Listeners' perception of lexical stress in the first words of infants with cochlear implants and normally hearing infants.

Normally hearing (NH) infants are able to produce lexical stress in their first words, but congenitally hearing-impaired children with cochlear implants (CI) may find this more challenging, given the limited transmission of spectro-temporal information by the implant. Acoustic research has shown that the acoustic cues to stress in the first words of Dutch-acquiring CI infants are less pronounced (Pettinato, De Clerck, Verhoeven, & Gillis, 2017). The present study investigates how listeners perceive lexical stress in the first words of CI and NH infants. Two research questions are addressed: (1) How successful are CI and NH children in implementing the prosodic cues to prominence? (2) Is the degree of stress in CI and NH words perceived to be similar? The stimuli used in this study are disyllabic words (n = 1089) produced by 9 infants with CI and 9 NH infants acquiring Dutch. The words were presented to adult listeners in a listening experiment, in which they assessed the stress pattern on a continuous visual analogue scale (VAS) which expresses to what extent syllables are perceived as stressed. The results show that listeners perceive typical word stress production in the first words of infants with CI. The words of CI and NH infants were rated in agreement with the target stress pattern as often, and trochaic words were rated more frequently as such than iambic words. Listeners more frequently perceive unstressed syllables in the first words of infants with CI. However, for the words that are perceived to be clearly stressed, the degree of word stress is comparable in the two groups, and both infant groups are perceived to produce more contrast between stressed and unstressed syllables in trochees than in iambs. It is concluded that that acoustic differences between CI and NH infants' stress production are not necessarily perceptually salient.

Neurological Aspects of Foreign Accent Syndrome in Stroke Patients.

Foreign Accent Syndrome (FAS) is an intriguing motor speech disorder which has captured the interest of the scientific community and media for decades. At the moment, there is no comprehensive model which can account for the pathophysiology of this disorder. This paper presents a review of 112 FAS cases published between 1907 and October 2016: these were analyzed with respect to demographic characteristics, lesion location, associated neurocognitive symptoms, and comorbid speech and language disorders. The analysis revealed that organic-neurogenic FAS is more frequent in women than in men. In organic-neurogenic FAS over half of the patients acquired the foreign accent after a stroke. Their lesions are typically located in the left supratentorial regions of the brain, and generally involve the primary motor cortex and premotor cortex (BA 4 and 6), and/or the basal ganglia. Although neurocognitive data are not consistently reported, vascular FAS patients regularly suffer frontal executive dysfunctions. On the basis of a careful comparison of the cognitive and theoretical accounts of FAS, AoS and ataxic dysarthria, it is concluded that FAS should be regarded a dual component motor speech disorder in which both planning and motor execution of speech may be affected.

Visualisation and Analysis of Speech Production with Electropalatography.

The process of speech production, i.e., the compression of air in the lungs, the vibration activity of the larynx, and the movement of the articulators, is of great interest in phonetics, phonology, and psychology. One technique by which speech production is analysed is electropalatography, in which an artificial palate, moulded to the speaker's hard palate, is introduced in the mouth. The palate contains a grid of electrodes, which monitor the spatial and temporal pattern of contact between the tongue and the palate during speech production. The output is a time sequence of images, known as palatograms, which show the 2D distribution of electrode activation. This paper describes a series of tools for the visualisation and analysis of palatograms and their associated sound signals. The tools are developed as Matlab® routines and released as an open-source toolbox. The particular focus is the analysis of the amount and direction of left-right asymmetry in tongue-palate contact during the production of different speech sounds. Asymmetry in the articulation of speech, as measured by electropalatography, may be related to the language under consideration, the speaker's anatomy, irregularities in the palate manufacture, or speaker handedness (i.e., left or right). In addition, a pipeline for the segmentation and analysis of a three-dimensional computed tomography data set of an artificial palate is described and demonstrated. The segmentation procedure provides quantitative information about asymmetry that is due to a combination of speaker anatomy (the shape of the hard palate) and the positioning of the electrodes during manufacture of the artificial palate. The tools provided here should be useful in future studies of electropalatography.

