Dissociation between speech modalities in a case of altered accent with unknown origin.

We present a case of sudden onset, acquired altered accent in the speech of NL, a 48-year-old, left-handed female. NL's typical Standard Southern British English accent was preserved in singing and reading, but altered in recitation, repetition and spontaneous speech. Neuropsychological investigation, impressionistic and acoustic analysis of accented and unaccented speech are documented. The altered accent displays a slower speech rate and longer duration of consonants and vowels. There is evidence for a shift towards syllable-timed rhythm. NL's altered accent displays atypical coordination between voicing and supra-laryngeal articulation, reduced mean and range of F0, and minor differences in vowel space. These features are broadly consistent with other documented cases of Foreign Accent Syndrome, regardless of aetiology. However, NL's profile of preserved and impaired speech does not fit any pattern typically associated with organic neurological disorder. Moreover, left-handed preference may contribute to differences between singing and reading, versus recitation, repetition and spontaneous speech.

Are children with developmental dyslexia all the same? A cluster analysis with more than 300 cases.

Reading is vital to every aspect of modern life, exacerbated by reliance of the internet, email, and social media on the written medium. Developmental dyslexia (DD) characterizes a disorder in which the core deficit involves reading. Traditionally, DD is thought to be associated with a phonological impairment. However, recent evidence has begun to suggest that the reading impairment in some individuals is provoked by a visual processing deficit. In this paper, we present WISC-IV data from more than 300 Italian children with a diagnosis of DD to investigate the manifestation of phonological and visual subtypes. Our results indicate the existence of two clusters of children with DD. In one cluster, the deficit was more pronounced in the phonological component, while both clusters were impaired in visual processing. These data indicate that DD may be an umbrella term that encompasses different profiles. From a theoretical perspective, our results demonstrate that dyslexia cannot be explained in terms of an isolated phonological deficit alone; visual impairment plays a crucial role. Moreover, general rather than specific accounts of DD are discussed.

Exploring the speech and language of individuals with non-syndromic submucous cleft palate: a preliminary report.

BACKGROUND: Submucous cleft palate (SMCP) has a heterogeneous presentation and is often identified late or misdiagnosed. Diagnosis is prompted by speech, resonance or feeding symptoms associated with velopharyngeal insufficiency. However, the broader impacts of SMCP on communication have rarely been examined and therefore are poorly understood. AIM: To describe the communicative profile of individuals with non-syndromic SMCP by examining speech, language and pragmatics (social language). METHODS & PROCEDURES: Fifteen participants with SMCP aged 5;1-12;8, without a genetic diagnosis, participated in the study. Participants completed standardized assessments examining language, resonance, speech and non-verbal intellect. Parents also completed the Children's Communication Checklist (CCC-2), which provided a measure of overall communicative ability, including pragmatic skills. Formal language outcomes were compared with two cohorts: 36 individuals with overt non-syndromic clefts and 129 individuals with no history of clefting. OUTCOMES & RESULTS: Speech intelligibility was reduced secondary to hypernasality, disordered articulation and/or impaired phonology (n = 7) in children with SMCP. Poorer overall language outcomes were observed for children with SMCP compared with both those with overt clefts and no history of clefting (p < 0.001). Language scores for children with SMCP ranged from impaired (n = 6) to above the standardized mean (n = 4). Receptive and expressive language performance were independently correlated with non-verbal IQ (p < 0.01). Those with severe language impairment (n = 4) also had borderline or impaired non-verbal IQ. Parents reported that speech and semantics were the most affected sub-domains of communication, while scores were the highest for the initiation domain. Speech and language skills were correlated strongly with pragmatics (r = 0.877, p < 0.01). CONCLUSIONS & IMPLICATIONS: Overall, performance was variable within the SMCP group across speech, language and pragmatic assessments. In addition to well-documented speech difficulties, children with SMCP may have language or pragmatic impairments, suggesting that further neurodevelopmental influences may be at play. As such, for individuals with SMCP, additional clinical screening of language and pragmatic abilities may be required to ensure accurate diagnosis and guide both cleft and non-cleft related therapy programmes.

