Children with hearing impairment in Malawi, a cohort study.

OBJECTIVE: To assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation. METHODS: We conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key informants within the community identified the cohort in 2013 (baseline). Informants clinically screened children at baseline, and by questionnaires at baseline and follow-up in 2016. We investigated associations between sociodemographic characteristics and outcomes by multivariate logistic regression. RESULTS: We diagnosed 752 children in 2013 as having a hearing impairment and traced 307 (40.8%) children of these for follow-up in 2016. Referral uptake was low (102/184; 55.4%), more likely among older children (odds ratio, OR: 3.5; 95% confidence interval, CI: 1.2-10.2) and less likely for those with an illiterate caregiver (OR: 0.5; 95% CI: 0.2-0.9). Few of the children who attended hospital received any treatment (33/102; 32.4%) and 63.6% (21/33) of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% (30/299) and 35.6% (107/301) of the children, respectively. Lack of school enrolment was observed for 29.5% (72/244) of children, and was more likely for older children (OR: 28.6; 95% CI: 10.3-79.6), girls (OR: 2.4; 95% CI: 1.2-4.8) and those with an illiterate caregiver (OR: 2.1; 95% CI: 1.0-4.1). CONCLUSION: More widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.

Speech difficulties and patient health communication mediating effects on worry and health-related quality of life in children, adolescents, and young adults with Neurofibromatosis Type 1.

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease-specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health-related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi-site national study by 305 patients ages 5-25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease-specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1-specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient-centered comprehensive care approach for children, adolescents, and young adults with NF1.

The Impact of Expiratory Muscle Strength Training on Speech Breathing in Individuals With Parkinson's Disease: A Preliminary Study.

PURPOSE: The purpose of this study was to examine the impact of expiratory muscle strength training on speech breathing and functional speech outcomes in individuals with Parkinson's disease (PD). METHOD: Twelve individuals with PD were seen once a week for 8 weeks: 4 pretraining (baseline) sessions followed by a 4-week training period. Posttraining data were collected at the end of the 4th week of training. Maximum expiratory pressure, an indicator of expiratory muscle strength, and lung volume at speech initiation were the primary outcome measures. Secondary outcomes included lung volume at speech termination, lung volume excursion, utterance length, and vocal intensity. Data were collected during a spontaneous speech sample. Individual effect sizes > 1 were considered significant. RESULTS: Maximum expiratory pressure increased in a majority of participants after training. Training resulted in 2 main respiratory patterns: increasing or decreasing lung volume initiation. Lung volume termination and excursion, utterance length, and vocal loudness were not consistently altered by training. CONCLUSIONS: Preliminary evidence suggests that the direct physiologic intervention of the respiratory system via expiratory muscle strength training improves speech breathing in individuals with PD, with participants using more typical lung volumes for speech following treatment.

Acquired Apraxia of Speech: The Relationship Between Awareness of Errors in Word Productions and Treatment Outcomes.

PURPOSE: Awareness of errors has been considered a clinical feature of acquired apraxia of speech (AOS). However, there is limited research examining error awareness in speakers with AOS. The purpose of this investigation was to examine awareness of errors and explore the relationship between awareness of errors and treatment outcomes in speakers with AOS. METHOD: Twenty speakers with AOS and aphasia produced mono- and multisyllabic words in a repetition task. Following each production, speakers were asked to judge the accuracy of their production (i.e., correct or incorrect). Then, speakers received Sound Production Treatment. RESULTS: Judgment accuracy of productions for the group ranged from 20% to 96%. There was a weak relationship between judgment accuracy and probe performance at posttreatment (r = .47) and a moderate relationship between judgment accuracy and probe performance at follow-up (r = .53). CONCLUSION: Findings indicate that speakers with AOS varied in their ability to judge the accuracy of their productions. For some speakers, the ability to judge the accuracy of their productions did not coincide with their production accuracy of treatment stimuli at posttreatment and at follow-up. Further research is needed to explore the relationship between error awareness and treatment outcomes.