Can listeners hear the difference between children with normal hearing and children with a hearing impairment?

Acoustic measurements have shown that the speech of hearing-impaired (HI) children differs from that of normally hearing (NH) children, even after several years of device use. This study focuses on the perception of HI speech in comparison to NH children's speech. The purpose of this study was to investigate whether adult listeners can identify the speech of NH and HI children. Moreover, it is studied whether listeners' experience and the children's length of device use play a role in that assessment. For this study, short utterances of 7 children with a cochlear implant (CI), 7 children with an acoustic hearing aid (HA) and 7 children with NH were presented to 90 listeners who were required to specify the hearing status of each speech sample. The judges had different degrees of familiarity with hearing disorders: there were 30 audiologists, 30 primary schoolteachers and 30 inexperienced listeners. The results show that the speech of children with NH and HI can reliably be identified. However, listeners do not manage to distinguish between children with CI and HA. Children with CI are increasingly identified as NH with increasing length of device use. For children with HA, there is no similar change with longer device use. Also, experienced listeners seem to display a more lenient attitude towards atypical speech, whereas inexperienced listeners are stricter and generally consider more utterances to be produced by children with HI.

Oral and written picture description in individuals with aphasia.

BACKGROUND: Aphasia is characterized by difficulties in connected speech/writing. AIMS: To explore the differences between the oral and written description of a picture in individuals with chronic aphasia (IWA) and healthy controls. Descriptions were controlled for productivity, efficiency, grammatical organization, substitution behaviour and discourse organization. METHODS & PROCEDURES: Fifty IWA and 50 healthy controls matched for age, gender and education provided an oral and written description of a black-and-white situational drawing from the Dutch version of the Comprehensive Aphasia Test. Between- and within-group analyses were carried out and the reliability of the test instrument was assessed. OUTCOMES & RESULTS: The language samples of the healthy controls were more elaborate, more efficient, syntactically richer, more coherent, and consisted of fewer spoken and written language errors than the samples of the IWA. Within-group comparisons showed that connected writing is more sensitive than connected speech to capture aphasic symptoms. CONCLUSIONS & IMPLICATIONS: The analysis of both modalities (speech and writing) at the discourse level allows one to assess simultaneously micro- and macro-linguistic skills and their potential interrelations in a given IWA. Connected writing appears to be more sensitive in discriminating IWA from healthy controls than connected speech. This method for analyzing language samples should, however, be used in conjunction with other assessment tools.

Cerebellar induced differential polyglot aphasia: A neurolinguistic and fMRI study.

Research has shown that linguistic functions in the bilingual brain are subserved by similar neural circuits as in monolinguals, but with extra-activity associated with cognitive and attentional control. Although a role for the right cerebellum in multilingual language processing has recently been acknowledged, a potential role of the left cerebellum remains largely unexplored. This paper reports the clinical and fMRI findings in a strongly right-handed (late) multilingual patient who developed differential polyglot aphasia, ataxic dysarthria and a selective decrease in executive function due to an ischemic stroke in the left cerebellum. fMRI revealed that lexical-semantic retrieval in the unaffected L1 was predominantly associated with activations in the left cortical areas (left prefrontal area and left postcentral gyrus), while naming in two affected non-native languages recruited a significantly larger bilateral functional network, including the cerebellum. It is hypothesized that the left cerebellar insult resulted in decreased right prefrontal hemisphere functioning due to a loss of cerebellar impulses through the cerebello-cerebral pathways.

The Posterior Fossa and Foreign Accent Syndrome: Report of Two New Cases and Review of the Literature.

Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area and the primary motor cortex. Here, we present two new cases of FAS after posterior fossa lesions. The first case is a 44-year-old, right-handed, Dutch-speaking man who suffered motor speech disturbances and a left hemiplegia after a pontine infarction. Quantified SPECT showed a bilateral hypoperfusion in the inferior lateral prefrontal and medial inferior frontal regions as well as a significant left cerebellar hypoperfusion. Further clinical investigations led to an additional diagnosis of brainstem cognitive affective syndrome which closely relates to Schmahmann's syndrome. The second patient was a 72-year-old right-handed polyglot English man who suffered a stroke in the vascular territory of the left posterior inferior cerebellar artery (PICA) and developed a foreign accent in his mother tongue (English) and in a later learnt language (Dutch). In this paper, we discuss how the occurrence of this peculiar motor speech disorder can be related to a lesion affecting the posterior fossa structures.

Expansion of Prosodic Abilities at the Transition From Babble to Words: A Comparison Between Children With Cochlear Implants and Normally Hearing Children.

OBJECTIVES: This longitudinal study examined the effect of emerging vocabulary production on the ability to produce the phonetic cues to prosodic prominence in babbled and lexical disyllables of infants with cochlear implants (CI) and normally hearing (NH) infants. Current research on typical language acquisition emphasizes the importance of vocabulary development for phonological and phonetic acquisition. Children with CI experience significant difficulties with the perception and production of prosody, and the role of possible top-down effects is, therefore, particularly relevant for this population. DESIGN: Isolated disyllabic babble and first words were identified and segmented in longitudinal audio-video recordings and transcriptions for nine NH infants and nine infants with CI interacting with their parents. Monthly recordings were included from the onset of babbling until children had reached a cumulative vocabulary of 200 words. Three cues to prosodic prominence, fundamental frequency (f0), intensity, and duration, were measured in the vocalic portions of stand-alone disyllables. To represent the degree of prosodic differentiation between two syllables in an utterance, the raw values for intensity and duration were transformed to ratios, and for f0, a measure of the perceptual distance in semitones was derived. The degree of prosodic differentiation for disyllabic babble and words for each cue was compared between groups. In addition, group and individual tendencies on the types of stress patterns for babble and words were also examined. RESULTS: The CI group had overall smaller pitch and intensity distances than the NH group. For the NH group, words had greater pitch and intensity distances than babbled disyllables. Especially for pitch distance, this was accompanied by a shift toward a more clearly expressed stress pattern that reflected the influence of the ambient language. For the CI group, the same expansion in words did not take place for pitch. For intensity, the CI group gave evidence of some increase of prosodic differentiation. The results for the duration measure showed evidence of utterance final lengthening in both groups. In words, the CI group significantly reduced durational differences between syllables so that a more even-timed, less differentiated pattern emerged. CONCLUSIONS: The onset of vocabulary production did not have the same facilitatory effect for the CI infants on the production of phonetic cues for prosody, especially for pitch. It was argued that the results for duration may reflect greater articulatory difficulties in words for the CI group than the NH group. It was suggested that the lack of clear top-down effects of the vocabulary in the CI group may be because of a lag in development caused by an initial lack of auditory stimulation, possibly compounded by the absence of auditory feedback during the babble phase.

Mutated CTSF in adult-onset neuronal ceroid lipofuscinosis and FTD.

