childhood.

Transient Aphasia Following Resection of a Thalamic Cavernous Malformation.

BACKGROUND: The thalamus has a demonstrated role in language, particularly through its connectivity to frontal language cortices. CASE DESCRIPTION: A 59-year-old man with transient mixed aphasia following resection of a left-sided thalamic cavernous malformation is reported. No operative complications were encountered, and there was no surgical contact with cortical language areas. The patient recovered full language function within a week postoperatively. CONCLUSIONS: The role of thalamic nuclei in language processes and other reports of transient thalamic aphasia are reviewed.

Influência da cardiopatia congênita no desenvolvimento neuropsicomotor de lactentes / Influencia de la cardiopatía congénita en el desarrollo neuropsicomotor de los lactantes / Influence of congenital heart disease on the neuropsychomotor development of infants

RESUMO As cardiopatias congênitas (CC) estão entre as principais causas de morbimortalidade na primeira infância e os lactentes com essa condição podem apresentar atrasos no desenvolvimento neuropsicomotor (DNPM). O objetivo deste estudo foi avaliar a influência da CC no DNPM de lactentes. Trata-se de um estudo observacional com avaliação do desenvolvimento neuropsicomotor realizada pela Bayley Scales of Infant and Toddler Development (BSID-III). As condições maternas e clínicas dos lactentes foram verificadas no relatório de alta médica e na caderneta de saúde da criança, e a condição socioeconômica das famílias pelo Critério da Classificação Econômica Brasil. Para associar as variáveis clínicas e o DNPM foram utilizados o coeficiente de correlação de Spearman e o teste de razão de verossimilhança. Foram avaliados 18 lactentes, com predomínio do sexo feminino (72,2%). A maioria das mães (47,1%) possuía ensino médio completo ou superior incompleto, com média da idade de 27,2±5,5 anos. Houve correlação das escalas do BSID-III com as variáveis quantitativas analisadas: escala motora com o peso (p=0,02 e r=0,54) e com uso de oxigenoterapia (p=0,009 e r=−0,591); já para as variáveis qualitativas as associações foram entre: escala motora e condição socioeconômica (p=0,015), escala motora e comunicação interatrial - (CIA) (p=0,023) e escala da linguagem e CIA (p=0,038). A CC influenciou o DNPM, principalmente no aspecto motor. Além disso peso, diagnóstico de CIA, uso de oxigenoterapia e condição socioeconômica foram considerados como principais fatores de risco para o atraso no DNPM.

RESUMEN Las cardiopatías congénitas (CC) se encuentran entre las principales causas de morbimortalidad en la primera infancia, y los lactantes con esta afección pueden tener retrasos en el desarrollo neuropsicomotor (DNPM). El presente estudio tuvo el objetivo de evaluar la influencia de las CC en el DNPM de los lactantes. Este es un estudio observacional en el cual se evaluó el desarrollo neuropsicomotor utilizando la Bayley scales of infant and toddler development (BSID-III). Las condiciones maternas y clínicas de los lactantes se obtuvieron en el informe de alta médica y en la libreta de salud del niño, y el estado socioeconómico de las familias en el Criterio de Clasificación Económica de Brasil. Para asociar las variables clínicas y el DNPM, se utilizaron el coeficiente de correlación de Spearman y la prueba de razón de probabilidad. Se evaluaron a 18 lactantes, con un predominio del sexo femenino (72,2%). La mayoría de las madres (47,1%) tenían la secundaria completa o la educación superior incompleta, con una edad promedio de 27,2±5,5 años. Hubo una correlación entre las escalas BSID-III y las variables cuantitativas analizadas: escala motora con el peso (p=0,02 y r=0,54) y con el uso de oxigenoterapia (p=0,009 y r=−0,591); para las variables cualitativas, las asociaciones fueron entre: escala motora y estado socioeconómico (p=0,015), escala motora y comunicación interauricular (CIA) (p=0,023) y escala de lenguaje y CIA (p=0,038). Las CC influyeron en el DNPM, principalmente en el aspecto motor. Además, el peso, el diagnóstico de CIA, el uso de oxigenoterapia y el estado socioeconómico fueron considerados los principales factores de riesgo para el retraso en el DNPM.

