Development of a Tool to Assess Medical Oral Language Proficiency.

PURPOSE: To communicate with linguistically diverse patients, medical students and physicians often use their non-English-language skills. However, there is no standard protocol to determine whether those skills are adequate before patient care. This causes many physicians, institutions, educators, and learners to forgo non-English-language proficiency assessment altogether. The purpose of this study is to report on the development, refinement, and interrater reliability of the Physician Oral Language Observation Matrix (POLOM), a rater-based tool assessing 6 language skill categories observed during clinical interactions: comprehension, fluency/fluidity, vocabulary, pronunciation, grammar, and communication. This study focused on the use of the POLOM in Spanish interactions. METHOD: The authors adapted an existing language observation tool for use in clinical settings, creating the preliminary POLOM. Next, they iteratively refined the tool from April to July 2021 using videorecorded medical student-standardized patient encounters from a U.S.-based medical Spanish program. In each refinement iteration, 4 bilingual raters (2 physicians and 2 linguists) independently rated 3 to 6 encounters and convened to discuss ratings with the goals of improving instrument instructions, descriptors, and subsequent rater agreement. Using the final POLOM, raters independently rated 50 videos in rotating interdisciplinary pairs. Generalizability theory was applied to estimate reliability via interrater agreement (dependability) coefficients (range 0-1) for each POLOM category and the total score. RESULTS: POLOM total score dependability equaled 0.927 (single rater) and 0.962 (averaged across 2 raters). The highest mean score was observed for the comprehension category (4.15; range 1-5) while the lowest was for communication (3.01; range 1-5). CONCLUSIONS: Raters achieved a high level of agreement on POLOM assessments of students' medical oral Spanish proficiency. The POLOM is the first assessment tool that provides examinees and instructors with both a holistic and detailed review of clinician non-English oral language skills as contextualized for patient care.

Using transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex to promote long-term foreign language vocabulary learning.

Transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex (DLPFC) was used to improve foreign-langue learning while using mental imagery. Participants underwent two sessions of 1 mA, 1.5 mA, or sham stimulation prior to learning Swahili-English word pairs two consecutive days. During learning, participants were encouraged to create a mental image of the associated English word. Twenty-four hours after learning and one week later, participants received a cued recall test. A linear dose-response effect of stimulation was found across both tests that occurred long after the immediate effects of stimulation. Follow-up comparisons revealed that only the 1.5 mA condition differed from the sham group. Exploratory moderating effects revealed interactions with sleep quality and handedness. Those with poorer sleep and who were left-handed showed greater recall after 1.5 mA of stimulation than those with better sleep and right-handers. A follow-up behavioral study probing strategy usage indicated that mental imagery strategy use did not strongly impact learning but point to other possible mechanisms including the importance of attending to multimodal perceptual details and memory consolidation. This preliminary evidence supports the role of the DLPFC or connected regions in foreign language vocabulary learning and verbal memory encoding.

Screen-time influences children's mental imagery performance.

Mental imagery is a foundational human faculty that depends on active image construction and sensorimotor experiences. However, children now spend a significant proportion of their day engaged with screen-media, which (a) provide them with ready-made mental images, and (b) constitute a sensory narrowing whereby input is typically focused on the visual and auditory modalities. Accordingly, we test the idea that screen-time influences the development of children's mental imagery with a focus on mental image generation and inspection from the visual and haptic domains. In a longitudinal cross-lagged panel design, children (n = 266) aged between 3 and 9 years were tested at two points in time, 10 months apart. Measures of screen-time and mental imagery were employed, alongside a host of control variables including working memory, vocabulary, demographics, device ownership, and age of exposure to screen-media. Findings indicate a statistically significant path from screen-time at time 1 to mental imagery at time 2, above and beyond the influence of the control variables. These unique findings are discussed in terms of the influence of screen-time on mental imagery.

Network dynamics of Broca's area during word selection.