Phonological Treatment Approaches for Spoken Word Production in Aphasia.

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation.

Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation.

Structural, neurological and muscular diseases can lead to impairments of articulation. These impairments can severely impact social life. To judge health status comprehensively, this impact must be adequately quantified. For this purpose, the articulation handicap index (AHI) has been developed. Psychometric analyses referring to this index are presented here. The AHI was completed by 113 patients who had undergone treatment of tumours of the head or neck. The patients also gave a general self-assessment of their impairments due to articulation problems. Furthermore, tumour size, tumour location and kind of therapy were recorded. Missing data were analysed and replaced by multiple imputation. Internal structure was investigated using principal component analysis (PCA); reliability using Cronbach's alpha. Validity was investigated by analysing the relationship between AHI and general self-assessment of impairments. Moreover, the relationships with tumour size, tumour location and kind of therapy were analysed. Only 0.12 % of the answers to the AHI were missing. The Scree test performed with the PCA results suggested one-dimensionality with the first component explaining 49.6 % of the item variance. Cronbach's alpha was 0.96. Kendall's tau between the AHI sum score and the general self-assessment was 0.69. The intervals of AHI sum scores for the self-assessment categories were determined with 0-13 for no, 14-44 for mild, 46-76 for moderate, and 77-120 for severe impairment. The AHI sum score did not systematically relate to tumour size, tumour location or kind of therapy. The results are evidence for high acceptance, reliability and validity.

Sensitive periods and language in cochlear implant users.

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.

Speech rate in Parkinson's disease: A controlled study. / Estudio controlado del ritmo del habla en la enfermedad de Parkinson.

INTRODUCTION: Speech disturbances will affect most patients with Parkinson's disease (PD) over the course of the disease. The origin and severity of these symptoms are of clinical and diagnostic interest. PURPOSE: To evaluate the clinical pattern of speech impairment in PD patients and identify significant differences in speech rate and articulation compared to control subjects. Speech rate and articulation in a reading task were measured using an automatic analytical method. PATIENTS: A total of 39 PD patients in the 'on' state and 45 age-and sex-matched asymptomatic controls participated in the study. None of the patients experienced dyskinesias or motor fluctuations during the test. RESULTS: The patients with PD displayed a significant reduction in speech and articulation rates; there were no significant correlations between the studied speech parameters and patient characteristics such as L-dopa dose, duration of the disorder, age, and UPDRS III scores and Hoehn & Yahr scales. CONCLUSION: Patients with PD show a characteristic pattern of declining speech rate. These results suggest that in PD, disfluencies are the result of the movement disorder affecting the physiology of speech production systems.

Is Language a Factor in the Perception of Foreign Accent Syndrome?

Neurogenic foreign accent syndrome (FAS) is diagnosed when listeners perceive speech associated with motor speech impairments as foreign rather than disordered. Speakers with foreign accent syndrome typically have aphasia. It remains unclear how far language changes might contribute to the perception of foreign accent syndrome independent of accent. Judges with and without training in language analysis rated orthographic transcriptions of speech from people with foreign accent syndrome, speech-language disorder and no foreign accent syndrome, foreign accent without neurological impairment and healthy controls on scales of foreignness, normalness and disorderedness. Control speakers were judged as significantly more normal, less disordered and less foreign than other groups. Foreign accent syndrome speakers' transcriptions consistently profiled most closely to those of foreign speakers and significantly different to speakers with speech-language disorder. On normalness and foreignness ratings there were no significant differences between foreign and foreign accent syndrome speakers. For disorderedness, foreign accent syndrome participants fell midway between foreign speakers and those with speech-language impairment only. Slower rate, more hesitations, pauses within and between utterances influenced judgments, delineating control scripts from others. Word-level syntactic and morphological deviations and reduced syntactic and semantic repertoire linked strongly with foreignness perceptions. Greater disordered ratings related to word fragments, poorly intelligible grammatical structures and inappropriate word selection. Language changes influence foreignness perception. Clinical and theoretical issues are addressed.