OBJECTIVE: To investigate the molecular basis of a Belgian family with autosomal recessive adult-onset neuronal ceroid lipofuscinosis (ANCL or Kufs disease [KD]) with pronounced frontal lobe involvement and to expand the findings to a cohort of unrelated Belgian patients with frontotemporal dementia (FTD). METHODS: Genetic screening in the ANCL family and FTD cohort (n = 461) was performed using exome sequencing and targeted massive parallel resequencing. RESULTS: We identified a homozygous mutation (p.Ile404Thr) in the Cathepsin F (CTSF) gene cosegregating in the ANCL family. No other mutations were found that could explain the disease in this family. All 4 affected sibs developed motor symptoms and early-onset dementia with prominent frontal features. Two of them evolved to akinetic mutism. Disease presentation showed marked phenotypic variation with the onset ranging from 26 to 50 years. Myoclonic epilepsy in one of the sibs was suggestive for KD type A, while epilepsy was not present in the other sibs who presented with clinical features of KD type B. In a Belgian cohort of unrelated patients with FTD, the same heterozygous p.Arg245His mutation was identified in 2 patients who shared a common haplotype. CONCLUSIONS: A homozygous CTSF mutation was identified in a recessive ANCL pedigree. In contrast to the previous associations of CTSF with KD type B, our findings suggest that CTSF genetic testing should also be considered in patients with KD type A as well as in early-onset dementia with prominent frontal lobe and motor symptoms.

Foreign Accent Syndrome As a Psychogenic Disorder: A Review.

In the majority of cases published between 1907 and 2014, FAS is due to a neurogenic etiology. Only a few reports about FAS with an assumed psychogenic origin have been published. The present article discusses the findings of a careful database search on psychogenic FAS. This review may be particularly relevant as it is the first to analyze the salient features of psychogenic FAS cases to date. This article hopes to pave the way for the view that psychogenic FAS is a cognate of neurogenic FAS. It is felt that this variant of FAS may have been underreported, as most of the psychogenic cases have been published after the turn of the century. This review may improve the diagnosis of the syndrome in clinical practice and highlights the importance of recognizing psychogenic FAS as an independent taxonomic entity.

Psychogenic Foreign Accent Syndrome: A New Case.

This paper presents the case of a 33-year-old, right-handed, French-speaking Belgian lady who was involved in a car accident as a pedestrian. Six months after the incident she developed a German/Flemish-like accent. The patient's medical history, the onset of the FAS and the possible psychological causes of the accent change are analyzed. Relevant neuropsychological, neurolinguistic, and psychodiagnostic test results are presented and discussed. The psychodiagnostic interview and testing will receive special attention, because these have been underreported in previous FAS case reports. Furthermore, an accent rating experiment was carried out in order to assess the foreign quality of the patient's speech. Pre- and post-morbid spontaneous speech samples were analyzed phonetically to identify the pronunciation characteristics associated with this type of FAS. Several findings were considered essential in the diagnosis of psychogenic FAS: the psychological assessments as well as the clinical interview confirmed the presence of psychological problems, while neurological damage was excluded by means of repeated neuroimaging and neurological examinations. The type and nature of the speech symptoms and the accent fluctuations associated with the patient's psychological state cannot be explained by a neurological disorder. Moreover, the indifference of the patient toward her condition may also suggest a psychogenic etiology, as the opposite is usually observed in neurogenic FAS patients.

Perceptual Accent Rating and Attribution in Psychogenic FAS: Some Further Evidence Challenging Whitaker's Operational Definition.

A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, and L3: English) woman with a 12-year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved toward a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based on the patient's complex medical history and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker's (1982) definition of foreign accent syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke.

Developmental Foreign Accent Syndrome: Report of a New Case.

This paper presents the case of a 17-year-old right-handed Belgian boy with developmental FAS and comorbid developmental apraxia of speech (DAS). Extensive neuropsychological and neurolinguistic investigations demonstrated a normal IQ but impaired planning (visuo-constructional dyspraxia). A Tc-99m-ECD SPECT revealed a significant hypoperfusion in the prefrontal and medial frontal regions, as well as in the lateral temporal regions. Hypoperfusion in the right cerebellum almost reached significance. It is hypothesized that these clinical findings support the view that FAS and DAS are related phenomena following impairment of the cerebro-cerebellar network.

Hearing impairment and vowel production. A comparison between normally hearing, hearing-aided and cochlear implanted Dutch children.