Current models of word-production in Broca's area (i.e. left ventro-lateral prefrontal cortex, VLPFC) posit that sequential and staggered semantic, lexical, phonological and articulatory processes precede articulation. Using millisecond-resolution intra-cranial recordings, we evaluated spatiotemporal dynamics and high frequency functional interconnectivity between left VLPFC regions during single-word production. Through the systematic variation of retrieval, selection, and phonological loads, we identified specific activation profiles and functional coupling patterns between these regions that fit within current psycholinguistic theories of word production. However, network interactions underpinning these processes activate in parallel (not sequentially), while the processes themselves are indexed by specific changes in network state. We found evidence that suggests that pars orbitalis is coupled with pars triangularis during lexical retrieval, while lexical selection is terminated via coupled activity with M1 at articulation onset. Taken together, this work reveals that speech production relies on very specific inter-regional couplings in rapid sequence in the language dominant hemisphere.

Fine motor skills and mental imagery: Is it all in the mind?

Previous work has indicated that children's fine motor skills (FMS) contribute to cognitive performance in a number of domains. A philosophically and scientifically central aspect of cognitive skill is the ability to mentally simulate external events; however, very little research has examined whether FMS relate to mental imagery. Children aged 35-129 months (N = 294) were administered measures of FMS and mental imagery. Control variables included working memory, vocabulary, visual closure, chronological age, and a vast array of stimulus lexical features. Multilevel linear models indicated that FMS uniquely predicted mental imagery abilities, as did visual closure, chronological age, and various lexical features, whereas working memory and vocabulary did not. Findings are taken to support the idea that both mental imagery and FMS share, in part, similar functional systems.

BiLex: A computational approach to the effects of age of acquisition and language exposure on bilingual lexical access.

Lexical access in bilinguals can be modulated by multiple factors in their individual language learning history. We developed the BiLex computational model to examine the effects of L2 age of acquisition, language use and exposure on lexical retrieval in bilingual speakers. Twenty-eight Spanish-English bilinguals and five monolinguals recruited to test and validate the model were evaluated in their picture naming skills in each language and filled out a language use questionnaire. We examined whether BiLex can (i) simulate their naming performance in each language while taking into account their L2 age of acquisition, use and exposure to each language, and (ii) predict naming performance in other participants not used in model training. Our findings showed that BiLex could accurately simulate naming performance in bilinguals, suggesting that differences in L2 age of acquisition, language use and exposure can account for individual differences in bilingual lexical access.

Sentence Context Facilitation for Children's and Adults' Recognition of Native- and Nonnative-Accented Speech.

Purpose Supportive semantic and syntactic information can increase children's and adults' word recognition accuracy in adverse listening conditions. However, there are inconsistent findings regarding how a talker's accent or dialect modulates these context effects. Here, we compare children's and adults' abilities to capitalize on sentence context to overcome misleading acoustic-phonetic cues in nonnative-accented speech. Method Monolingual American English-speaking 5- to 7-year-old children ( n = 90) and 18- to 35-year-old adults ( n = 30) were presented with full sentences or the excised final word from each of the sentences and repeated what they heard. Participants were randomly assigned to 1 of 2 conditions: native-accented (Midland American English) or nonnative-accented (Spanish- and Japanese-accented English) speech. Participants also completed the NIH Toolbox Picture Vocabulary Test. Results Children and adults benefited from sentence context for both native- and nonnative-accent talkers, but the benefit was greater for nonnative than native talkers. Furthermore, adults showed a greater context benefit than children for nonnative talkers, but the 2 age groups showed a similar benefit for native talkers. Children's age and vocabulary scores both correlated with context benefit. Conclusions The cognitive-linguistic development that occurs between the early school-age years and adulthood may increase listeners' abilities to capitalize on top-down cues for lexical identification with nonnative-accented speech. These results have implications for the perception of speech with source degradation, including speech sound disorders, hearing loss, or signal processing that does not faithfully represent the original signal.