A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs.

BACKGROUND: Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change. AIMS: Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered. METHODS & PROCEDURES: A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived. OUTCOMES & RESULTS: We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked professionalism and trust was absent between professions. Where practitioners embraced and services and systems enabled more fluid forms of collaboration, then trust and reciprocity developed. CONCLUSIONS & IMPLICATIONS: Highly collaborative forms of co-practice, inherently more complex at the service governance, macro-level, bring benefits. At the meso-level of the school and support team network there was greater capacity to individualize co-practice to the needs of the child. Capacity was increased at the micro-level of knowledge and skills to harness the overall resource distributed amongst members of the inter-professional team. The development of social capital, networks of trust across SLCN support teams, should be a priority at all levels-for practitioners, services, commissioners and schools.

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

OBJECTIVE: A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years. METHODS: The Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children which commenced in May 2004. Data were analyzed from the LSAC kindergarten cohort (n = 4,983), as well as a subsample of 720 children for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development at school entry that includes SHCN. RESULTS: Latent class analysis was utilized to establish 3 academic trajectories from 4-5 to 10-11 years: high (24.3%), average (49.8%), and low (23.6%). Descriptive statistics revealed a trend for both children with established and emerging SHCN to fall into weaker performing learning pathways. Multinomial logistic regression focusing on those children with emerging SHCN confirmed this pattern of results, even after adjustment for covariates (relative risk 3.06, 95% confidence interval 1.03-9.10). Children who additionally had low socioeconomic standing were particularly at risk. CONCLUSIONS: Even children with less complex SCHN are at risk for academic failure. Early identification, together with integrated health and educational support, may promote stronger pathways of educational attainment for these children. Achieving these better outcomes will require the involvement of both educational and health practitioners.

Auditory implicit semantic priming in Spanish-speaking children with and without specific language impairment

We analyzed whether Spanish-speaking children with Specific Language Impairment (SLI) showed deficits in lexical-semantic processing/organization, and whether these lexical measures correlated with standardized measures of language abilities. Fourteen children with Typical Language Development (TLD) and 16 age-matched children with SLI (8;0-9;11 years) participated. In a Lexical Decision (LD) task with implicit semantic priming, children judged whether a given speech pair contained two words (semantically related/unrelated) or a word-pseudoword. Children received a comprehensive language and reading test battery. Children with TLD exhibited significant semantic priming; they were faster for semantically related word pairs than for unrelated (p < .001) and than for word-pseudoword pairs (p < .0002). The group with SLI did not exhibit significant semantic priming, despite showing more variability. Children with SLI made significantly slower LDs [F(1, 26) = 4.61, p < .05, partial η2 = .15] and more errors [F(1, 26) = 4.16, p < .05, partial η2 = .13] than children with TLD. Mean response time across all LD conditions and the receptive vocabulary (PPVT-III) were significantly negativity correlated for children with SLI (r = -.71, p = .004). Children with SLI, especially those with the poorest language scores, showed a semantic-lexical deficit and a weakness in lexical-semantic association networks. Their performance on the LD task was significantly slower and poorer than for children with TLD. Increasing a child’s vocabulary may benefit lexical access (AU)

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Parental perceptions of posterior pharyngeal wall augmentation using autologous fat for treating velopharyngeal dysfunction.

Posterior pharyngeal wall augmentation using autologous fat to treat velopharyngeal dysfunction (VPD) is an alternative surgical procedure to more commonly used invasive procedures such as the pharyngeal flap. However, limited research exists on this technique. The aim of this study was to qualitatively investigate parental perceptions of posterior pharyngeal wall augmentation using autologous fat when treating velopharyngeal dysfunction. Furthermore, this research aimed to examine parent's perspectives of their child's speech and quality-of-life following this procedure. A qualitative collective case study methodology was used in the form of semi-structured interviews with seven participants. These were then analysed using constant comparative analysis. Four distinct themes emerged: post-surgical outcomes; speech-language pathology, not just medicine; factors for successful post-operative speech and resonance; and long-term sustainability and worthiness of the procedure. Six out of seven participants expressed positive post-operative speech and resonance results. Five further expressed long-term satisfaction up to 6 years post-operatively. Overall the majority of participants were satisfied that this procedure provided their child with long-term successful speech outcomes. The participants also discussed the importance of receiving speech-language pathology services alongside surgery and the positive impact of the procedure on their child's quality-of-life including social interactions, confidence, friendships, as well as eating and drinking.