This study investigated the acoustic characteristics of the Belgian Standard Dutch vowels in children with hearing impairment and in children with normal hearing. In a balanced experimental design, the 12 vowels of Belgian Standard Dutch were recorded in three groups of children: a group of children with normal hearing, a group with a conventional hearing aid and a group with a cochlear implant. The formants, the surface area of the vowel space and the acoustic differentiation between the vowels were determined. The analyses revealed that many of the vowels in hearing-impaired children showed a reduction of the formant values. This reduction was particularly significant with respect to F2. The size of the vowel space was significantly smaller in the hearing-impaired children. Finally, a smaller acoustic differentiation between the vowels was observed in children with hearing impairment. The results show that even after 5 years of device use, the acoustic characteristics of the vowels in hearing-assisted children remain significantly different as compared to their NH peers.

Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia.

OBJECTIVE: The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001). METHOD: Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX). RESULTS: Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication-namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology. CONCLUSION: The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.

Cerebellum and apraxia.

As early as the beginning of the nineteenth century, a variety of nonmotor cognitive and affective impairments associated with cerebellar pathology were occasionally documented. A causal link between cerebellar disease and nonmotor cognitive and affective disorders has, however, been dismissed for almost two centuries. During the past decades, the prevailing view of the cerebellum as a mere coordinator of autonomic and somatic motor function has changed fundamentally. Substantial progress has been made in elucidating the neuroanatomical connections of the cerebellum with the supratentorial association cortices that subserve nonmotor cognition and affect. Furthermore, functional neuroimaging studies and neurophysiological and neuropsychological research have shown that the cerebellum is crucially involved in modulating cognitive and affective processes. This paper presents an overview of the clinical and neuroradiological evidence supporting the view that the cerebellum plays an intrinsic part in purposeful, skilled motor actions. Despite the increasing number of studies devoted to a further refinement of the typology and anatomoclinical configurations of apraxia related to cerebellar pathology, the exact underlying pathophysiological mechanisms of cerebellar involvement remain to be elucidated. As genuine planning, organization, and execution disorders of skilled motor actions not due to motor, sensory, or general intellectual failure, the apraxias following disruption of the cerebrocerebellar network may be hypothetically considered to form part of the executive cluster of the cerebellar cognitive affective syndrome (CCAS), a highly influential concept defined by Schmahmann and Sherman (Brain 121:561-579, 1998) on the basis of four symptom clusters grouping related neurocognitive and affective deficits (executive, visuospatial, affective, and linguistic impairments). However, since only a handful of studies have explored the possible role of the cerebellum in apraxic disorders, the pathophysiological mechanisms subserving cerebellar-induced apraxia remain to be elucidated.

Posterior fossa syndrome after cerebellar stroke.

Posterior fossa syndrome (PFS) due to vascular etiology is rare in children and adults. To the best of our knowledge, PFS due to cerebellar stroke has only been reported in patients who also underwent surgical treatment of the underlying vascular cause. We report longitudinal clinical, neurocognitive and neuroradiological findings in a 71-year-old right-handed patient who developed PFS following a right cerebellar haemorrhage that was not surgically evacuated. During follow-up, functional neuroimaging was conducted by means of quantified Tc-99m-ECD SPECT studies. After a 10-day period of akinetic mutism, the clinical picture developed into cerebellar cognitive affective syndrome (CCAS) with reversion to a previously learnt accent, consistent with neurogenic foreign accent syndrome (FAS). No psychometric evidence for dementia was found. Quantified Tc-99m-ECD SPECT studies consistently disclosed perfusional deficits in the anatomoclinically suspected but structurally intact bilateral prefrontal brain regions. Since no surgical treatment of the cerebellar haematoma was performed, this case report is presumably the first description of pure, "non-surgical vascular PFS". In addition, reversion to a previously learnt accent which represents a subtype of FAS has never been reported after cerebellar damage. The combination of this unique constellation of poststroke neurobehavioural changes reflected on SPECT shows that the cerebellum is crucially implicated in the modulation of neurocognitive and affective processes. A decrease of excitatory impulses from the lesioned cerebellum to the structurally intact supratentorial network subserving cognitive, behavioural and affective processes constitutes the likely pathophysiological mechanism underlying PFS and CCAS in this patient.