The Impact of Manipulating Attentional Shifting Demands on Preschool Children With Specific Language Impairment.

Purpose This study investigated attentional shifting in preschool children with specific language impairment (SLI) compared to their typically developing peers. Children's attentional shifting capacity was assessed by varying attentional demands. Method Twenty-five preschool children with SLI and 25 age-matched, typically developing controls participated. A behavioral task measuring attentional shifting within and across multiple dimensions (auditory, linguistic, and visual) was employed. Demands on attentional shifting were increased based on input dimension (low load: staying within dimension; medium load: shifting between 2 dimensions; and high load: shifting among 3 dimensions). Results Compared to controls, the group with SLI made more erroneous responses and exhibited longer response times. Although both groups' error rates were similarly affected by shifting compared to nonshifting trials, their response speed was not. The group with SLI exhibited a larger comparative decrement to their response speed in the high-attentional load condition. Discussion When demands on attentional shifting increase, children with SLI struggle to shift their attention as efficiently to changing stimuli as their unimpaired peers. Potential implications for the assessment and treatment of this population are discussed.

Enabling New Articulatory Gestures in Children With Persistent Speech Sound Disorders Using Ultrasound Visual Biofeedback.

Purpose This study evaluated ultrasound visual biofeedback treatment for teaching new articulations to children with a wide variety of speech sound disorders. It was hypothesized that motor-based intervention incorporating ultrasound would lead to rapid acquisition of a range of target lingual gestures with generalization to untreated words. Method Twenty children aged 6-15 years with a range of mild to severe speech disorders affecting a variety of lingual targets enrolled in a case series with replication. Of these, 15 children completed the intervention. All of the children presented with a variety of errors. We therefore employed a target selection strategy to treat the most frequent lingual error. These individual speech targets were treated using ultrasound visual biofeedback as part of ten to twelve 1-hr intervention sessions. The primary outcome measure was percentage of target segments correct in untreated wordlists. Results Six children were treated for velar fronting; 3 children, for postalveolar fronting; 2 children, for backing alveolars to pharyngeal or glottal place; 1 child, for debuccalization (production of all onsets as [h]); 1 child, for vowel merger; and 2 children, for lateralized sibilants. Ten achieved the new articulation in the 1st or 2nd session of intervention, despite no children being readily stimulable for their target articulation before intervention. In terms of generalization, effect sizes for percentage of target segments correct ranged from no effect (5 children), small effect (1 child), medium effect (4 children), and large effect (5 children). Conclusions Ultrasound visual biofeedback can be used to treat a wide range of lingual errors in children with various speech sound disorders, from mild to severe. Visual feedback may be useful for establishing new articulations; however, generalization is more variable.

Reconstructing imagined letters from early visual cortex reveals tight topographic correspondence between visual mental imagery and perception.

Visual mental imagery is the quasi-perceptual experience of "seeing in the mind's eye". While a tight correspondence between imagery and perception in terms of subjective experience is well established, their correspondence in terms of neural representations remains insufficiently understood. In the present study, we exploit the high spatial resolution of functional magnetic resonance imaging (fMRI) at 7T, the retinotopic organization of early visual cortex, and machine-learning techniques to investigate whether visual imagery of letter shapes preserves the topographic organization of perceived shapes. Sub-millimeter resolution fMRI images were obtained from early visual cortex in six subjects performing visual imagery of four different letter shapes. Predictions of imagery voxel activation patterns based on a population receptive field-encoding model and physical letter stimuli provided first evidence in favor of detailed topographic organization. Subsequent visual field reconstructions of imagery data based on the inversion of the encoding model further showed that visual imagery preserves the geometric profile of letter shapes. These results open new avenues for decoding, as we show that a denoising autoencoder can be used to pretrain a classifier purely based on perceptual data before fine-tuning it on imagery data. Finally, we show that the autoencoder can project imagery-related voxel activations onto their perceptual counterpart allowing for visually recognizable reconstructions even at the single-trial level. The latter may eventually be utilized for the development of content-based BCI letter-speller systems.

