Effect of Nonnutritive Sucking on Oral Feeding in Neonates With Perinatal Asphyxia: A Randomized Controlled Trial.

AIMS: The effect of nonnutritive sucking (NNS) stimulation is unclear in infants with perinatal asphyxia. Thus, the aim of this study was to assess the effect of NNS stimulation on oral intake, discharge time, and early feeding skills in infants with perinatal asphyxia. DESIGN: A randomized controlled study was conducted. METHOD: Of the 94 infants, 47 were included in the experimental group and given NNS stimulation once a day before tube feeding by a speech-language therapist (SLT) in addition to hypothermia treatment. Infants' feeding performances on the days of first oral intake and discharge were evaluated with the Early Feeding Skills Scale (EFS). RESULTS: The time from tube feeding to oral intake was significantly lower in the experimental group compared to the control group (p < .05). EFS scores at discharge were significantly higher in the experimental group than in the control group (p < .05). There was no significant difference between the experimental and control groups in terms of discharge and weight gain (p > .05). CONCLUSIONS: The findings indicated that the NNS stimulation positively affected oral intake and early feeding skills in infants with perinatal asphyxia, as in preterms. However, NNS stimulation had no significant effect on discharge and weight gain in infants with asphyxia. This finding may be attributed to other factors. It is recommended to use NNS by an SLT in a neonatal intensive care unit within a multidisciplinary team to accelerate the transition to oral feeding and improve feeding skills in infants with perinatal asphyxia. Further studies on the effect of NNS stimulation in infants with perinatal asphyxia are needed to corroborate its effects on discharge time and weight gain.

How aware is the public of the existence, characteristics and causes of language impairment in childhood and where have they heard about it? A European survey.

Public awareness of language impairment in childhood (Developmental Language Disorder (DLD)) has been identified as an important determiner of research and clinical service delivery, yet studies directly assessing public awareness are lacking. This study surveyed awareness across 18 countries of Europe. METHOD: A questionnaire developed by an international team asked whether respondents had heard of language impairment affecting children, what they thought its manifestations and causes were and where they had heard of it. Respondents were also asked whether they had heard of autism, dyslexia, ADD/ADHD and speech disorder. The questionnaire was administered to members of the public in 18 European countries. A total of 1519 responses were obtained, spanning 6 age groups, 4 educational level groups and 3 income level groups. RESULTS: Across all but one country, significantly fewer people had heard of language impairment than any of the other disorders (or 60 % compared to over 90 % for autism). Awareness tended to be lowest in Eastern Europe and greatest in North-Western Europe, and was influenced by education level, age and income level. People in countries with overall low and overall high awareness differed in their views on manifestations and causes. People had heard of language impairment and autism the same way - most frequently through the media, including Internet, and less frequently through their child's school or a medical professional. DISCUSSION: The study confirms that awareness of language impairment and knowledge of the breadth of its manifestations are low. It also suggests opportunities for how to increase awareness, including greater media coverage of language impairment and more efficient use of venues such as schools and healthcare. Ways in which cultural and linguistic differences may influence public awareness efforts are discussed, including the translatability of clinical labels and scientific terms. These may impact the acceptance of a common term and definition across all countries. As awareness campaigns are gaining momentum, the findings of this study can serve as a baseline against which to compare future findings.

Nasometric evaluation of resonance disorders: A norm study In Turkish.

OBJECTIVE: The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage. METHODS: 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy. RESULTS: This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels. CONCLUSION: This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.

Profiling morpho-syntactical development of cochlear implanted children with TR-LARSP.

This research aims to describe the grammatical development of Turkish-speaking children with cochlear implants (CI) using the Turkish adaptation of the Language Assessment and Remediation Profile (LARSP). The study was conducted on a total of 15 children with CIs aged 43-87 months with 22-45 months of hearing age. A total of 750 utterances were elicited from the CI group's recorded speech samples and analysed using the methodology of Turkish-Language Assessment and Remediation Profile (TR-LARSP). A cross-sectional descriptive model is used in the study. The results show that there is a significant difference in the acquisition of grammatical structures in children with CIs as compared to typically developing (TD) age-matched children in Turkish. In conclusion, this study suggests that after the implantation of these children, the speech therapist should consider the acquisition time of morpho-syntactical structures before making a language-based therapy plan.

Epistemic uncertainty: Turkish children with specific language impairment and their comprehension of tense and aspect.