[Post-stroke speech disorder treated with acupuncture and psychological intervention combined with rehabilitation training: a randomized controlled trial].

OBJECTIVE: To assess the clinical efficacy on post-stroke speech disorder treated with acupuncture and psychological intervention combined with rehabilitation training. METHODS: The multi-central randomized controlled study was adopted. One hundred and twenty cases of brain stroke were divided into a speech rehabilitation group (control group), a speech rehabilitation plus acupuncture group (observation group 1) and a speech rehabilitation plus acupuncture combined with psychotherapy group (observation group 2), 40 cases in each one. The rehabilitation training was conducted by a professional speech trainer. In acupuncture treatment, speech function area in scalp acupuncture, Jinjin (EX-HN 12) and Yuye (EX-HN 13) in tongue acupuncture and Lianquan (CV 23) were the basic points. The supplementary points were selected according to syndrome differentiation. Bloodletting method was used in combination with acupuncture. Psychotherapy was applied by the physician in psychiatric department of the hospital. The corresponding programs were used in each group. Examination of Aphasia of Chinese of Beijing Hospital was adopted to observe the oral speech expression, listening comprehension and reading and writing ability. RESULTS: After 21-day treatment, the total effective rate was 92.5% (37/40) in observation group 1, 97.5% (39/40) in observation group 2 and 87.5% (35/40) in control group. The efficacies were similar in comparison among 3 groups. The remarkable effective rate was 15.0% (6/40) in observation group 1, 50.0% (20/40) in observation group 2 and 2.5% (1/40) in control group. The result in observation group 2 was superior to the other two groups (P<0.01, P<0.001). In comparison of the improvements of oral expression, listening comprehension, reading and writing ability, all of the 3 groups had achieved the improvements to different extents after treatment (P<0.01, P<0.001). The results in observation group 2 were better than those in observation group 1 and control group. CONCLUSION: Acupuncture and psychological intervention combined with rehabilitation training is obviously advantageous in the treatment of post-stroke speech disorder.

[Micro-current reflexotherapy in the rehabilitative treatment of the speech function disorders in children with cerebral palsy].

The objective of the present paper was to study the influence of microcurrent reflexotherapy on the compromised speech functions in children (n = 84) presenting with cerebral palsy in comparison with the control group comprised of children (n = 56) with the same problems treated by medicamental therapy. The microcurrent reflexotherapy was shown to be instrumental in the restoration of the compromised speech function. Moreover, it promoted positive dynamics of locomotor and cognitive disorders.

Rhythmic motor entrainment in children with speech and language impairments: tapping to the beat.

In prior work (Corriveau et al., 2007), we showed that children with speech and language impairments (SLI) were significantly less sensitive than controls to two auditory cues to rhythmic timing, amplitude envelope rise time and duration. Here we explore whether rhythmic problems extend to rhythmic motor entrainment. Tapping in synchrony with a beat has been described as the simplest rhythmic act that humans perform. We explored whether tapping to a beat would be impaired in children for whom auditory rhythmic timing is impaired. Children with SLI were indeed found to be impaired in a range of measures of paced rhythmic tapping, but were not equally impaired in tapping in an unpaced control condition requiring an internally-generated rhythm. The severity of impairment in paced tapping was linked to language and literacy outcomes.

Impaired processing of brief, rapidly presented auditory cues in infants with a family history of autoimmune disorder.