A randomized controlled trial to test efficacy of digital enhancements of storybooks in support of narrative comprehension and word learning.

Experiments with film-like story presentations have been found to be beneficial in supporting children's story comprehension and word learning. The main goal of the current study was to disentangle the effects of visual and auditory enhancements in digital books. Participants were 99 typically developing children (41 boys and 58 girls) aged 4-6 years from two public kindergartens in Bursa, Turkey. A randomized controlled trial was conducted with a control group and four experimental conditions that included all possible combinations: static illustrations with and without music/sounds and animated illustrations with and without music/sounds. In each experimental condition, children read two different storybooks twice, each time in small group sessions of 2 or 3 children. The posttest included, apart from story comprehension, expressive and receptive vocabulary tests of book-based words. Story comprehension, not word learning, benefited from visual enhancements in digital books. Music and background sounds did not stimulate story comprehension and even had a negative effect on receptive vocabulary. To explain the findings, we refer to multimedia learning principles such as temporal contiguity. Consequences for a digital storybook format are discussed.

The use of acoustic information in lexical ambiguity resolution: an event-related potential study.

Words that can be used as both noun and verb create regions of syntactic ambiguity that could create processing challenges for listeners. However, acoustic properties, such as duration, differ between noun and verb uses of such words, and listeners may use these differences to facilitate ambiguity processing. In this study, we replaced noun uses of ambiguous words with verb uses to determine whether these manipulations affected the N400 event-related potential, which is associated with semantic violations, or the P600 component, which is associated with syntactic ambiguity. The results suggest that the acoustic differences between noun/verb polysemes mitigate the extent to which these words are perceived as ambiguous, although the results do not indicate whether replacing one with the other produces a meaning violation. Durational differences in noun/verb polysemes may affect their processing in fluent speech.

Music playschool enhances children's linguistic skills.

Several studies have suggested that intensive musical training enhances children's linguistic skills. Such training, however, is not available to all children. We studied in a community setting whether a low-cost, weekly music playschool provided to 5-6-year-old children in kindergartens could already affect their linguistic abilities. Children (N = 66) were tested four times over two school-years with Phoneme processing and Vocabulary subtests, along with tests for Perceptual reasoning skills and Inhibitory control. We compared the development of music playschool children to their peers either attending to similarly organized dance lessons or not attending to either activity. Music playschool significantly improved the development of children's phoneme processing and vocabulary skills. No such improvements on children's scores for non-verbal reasoning and inhibition were obtained. Our data suggest that even playful group music activities - if attended to for several years - have a positive effect on pre-schoolers' linguistic skills. Therefore we promote the concept of implementing regular music playschool lessons given by professional teachers in early childhood education.

Exploring the role of subcortical structures in developmental reading impairments: evidence for subgroups differentiated by caudate activity.

Although the role of cortical structures in skilled and impaired reading has been the topic of considerable investigation, the contribution of subcortical structures to reading performance is less well understood. Here, we assess the role of the caudate, putamen, and thalamus in adults with and without reading impairment. Thirty-three individuals (19 skilled readers and 14 reading impaired individuals) participated in two functional MRI tasks: (a) silent reading of real words and (b) silent reading of nonwords. Percent signal change was calculated for each of the three structures by evaluating the signal change relative to the baseline (i.e. no task or fixation crosses), and response time was measured for each reading condition. We found that for skilled readers, activity in the putamen predicted behavioral performance for both real words and nonwords. In contrast, we found evidence for two subgroups of impaired readers: a positive caudate activity group and a negative caudate activity group. Interestingly, brain activity differentially predicted reading performance depending on whether individuals had positive or negative caudate activity. We discuss our findings in the context of developmental reading impairments, print-to-speech networks, and language processing in general.