BACKGROUND: Impairments in tense morphology are characteristic of English-speaking children with specific language impairment (SLI). Recent studies have investigated the role that aspect plays in the difficulties found in tense morphology. It has been suggested that children with SLI are less sensitive to aspect and its interaction with tense than typically developing (TD) children. Profound impairment in past tense morphology compared with the present in this population was explained by a breakdown in the association between event completion information and past tense. To date, research on tense morphology in this population has not examined all three tense conditions in a single study. AIMS: To examine whether monolingual Turkish-speaking children with SLI exhibit deficits in comprehending tense and aspect morphology, and, if so, whether these deficits are restricted to completed events (past tense) or also occur for incomplete non-past events (future and present tense). METHODS & PROCEDURES: A sentence-picture matching task was administered to 36 monolingual Turkish-speaking children: 13 with SLI (mean age = 6;9 years) and 23 age-matched TD children (mean age = 6;5 years). Upon hearing a sentence, each child had to select between a target (past, present or future) and a distracter picture. Tense and aspect information could only be established from verb morphology. OUTCOMES & RESULTS: The SLI group had lower accuracy than the TD group on all test conditions. For both groups, present tense had the highest accuracy scores. Performance scores within the SLI group showed the following hierarchy from easy to difficult: present > future > past. CONCLUSIONS & IMPLICATIONS: Turkish children with SLI have deficits in comprehending tense and aspect morphology. Although comprehending past was more difficult than non-past (present and future), future was more difficult to comprehend than the present. This disassociation between two non-past incomplete events indicates that the underlying difficulties comprehending (past) tense-aspect is not restricted to event completion in past tense contexts. This finding raises the possibility that in children with SLI, non-temporal epistemic functions of verb morphology (i.e., certainty, probability or possibility of an event occurring) might play a role in efficient understanding of tense and aspect morphology. If so, children with SLI may benefit from language therapy focused on the epistemic functions of verb morphology to improve comprehension of tense and aspect.

Reliability and validity of the Turkish pediatric Voice Handicap index.

OBJECTIVES: The aim of this study is to develop a Turkish version of the pediatric voice index (pVHI) and to evaluate its reliability and validity for cultural adaptation. METHODS: The original pVHI was translated to Turkish. It was administered to 151 parents of 40 dysphonic children and 111 non-dysphonic children. A cross-sectional descriptive model is used with two-sample methodology. The reliability, validity measures, sensitivity, specifity and receiver operating characteristics (ROC) analysis with AUC values were calculated. RESULTS: The findings showed that the Turkish version of the pVHI had highly significant validity, reliability and excellent internal consistency, sensitivity and specifity for functional, physical and emotional domains and the total score. CONCLUSIONS: The Turkish version of the pVHI is a valid and reliable tool to assess the parents' perception about their children with voice disorders.

At the intersection of cognition and grammar: deficits comprehending counterfactuals in Turkish children with specific language impairment.

PURPOSE: This study investigated the comprehension of counterfactual conditionals in monolingual Turkish children with specific language impairment (SLI) and typically developing (TD) children. Comprehending counterfactuals requires a well-developed cognitive system (Beck, Riggs, & Gorniak, 2009). Children with SLI have impaired cognitive functioning (Im-Bolter, Johnston, & Pascual-Leone, 2006), which affects their ability to comprehend counterfactuals. METHOD: The sample consisted of 13 children (9 boys, 4 girls) with SLI who were matched in age and nonverbal intelligence with 13 TD children (8 boys, 5 girls; mean age 6;9 [years; months] for both groups). Each group completed a sentence comprehension and repetition task with 3 sentence conditions: nonconditional, factual, and counterfactual. Nonconditionals did not have if-embedding, whereas factual and counterfactual conditionals were morphosyntactically equivalent if-clauses, but only the latter was cognitively complex. RESULTS: Conditionals were more difficult to comprehend than nonconditionals for both groups. Counterfactuals were more difficult to comprehend than the morphosyntactically equivalent factual counterparts for the SLI group. There was no discrepancy between the groups for repetition of counterfactuals and factuals. CONCLUSIONS: Children with SLI have difficulty processing counterfactuals due to morphosyntactic complexity (if-embedding) and the cognitive processes involved in comprehending counterfactuals. This indicates that cognitive complexity adds to sentence comprehension deficits in SLI.

Performance of children on the Turkish Nonword Repetition Test: Effect of word similarity, word length, and scoring.

This study aims to report the preliminary results of the development of the Turkish Nonword Repetition Test and to contribute to the clinical accuracy of the test by comparing the performance of children with specific language impairment with that of language-level matched and age-matched typically developing children on a nonword repetition (NWR) test developed for Turkish. To determine the effect of word similarity and word length, the Turkish Nonword Repetition Test is composed of language-like and language-unlike items. To determine the effect of scoring, the performances of children were scored as correct/incorrect for a whole word, for only the consonants, and for only the vowels. The findings suggest that the test is a reliable tool to differentiate Turkish-speaking children with SLI from typically developing children.

Education of speech and language therapists/logopedists in selected Central and Southeastern European countries: challenges and new horizons.