Studies have shown that individuals with language disorders, such as developmental dyslexia and specific language impairment, exhibit impairments in the processing of brief, successive, or rapidly changing auditory information. It is also the case that a higher rate of autoimmune disorders have been identified in those with language-based learning disorders and, conversely, that individuals with autoimmune disorders show a higher incidence of language-related disorders. The rapid auditory processing (RAP) deficits described for older individuals with language impairments may also be used as a behavioral marker to identify infants at higher risk for language delays. Thus, we were interested in examining RAP abilities in a subset of infants with a positive family history of autoimmune disorders. Eleven infants from our ongoing prospective longitudinal studies were identified based on parental response to a question about the presence of a family history of autoimmune disease and compared to 11 matched controls. The RAP threshold of each infant was assessed at 6 and 9 months of age using a conditioned head-turn procedure (using tone pairs with brief interstimulus intervals) and an auditory-visual habituation-recognition memory task using computer-generated consonant-vowel syllables (/ba/ vs. /da/). A visual habituation-recognition memory task that did not require processing of brief temporal cues was also administered. Group differences emerged on the infant RAP tasks, and on language outcome measures at 12 and 16 months of age. Infants from families with a history of autoimmune disorder had significantly higher (i.e., poorer) RAP thresholds and lower language scores than did control infants, whereas visual discrimination scores did not differ between family history infants and controls. Moreover, when brief auditory cues were necessary for the discrimination of /ba/ vs. /da/, infants with a family history of autoimmune disorder performed significantly more poorly than did controls. These findings lend support to the hypothesis that a similar mechanism, perhaps a neural-immune interaction, may underlie the observed co-occurrence of autoimmune disorders and learning impairments.

Music therapy for children with Rett syndrome.

The Rett syndrome is good reactivity for sound and music. We enforced active music therapy (MT) individual session to patients with Rett syndrome. The patients were 4, 5 and 6-year-old. The active music therapy and individual session of 30 min/week were performed. It was recorded in video and description, and using the original evaluation list, six items of fact. On largest problem that is hand operation with purpose in childhood of Rett syndrome, we recorded the longest duration and frequency of hand grasping time in one session. There was the improvement of 35.0% of listening music, 33.3% play music, 13.3% singing music, 11.7% minute motion, 11.7% language, and 20.0% personal relation and sociality. The longest duration of hand grasping time was improved from 2 to 12 s in case 2 and from 7 to 80 s in case 3. Grasp frequency which showed the volition rapidly increased from 3 to 41 times, though the elongation for the duration of grasping was little for case 2. Rett syndrome is the disease in which the psychomotor performance regresses with the age, but the aspect that surely developed in the session could be evaluated. Rett syndrome has the ability understanding the music, and music therapy is suitable for them.

Disturbances in conceptual space involving language and speech.

We report on a patient, with a CT-verified low density lesion in the right parietal area, who exhibited not only deficits in left conceptual space, but also in reading, writing, and the production of speech. He presented with a left homonymous hemianopia, tactile inattention, and dysphasia that quickly resolved, leaving a left-sided inattention and less marked dysphasia. Several language tasks and language-based imagery tasks revealed poor language processing of the left portion of words which could be remedied if the patient was instructed to do things like spell the word backwards. The overall results were consistent with the idea that some aspects of language processing involve spatial mechanisms.

Disturbances of the temporal organization of speech following bilateral thalamic surgery in a patient with Parkinson's disease.

This report summarizes a detailed analysis of the speech of a 45-yr-old man who had become dysarthric following bilateral thalamic surgery for the relief of symptoms of Parkinson's disease. His speech was characterized by a rapid rate and a mild-to-moderate articulatory deficit. Intelligibility was markedly reduced. The rapid rate was found to be the result of decreased syllable durations rather than to changes in pause or phrase patterns. Decreased syllable durations resulted from abnormal shortening of vowels. Consonant releases were found to be prolonged. This distorted temporal relationship among speech segments was considered to be an important factor in the patient's poor intelligibility and partially explained why uniform electronic expansion of his speech resulted in only negligible increase in intelligibility. It is hypothesized that this speech disturbance results from the interaction of central "metronomic" abnormality with a peripheral neuromotor articulatory impairment.