Listeners' processing of a given reduced word pronunciation variant directly reflects their exposure to this variant: Evidence from native listeners and learners of French.

In casual conversations, words often lack segments. This study investigates whether listeners rely on their experience with reduced word pronunciation variants during the processing of single segment reduction. We tested three groups of listeners in a lexical decision experiment with French words produced either with or without word-medial schwa (e.g., /ʀvy/ and /ʀvy/ for revue). Participants also rated the relative frequencies of the two pronunciation variants of the words. If the recognition accuracy and reaction times (RTs) for a given listener group correlate best with the frequencies of occurrence holding for that given listener group, recognition is influenced by listeners' exposure to these variants. Native listeners' relative frequency ratings correlated well with their accuracy scores and RTs. Dutch advanced learners' accuracy scores and RTs were best predicted by their own ratings. In contrast, the accuracy and RTs from Dutch beginner learners of French could not be predicted by any relative frequency rating; the rating task was probably too difficult for them. The participant groups showed behaviour reflecting their difference in experience with the pronunciation variants. Our results strongly suggest that listeners store the frequencies of occurrence of pronunciation variants, and consequently the variants themselves.

Spontaneous retrieval reveals right-ear advantage in prospective memory.

The goal of this study was to investigate the impact of individual costs on prospective memory performance. Individual costs were assessed by contrasting participants with high costs and those with low costs. Specifically, we tested whether prospective memory performance is moderated by costs, cue-focality and intention specificity. Participants performed a dichotic listening paradigm where they had to indicate whether a word presented to one ear was abstract or concrete while ignoring the word presented to the other ear. For the prospective memory task, participants had to detect target items; half of them were presented focally to the same ear as the relevant words for the ongoing task and half of them were presented non-focally to the other ear. Moreover, half of the participants were given specific instructions and the other half were given categorical instructions. The results revealed a right-ear advantage for participants with low costs but not for participants with high costs. Moreover, the absence of costs was not necessarily accompanied by worse prospective memory performance. Given differential results under the same task conditions, we conclude that individual costs are an important factor which should be considered when investigating prospective memory processes.

Sensitivity of expressive linguistic domains to surgery age and audibility of speech in preschoolers with cochlear implants.

OBJECTIVES: To determine whether relative delays among domains exist in the conversational use of vocabulary, syntax, and morphology by children with cochlear implants (CIs) and whether these were differentially affected by age of implantation (AOI) and the audibility of speech. METHODS: Participants in this short-term longitudinal study were 126 children with AOI of 6-38 months and a matched group of 30 children without hearing loss. Language samples of the same children at ages 3.5 and 4.5 were analyzed for the breadth of vocabulary and bound morphemes used, and sentence length. RESULTS: At both test ages, expressive language domains were delayed equally. Higher performance across domains was independently associated with younger AOI and better pre-implant-aided thresholds. No domain was affected differently by very early implantation, but bound morpheme breadth was associated with better CI-aided thresholds. Between 63 and 78% of children with AOI of 6-11 months scored close to hearing age-mates by 4.5, a level achieved by fewer than 25% of those with AOI of 19-24 months or later ages. DISCUSSION: Previous studies indicated greater language delays in the areas of morphology and syntax than those of vocabulary, with the earliest ages of implantation conferring the greatest benefit to those domains. The current design addressed inconsistency across studies in modes of communication used, presence/absence of other disabilities, and differences in language domains chosen as outcome measures. CONCLUSIONS: Linguistic domains benefitted equally from early implantation, regardless of the duration of auditory stimulation. Better pre-CI-aided hearing often compensated for later AOI. Bound morpheme use was greater with better CI-aided thresholds.

Hearing without listening: Attending to a quiet audiobook.