OBJECTIVE: To provide an overview of student training in speech and language therapy/logopedics (SLT) in selected Central and Southeastern European countries (Poland, Slovenia, Bulgaria, Czech Republic, Serbia, Bosnia and Herzegovina and Turkey). METHOD: Data were collected using a special questionnaire developed by Söderpalm and supplemented by Georgieva. Results from 23 SLT programs in the seven countries were collected and organized. RESULTS: In all these countries, SLT has roots in special education or health and is centralized in the university environment. The training programs have positive accreditation provided by the national agencies of accreditation and evaluation. Results were examined specifically for evidence of the new paradigm of evidence-based practice (EBP) according to the revised International Association of Logopedics and Phoniatrics (IALP) guidelines and the application of research-based teaching in SLT. The professional bodies that govern clinical practice in public health and/or educational fields are in the process of EBP implementation. Most speech and language therapists/logopedists in the selected countries work in an educational setting, clinical organization and/or hospital as well as in social day care centers. Except in Turkey, private practices are not regulated by the law. CONCLUSIONS: In the seven countries examined in this survey, SLT is progressing as a professional discipline but must be supported by government funding of SLT education and services to relevant populations.

Public attitudes toward stuttering in Turkey: probability versus convenience sampling.

PURPOSE: A Turkish translation of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) was used to compare probability versus convenience sampling to measure public attitudes toward stuttering. METHOD: A convenience sample of adults in Eskisehir, Turkey was compared with two replicates of a school-based, probability cluster sampling scheme. RESULTS: The two replicates of the probability sampling scheme yielded similar demographic samples, both of which were different from the convenience sample. Components of subscores on the POSHA-S were significantly different in more than half of the comparisons between convenience and probability samples, indicating important differences in public attitudes. CONCLUSIONS: If POSHA-S users intend to generalize to specific geographic areas, results of this study indicate that probability sampling is a better research strategy than convenience sampling. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss the difference between convenience sampling and probability sampling; (2) describe a school-based probability sampling scheme; and (3) describe differences in POSHA-S results from convenience sampling versus probability sampling.

Stuttering attitudes among Turkish family generations and neighbors from representative samples.

PURPOSE: Attitudes toward stuttering, measured by the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S), are compared among (a) two different representative samples; (b) family generations (children, parents, and either grandparents or uncles and aunts) and neighbors; (c) children, parents, grandparents/adult relatives, and neighbors of the same family/neighbor units vs. individuals from different family/neighbor units; and (d) attitudes from one Turkish city with an international database archive. METHODS: Following a school-based, three-stage, cluster probability sampling scheme, two sets of children, parents, grandparents/adult relatives, and neighbors (50 each) in Eskisehir, Turkey (PROB1 and PROB2) completed Turkish translations of the POSHA-S. The POSHA-S measures attitudes toward stuttering within the context of other attributes, such as obesity and mental illness. RESULTS: Both replicates of the sampling procedure yielded strikingly similar attitudes for stuttering between children, parents, grandparents/adult relatives, and neighbors in PROB1 vs. PROB2, and between all pair-wise comparisons within PROB1 and PROB2. By contrast, attitudes toward obesity and mental illness were dissimilar. Correlations were small to moderate among attitudes of the same family/neighbor units but were essentially nonexistent between different family/neighbor units. Attitudes toward stuttering in Eskisehir were estimated to be less positive than attitudes from a wide range of samples around the world, although exceptions occurred. CONCLUSIONS: A school-based probability sampling procedure yielded consistent findings that are likely different from results from convenience samples. Families appear to be an important influence in determining public attitudes toward stuttering and other human attributes. EDUCATIONAL OBJECTIVES: The reader will be able to: (i) identify similarities and differences among attitudes toward stuttering across generations; (ii) identify similarities and differences among attitudes toward stuttering in Turkey vs. other places in the world; (iii) describe a school-based probability sampling scheme; (iv) describe advantages of using a standard instrument to measure public attitudes toward stuttering.

Implications of bilingual development for specific language impairments in Turkey.

The potential impact of bilingualism on children's language development has emerged as a crucial concern for Turkey, but so far it has not been addressed from the point of view of language disorders. This short review examines the potential impact of bilingual language development for language impairments in Turkey, with special emphasis on the largest minority population speaking Kurdish and Turkish.

An alternating treatment comparison of minimal and maximal opposition sound selection in Turkish phonological disorders.

A single-subject alternating treatment design in combination with a staggered multiple baseline model across subjects was implemented with two 6:0 year-old girls, monozygotic twins, who were referred to a university clinic for evaluation and treatment. The treatment programme was structured according to variants of minimal pair contrast treatment in which the target sounds and their oppositions were selected according to either minimal or maximal opposition (including major-class differences) contrast treatments to evaluate which of the sound selection strategy would result in better learning. Independent variables were the minimal and maximal opposition conditions; dependent variables were the target phonemes treated. Consistent with the literature, maximal opposition treatment resulted in significantly greater changes in the sound systems of the twins than minimal opposition treatment.