Speech processing in children with functional articulation disorders.

This study explored auditory speech processing and comprehension abilities in 5-8-year-old monolingual Hungarian children with functional articulation disorders (FADs) and their typically developing peers. Our main hypothesis was that children with FAD would show co-existing auditory speech processing disorders, with different levels of these skills depending on the nature of the receptive processes. The tasks included (i) sentence and non-word repetitions, (ii) non-word discrimination and (iii) sentence and story comprehension. Results suggest that the auditory speech processing of children with FAD is underdeveloped compared with that of typically developing children, and largely varies across task types. In addition, there are differences between children with FAD and controls in all age groups from 5 to 8 years. Our results have several clinical implications.

Phonological deficits in specific language impairment and developmental dyslexia: towards a multidimensional model.

An on-going debate surrounds the relationship between specific language impairment and developmental dyslexia, in particular with respect to their phonological abilities. Are these distinct disorders? To what extent do they overlap? Which cognitive and linguistic profiles correspond to specific language impairment, dyslexia and comorbid cases? At least three different models have been proposed: the severity model, the additional deficit model and the component model. We address this issue by comparing children with specific language impairment only, those with dyslexia-only, those with specific language impairment and dyslexia and those with no impairment, using a broad test battery of language skills. We find that specific language impairment and dyslexia do not always co-occur, and that some children with specific language impairment do not have a phonological deficit. Using factor analysis, we find that language abilities across the four groups of children have at least three independent sources of variance: one for non-phonological language skills and two for distinct sets of phonological abilities (which we term phonological skills versus phonological representations). Furthermore, children with specific language impairment and dyslexia show partly distinct profiles of phonological deficit along these two dimensions. We conclude that a multiple-component model of language abilities best explains the relationship between specific language impairment and dyslexia and the different profiles of impairment that are observed.

Development and validation of the quality-of-life adolescent cleft questionnaire in patients with cleft lip and palate.

Only a few reports in the literature have described the use of specific instruments for assessing the quality of life in adolescents and young adults with cleft lip and palate (CLP). This condition markedly affects their lifestyle, even after surgical treatment. In the present study, we aimed to develop a quality-of-life assessment tool specifically designed for such patients with CLP. Our multidisciplinary team created a questionnaire focused on the physical, psychological, and social satisfaction of adolescents and young adults with CLP, which was adapted from 3 dimensions of the 36-item Short-Form Health Survey. The questionnaire was administered to a randomized sample of 40 adolescents and young adults (aged 16-24 years) with CLP who had completed treatment protocols and 40 (aged 16-24 years) who were not affected by CLP. The statistical results stated that the questionnaire had good reliability and validity; the Cronbach α coefficient was found to be 0.944. Moreover, factorial analysis confirmed the presence of 3 subscales that were the fundamental components of this questionnaire, which is consistent with the areas theoretically proposed and from which the items were designed and selected. Thus, we validated our novel questionnaire that was administered in the present study and proved its consistency. However, further investigations on a larger population would be useful to confirm these findings.

Between L2 and SLI: inflections and prepositions in the Hebrew of bilingual children with TLD and monolingual children with SLI.

Verb inflectional morphology and prepositions are loci of difficulty for bilingual children with typical language development (TLD) as well as children with Specific Language Impairment (SLI). This paper examines errors in these linguistic domains in these two populations. Bilingual English-Hebrew and Russian-Hebrew preschool children, aged five to seven, with TLD, and age-matched monolingual Hebrew-speaking children with SLI, were tested using sentence completion and sentence imitation tasks in their L2 Hebrew. Our findings show that, despite the similarity in the locus of errors, the two populations can be distinguished by both the quantity and the quality of errors. While bilingual children with TLD had substitution errors often motivated by the first language, most of the errors of monolingual children with SLI involved omission of the whole morpheme or feature reduction. This difference in the nature of the errors is discussed in terms of bilingual processing vs. impaired representation.