ABSTRACT Congenital heart defects (CHD) are among the main causes of morbidity and mortality in infants who has this impairment may present delays in neuropsychomotor development (NPMD). This study assesses the influence of CHD on NPMD of infants. This is an observational study assessing neuropsychomotor development performed by Bayley Scales of Infant and Toddler Development - BSID-III. The Brazilian Economic Classification Criteria was used to verify the socioeconomic status of the families and also the maternal and infants' clinical conditions were verified in the medical discharge report and in the child's health handbook. For the association between the quantitative and qualitative variables with the NPMD, the Spearman's correlation coefficient and the likelihood ratio test were used. A total of 18 infants were assessed, with a predominance of females (72.2%). Most mothers (47.1%) had complete high school or incomplete higher education, with a mean age of 27.2±5.5 years. There was a correlation between the BSID-III scales and the quantitative variables analyzed: motor scale with weight (p=0.02 and r=0.54) and oxygen therapy (p=0.009 and r=−0.591); besides that, the qualitative variables correlation were: motor scale and socioeconomic condition (p=0.015), motor scale and Interatrial Communication - IAC (p=0.023) and language with IAC scales (p=0.038). CHD influences the delay of NPMD, mainly for motor aspect. Furthermore, weight, diagnosis of IAC, use of oxygen therapy and socioeconomic status were considered the main risk factors for the delay in NPMD.

Acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária em Saúde para vítimas de acidente de motocicleta / Access to speech-language pathology therapy and continuity of assistance in Primary Health Care for victims of motorcycle accidents

RESUMO Objetivo Verificar o acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária à Saúde (APS) em vítimas de acidente de motocicleta. Método Trata-se de estudo realizado em um hospital de grande porte localizado em Recife-Pernambuco, recrutado entre o período de junho e julho de 2014. Após a alta hospitalar todos foram contatados para investigação do processo de reabilitação fonoaudiológica. Para o estudo na Atenção Primária à Saúde, foram utilizadas medidas de frequência absoluta e relativa. Já os casos em reabilitação foram descritos através de quadros. Resultados Foi verificado que 99 indivíduos foram vítimas de acidentes por motocicletas no período estudado. Desses, 30 entrevistados referiram ter essas queixas de alteração no sistema estomatognático, dos quais 8 estavam em reabilitação e 18 referiram residir em área adstrita a Unidade de Saúde da Família. Os principais obstáculos para o acesso à fonoterapia apontados foram a distância aos serviços de Fonoaudiologia e o tempo de espera para início do tratamento. Um dos aspectos relacionados à continuidade do cuidado pela Atenção Primária à Saúde, como a busca e obtenção de insumos, foi visto como frequente. Ao contrário da visita domiciliar, menos frequente. Conclusão Foram identificados obstáculos que dificultaram o acesso à fonoterapia, assim como fragilidades nos cuidados dispensados pela Atenção Primária, como a visita domiciliar, contribuindo para a fragmentação do cuidado contínuo e integral às vítimas.

ABSTRACT Purpose To verify the access to speech-language pathology (SLP) therapy and continuity of assistance in Primary Health Care (PHC) for victims of motorcycle accidents. Methods A quantitative and qualitative study was conducted at a large hospital in the city of Recife, Pernanbuco state, Brazil. Among the 99 victims recruited between June and July 2014, 30 had SLP complaints as a result of the accidents. After hospital discharge, all victims were contacted for investigation of the SLP rehabilitation process. Absolute and relative frequencies were used for the analysis in PHC, and data were displayed in tables for the therapy cases. Results Among the 30 individuals who reported having alterations of the stomatognathic system, eight were undergoing rehabilitation and 18 reported residing in an area covered by the Family Health Strategy (primary care modality). Seeking and obtaining continuity of treatment (medication and bandaging) in primary care were frequent; in contrast, home visits were less frequent. The main obstacles to access SLP therapy were distance to the service and waiting time to begin treatment. Conclusion This study identified obstacles that hamper access to SLP therapy in PHC, such as the low frequency of home visits, contributing to the fragmentation of continuous and complete care for victims.

Resting-state functional connectivity predicts individual language impairment of patients with left hemispheric gliomas involving language network.

Language deficits following brain tumors should consider the dynamic interactions between different tumor growth kinetics and functional network reorganization. We measured the resting-state functional connectivity of 126 patients with left cerebral gliomas involving language network areas, including 77 patients with low-grade gliomas (LGG) and 49 patients with high-grade gliomas (HGG). Functional network mapping for language was performed by construction of a multivariate machine learning-based prediction model of individual aphasia quotient (AQ), a summary score that indicates overall severity of language impairment. We found that the AQ scores for HGG patients were significantly lower than those of LGG patients. The prediction accuracy of HGG patients (R2 = 0.27, permutation P = 0.007) was much higher than that of LGG patients (R2 = 0.09, permutation P = 0.032). The rsFC regions predictive of LGG's AQ involved the bilateral frontal, temporal, and parietal lobes, subcortical regions, and bilateral cerebro-cerebellar connections, mainly in regions belonging to the canonical language network. The functional network of language processing for HGG patients showed strong dependence on connections of the left cerebro-cerebellar connections, limbic system, and the temporal, occipital, and prefrontal lobes. Together, our findings suggested that individual language processing of glioma patients links large-scale, bilateral, cortico-subcortical, and cerebro-cerebellar functional networks with different network reorganizational mechanisms underlying the different levels of language impairments in LGG and HGG patients.