Identification of cluttering and stuttering by the public in four countries.

The investigators sought to explore and compare the identification of cluttering vs stuttering in four different country samples. After reading lay definitions of the two fluency disorders in their own language, convenience samples of 60-90 adult respondents from Turkey, Bulgaria, Russia, and the US identified 51-119 children or adults who either cluttered, stuttered, or both. They also indicated whether or not they, themselves, cluttered or stuttered. The majority of respondents in all four samples identified at least one person who cluttered, stuttered, or cluttered and stuttered. The average respondent identified one person with a fluency disorder, most likely a stutterer, less likely a clutterer, and least likely a clutterer-stutterer. Both similarities and differences characterized those identified in the three groups, e.g., the sex ratios were not the same. As with stuttering, the public apparently is aware of cluttering individuals and can identify such persons.

Reviewing sonority for word-final sonorant+obstruent consonant cluster development in Turkish.

The purpose of this study is to investigate the acquisition patterns of sonorant+obstruent coda clusters in Turkish to determine whether Turkish data support the prediction the Sonority Sequencing Principle (SSP) makes as to which consonant (i.e. C1 or C2) is more likely to be preserved in sonorant+obstruent clusters, and the error patterns of sonorant+obstruent coda clusters. Data from 350 typically developing monolingual Turkish speaking children (aged 2.0-5.11 years) were used in this study. Six types of sonorant+obstruent clusters were targeted for analysis of deletion, vowel lengthening, and substitution processes in C1 and C2 singletons of clusters separately. The results showed that the acquisition of Turkish clusters does not adhere to the SSP as indicated by a higher percentage of C1 errors than C2 errors. In Turkish, vowel lengthening occurred when C1 was deleted. To account for these, it is proposed that the syllable structure of Turkish plays a role in the acquisition process of sonorant+obstruent clusters. It is argued that Turkish children acquire moraic structure at an early age, as evidenced by vowel lengthening.

[The relationship between muscle tension dysphonia type 1 and soft phonation index and the effectiveness of voice therapy]. / Kas gerilimi disfonisi tip 1 hastaligi ile yumusak fonasyon indeksi arasindaki iliski ve ses terapisinin etkinligi.

OBJECTIVES: We investigated the relationship between muscle tension dysphonia (MTD) type 1 and soft phonation index (SPI) and evaluated the effect of voice therapy on MTD type 1. PATIENTS AND METHODS: The study included 20 patients (all females; mean age 27+/-6 years) whose diagnosis was made as MTD type 1 on videolaryngostroboscopic examination. Acoustic analysis was performed before and after voice therapy using the Multi-Dimensional Voice Program. Acoustic parameters were compared with those of a control group comprising 20 females (mean age 28+/-4 years) without any voice problem. RESULTS: In the patient group, 19 patients exhibited a significantly increased SPI compared to two subjects in the control group (p<0.05). The most significant improvements were seen in SPI, jitter, and PPQ following voice therapy, which was found to be effective in 19 patients. CONCLUSION: Our findings showed a close relationship between MTD type 1 and SPI. Voice therapy improves parameters of amplitude and frequency perturbations, in particular SPI.

Does the speech of Turkish-speaking phonologically disordered children differ from that of children speaking other languages?

How phonological disorders should be categorized in Turkish children remained vague for a long period of time due to a lack of normative studies. This paper reports the phonological systems of 70 phonologically disordered children, aged 4;0-8;0, in comparison with the results of a normative study of 665 Turkish-speaking children, aged 1;3-8;0. The current focus is on two aspects of development, mainly the differences between disordered and normal consonant acquisition and phonological error patterns from both longitudinal and cross-sectional data. The second concern of the paper is to sub-classify phonological disorders as proposed in the existing literature by examining the applicability of these proposals to Turkish, a typologically different language. It has been indicated that similar developmental trends occur across languages but consonant acquisition is more rapid and developmental errors are more predictable in Turkish. There is evidence for ambient language influence. Mostly, the sub-classifications of phonological disorders are valid for Turkish-speaking children with apparent saliency to language.

A Turkish perspective on communication disorders.

The population of Turkey is approximately 65 million people, and another 3 million people of Turkish descent live in Europe and the United States. The purpose of the present paper is to relay information that American or European clinicians who work with Turkish clients should know about their clients' country, including its language, education system, the current status of the profession and organization of professional services for communication disorders. The paper shows that the profession of speech-language pathology is young in Turkey; as a result, the roles of speech-language pathologists in this country are substantially different from those in the United States and in most European countries. It is envisioned that as the profession grows in Turkey its role will increasingly include direct provision of services, in-service training to service providers, and research on communication disorders.