Careful systematic tests of hearing ability may miss the cognitive consequences of sub-optimal hearing when listening in the real world. In Experiment 1, sub-optimal hearing is simulated by presenting an audiobook at a quiet but discriminable level over 50 min. Recall of facts, words and inferences are assessed and performance compared to another group at a comfortable listening volume. At the quiet intensity, participants are able to detect, discriminate and identify spoken words but do so at a cost to sequential accuracy and fact recall when attention must be sustained over time. To exclude other interpretations, the effects are studied in Experiment 2 by comparing recall to the same sentences presented in isolation. Here, the differences disappear. The results demonstrate that the cognitive consequences of listening at low volume arise when sustained attention is demanded over time.

Phonetic complexity affects children's Mandarin tone production accuracy in disyllabic words: A perceptual study.

This is the first study to examine the effect of phonetic contexts on children's lexical tone production. Mandarin tones in disyllabic words produced by forty-four 2- to 6-year-old children and twelve mothers were low-pass filtered to eliminate lexical information. Native Mandarin-speaking adults categorized the tones based on the pitch information in the filtered stimuli. All mothers' tones were categorized with ceiling accuracy. Counter to the findings in most previous studies on children's tone acquisition and the prevailing assumption in models of speech development that children acquire suprasegmental features much earlier than segmental features, this study found that children as old as six years of age have not mastered the production of Mandarin tones. Children's tones were judged with significantly lower accuracy than mothers' productions. Tone accuracy improved, while cross subject variability in tone accuracy decreased, with age. Children's tone accuracy was affected by the articulatory complexity of phonetic contexts. Children made more errors in tone combinations with more complex fundamental frequency (F0) contours than tone sequences with simpler F0 changes. When producing disyllabic tone sequences with complex F0 contours, children tended to shift the F0 contour of the first tone to reduce the F0 change, resulting in more tone errors in the first syllable than in the second syllable and showing substantially more anticipatory coarticulation than adults. The results provide further evidence that acquisition of lexical tones is a protracted process in children. Tones produced accurately by children in one phonetic context may not be produced correctly in another phonetic context. Children demonstrate more anticipatory coarticulation in their disyllabic productions than adults, which may be attributed to children's immature speech motor control in tone production, and is presumably a by-product of their inability to accomplish complex F0 changes within the syllable time-frame.

Artificial grammar learning in vascular and progressive non-fluent aphasias.

Patients with non-fluent aphasias display impairments of expressive and receptive grammar. This has been attributed to deficits in processing configurational and hierarchical sequencing relationships. This hypothesis had not been formally tested. It was also controversial whether impairments are specific to language, or reflect domain general deficits in processing structured auditory sequences. Here we used an artificial grammar learning paradigm to compare the abilities of controls to participants with agrammatic aphasia of two different aetiologies: stroke and frontotemporal dementia. Ten patients with non-fluent variant primary progressive aphasia (nfvPPA), 12 with non-fluent aphasia due to stroke, and 11 controls implicitly learned a novel mixed-complexity artificial grammar designed to assess processing of increasingly complex sequencing relationships. We compared response profiles for otherwise identical sequences of speech tokens (nonsense words) and tone sweeps. In all three groups the ability to detect grammatical violations varied with sequence complexity, with performance improving over time and being better for adjacent than non-adjacent relationships. Patients performed less well than controls overall, and this was related more strongly to aphasia severity than to aetiology. All groups improved with practice and performed well at a control task of detecting oddball nonwords. Crucially, group differences did not interact with sequence complexity, demonstrating that aphasic patients were not disproportionately impaired on complex structures. Hierarchical cluster analysis revealed that response patterns were very similar across all three groups, but very different between the nonsense word and tone tasks, despite identical artificial grammar structures. Overall, we demonstrate that agrammatic aphasics of two different aetiologies are not disproportionately impaired on complex sequencing relationships, and that the learning of phonological and non-linguistic sequences occurs independently. The similarity of profiles of discriminatory abilities and rule learning across groups suggests that insights from previous studies of implicit sequence learning in vascular aphasia are likely to prove applicable in nfvPPA.