Children's perception of their synthetically corrected speech production.

We explore children's perception of their own speech - in its online form, in its recorded form, and in synthetically modified forms. Children with phonological disorder (PD) and children with typical speech and language development (TD) performed tasks of evaluating accuracy of the different types of speech stimuli, either immediately after having produced the utterance or after a delay. In addition, they performed a task designed to assess their ability to detect synthetic modification. Both groups showed high performance in tasks involving evaluation of other children's speech, whereas in tasks of evaluating one's own speech, the children with PD were less accurate than their TD peers. The children with PD were less sensitive to misproductions in immediate conjunction with their production of an utterance, and more accurate after a delay. Within-category modification often passed undetected, indicating a satisfactory quality of the generated speech. Potential clinical benefits of using corrective re-synthesis are discussed.

Linguistic recycling in typical and atypical interaction.

I present evidence that linguistic "recycling" - i.e., the redeployment of linguistic material from prior utterances during conversation - is a striking and prevalent feature not only of interaction between typical speakers, but also, and notably, of interaction involving the communication impaired. In the latter case, recycling may sometimes be used as a compensatory communicative resource when linguistic ability is compromised. Despite its prevalence, however, recycling has largely been ignored by clinical linguists. In addition to providing illustrations of linguistic recycling across a range of communication disorders, I also examine how it is subserved by phenomena such as priming, short-term memory and alignment. I subsequently argue for a shift in perspective that puts recycling at the heart of our perception of how typical and atypical interaction works, and suggest a number of potential benefits for clinical linguistics, ranging from the way we understand and analyse communication disorders to how we assess and treat them.

Gaps-in-noise (GIN©) test results in children with and without reading disabilities and phonological processing deficits.

OBJECTIVE: To determine if the gaps-in-noise (GIN(©)) test could differentiate children with dyslexia and significant phonological awareness deficits from a group of children with normal reading skills. DESIGN: A prospective study of GIN test performance in two groups of children. Participants were administered routine audiological tests, a phonological processing test, and an auditory temporal resolution test (GIN test). Statistical testing was completed to determine if significant differences existed between groups on GIN test results and phonological processing measures, and to examine potential relationships between these test measures. Routine clinical analysis procedures examined the performance of the two groups from a clinical perspective. STUDY SAMPLE: Participants included 61 children between the ages of 8 years, 1 month and 9 years, 11 months, separated into two groups: children with dyslexia and significant phonological deficits (Group I); normal-reading peers with age-appropriate phonological skills (Group II). RESULTS: Children in Group I showed longer gap detection (GD) thresholds and lower gap identification scores than did the children in Group II. Results of statistical and clinical testing revealed significant differences between the groups. CONCLUSION: An auditory temporal processing deficit is a factor to be considered in children presenting with dyslexia and phonological processing disorders.

Children's recognition of their own recorded voice: influence of age and phonological impairment.

Children with phonological impairment (PI) often have difficulties perceiving insufficiencies in their own speech. The use of recordings has been suggested as a way of directing the child's attention toward his/her own speech, despite a lack of evidence that children actually recognize their recorded voice as their own. We present two studies of children's self-voice identification, one exploring developmental aspects, and one exploring potential effects of having a PI. The results indicate that children from 4 to 8 years recognize their recorded voice well (around 80% accuracy), regardless of whether they have a PI or not. A subtle change in this ability from 4 to 8 years is observed that could be linked to a development in short-term memory. Clinically, one can indeed expect an advantage of using recordings in therapy; this could constitute an intermediate step toward the more challenging task of online self-monitoring.

Tracking change in children with severe and persisting speech difficulties.

Standardised tests of whole-word accuracy are popular in the speech pathology and developmental psychology literature as measures of children's speech performance. However, they may not be sensitive enough to measure changes in speech output in children with severe and persisting speech difficulties (SPSD). To identify the best ways of doing this, we compared a range of commonly used procedures for perceptual phonological and phonetic analysis of developmental speech difficulties. Data are drawn from four children with SPSD, recorded at 4 years and again at 6 years old performing naming and repetition tasks. Measures of speech output included percentage of whole words correct (PWC), percentage of consonants correct (PCC), proportion of whole-word proximity (PWP), phonological pattern (process) analysis and phonetic inventory analysis. Results indicate that PWC captures change only when identical stimuli are used across time points. PCC is a more robust indicator of change, being less affected by the choice of stimuli. PWP also captures change across time and tasks, while appearing to be more sensitive than PCC to psycholinguistic variables. PCC and PWP are thus both potentially useful tools for evaluating speech outcomes.

Perception of stop onset spectra in Chinese children with phonological dyslexia.

The ability to identify stop consonants from brief onset spectra was compared between a group of Chinese children with phonological dyslexia (the PD group, with a mean age of 10 years 4 months) and a group of chronological age-matched control children. The linguistic context, which included vowels and speakers, and durations of stop onset spectra were varied. Children with PD showed lower identification accuracy and exhibited a smaller vowel context effect for some stop-vowel combinations compared with the chronological age-matched control group. Further analyses revealed that the PD group had more variable response patterns, and their responses were less consistent with the acoustic characteristics of stop onset spectra. The results suggest that Chinese children with PD do not show greater sensitivity to allophonic acoustic variability compared with control children and exhibit a generally less robust response pattern to phonetic categories.

Retraining left-handers and the aetiology of stuttering: the rise and fall of an intriguing theory.

Many twentieth-century British and American educators, psychologists, and psychiatrists advocated forcing left-handed children to write with their right hands. These experts asserted that a child's decision to rely on his or her left hand was a reflection of a defiant personality that could best be corrected by forcible switching. The methods used to retrain left-handers were often tortuous, including restraining a resistant child's left hand. In contrast, those who saw left-handedness as inherited, but natural, not only disapproved of forced switching, but also often warned of its putative negative consequences, especially stuttering. These claims were given credence in the 1930s by influential University of Iowa researchers, including psychiatrist S. T. Orton, psychologist L. E. Travis, and their students. From the late 1920s until the 1950s, the Iowa researchers published articles and books connecting the etiology of stuttering to forcing natural left-handers to write and perform other tasks with their right hand. Based on their clinical studies these practitioners concluded that stutterers displayed weak laterality. The Iowa group also published detailed case studies of patients whose stuttering was putatively cured by the restoration of their left-handedness. By the late-1940s, the connection between stuttering and retraining evaporated, due in large part to the growing dominance of psychoanalytic psychiatry. Despite robust statistical and clinical evidence, the connection between forced hand switching and stuttering has largely been forgotten. Recent imaging studies of stutterers, however, have suggested that stuttering is tied to disturbed signal transmission between the hemispheres. Similar to the Iowa researchers of the 1930s, current investigators have found connections between stuttering and weak laterality.

Oral and hand movement speeds are associated with expressive language ability in children with speech sound disorder.

This study tested the hypothesis that children with speech sound disorder have generalized slowed motor speeds. It evaluated associations among oral and hand motor speeds and measures of speech (articulation and phonology) and language (receptive vocabulary, sentence comprehension, sentence imitation), in 11 children with moderate to severe SSD and 11 controls. Syllable durations from a syllable repetition task served as an estimate of maximal oral movement speed. In two imitation tasks, nonwords and clapped rhythms, unstressed vowel durations and quarter-note clap intervals served as estimates of oral and hand movement speed, respectively. Syllable durations were significantly correlated with vowel durations and hand clap intervals. Sentence imitation was correlated with all three timed movement measures. Clustering on syllable repetition durations produced three clusters that also differed in sentence imitation scores. Results are consistent with limited movement speeds across motor systems and SSD subtypes defined by motor speeds as a corollary of expressive language abilities.