Accent attribution in speakers with Foreign Accent Syndrome.

PURPOSE: The main aim of this experiment was to investigate the perception of Foreign Accent Syndrome in comparison to speakers with an authentic foreign accent. METHOD: Three groups of listeners attributed accents to conversational speech samples of 5 FAS speakers which were embedded amongst those of 5 speakers with a real foreign accent and 5 native speaker controls. The listening panels differed in their familiarity with foreign accented speech and speech pathology. RESULTS: The findings indicate that listeners' perceptual responses to the three groups of speakers were essentially different at all levels of analysis. The native speaker controls were unequivocally recognized as native speakers of Dutch while the speakers with a real foreign accent were very reliably assessed as non-native speakers. The speakers with Foreign Accent Syndrome, however, were in some sense perceived as foreign and in some sense as native by listeners, but not as foreign as speakers with a real foreign accent nor as native as real native speakers. These results are accounted for in terms of a misinterpretation of markers of speech pathology as markers regional affiliation. CONCLUSIONS: The findings of the experiment are consistent with the idea that the very nature of the foreign accent is different in both groups of speakers, although it cannot be fully excluded that the foreign impression in the two groups is one of degree. LEARNING OUTCOMES: Readers are able to: (1) define Foreign Accent Syndrome as a motor speech disorder and identify the different subtypes of FAS, (2) describe the most important differences in listeners' perceptual reactions to FAS and real foreign accents, and (3) discuss the findings of the present study in relation to other studies investigating accent attribution in FAS.

The cerebellum: its role in language and related cognitive and affective functions.

The traditional view on the cerebellum as the sole coordinator of motor function has been substantially redefined during the past decades. Neuroanatomical, neuroimaging and clinical studies have extended the role of the cerebellum to the modulation of cognitive and affective processing. Neuroanatomical studies have demonstrated cerebellar connectivity with the supratentorial association areas involved in higher cognitive and affective functioning, while functional neuroimaging and clinical studies have provided evidence of cerebellar involvement in a variety of cognitive and affective tasks. This paper reviews the recently acknowledged role of the cerebellum in linguistic and related cognitive and behavioral-affective functions. In addition, typical cerebellar syndromes such as the cerebellar cognitive affective syndrome (CCAS) and the posterior fossa syndrome (PFS) will be briefly discussed and the current hypotheses dealing with the presumed neurobiological mechanisms underlying the linguistic, cognitive and affective modulatory role of the cerebellum will be reviewed.

Mastication dyspraxia: a neurodevelopmental disorder reflecting disruption of the cerebellocerebral network involved in planned actions.

This paper reports the longitudinal clinical, neurocognitive, and neuroradiological findings in an adolescent patient with nonprogressive motor and cognitive disturbances consistent with a diagnosis of developmental coordination disorder (DCD). In addition to prototypical DCD, the development of mastication was severely impaired, while no evidence of swallowing apraxia, dysphagia, sensorimotor disturbances, abnormal tone, or impaired general cognition was found. He suffered from bronchopulmonary dysplasia and was ventilated as a newborn for 1.5 months. At the age of 3 months, a ventriculoperitoneal shunt was surgically installed because of obstructive hydrocephalus secondary to perinatal intraventricular bleeding. At the age of 5 years, the patient's attempts to masticate were characterized by rough, effortful, and laborious biting movements confined to the vertical plane. Solid food particles had a tendency to get struck in his mouth and there was constant spillage. As a substitute for mastication, he moved the unground food with his fingers in a lateral direction to the mandibular and maxillary vestibule to externally manipulate and squeeze the food between cheek and teeth with the palm of his hand. Once the food was sufficiently soft, the bolus was correctly transported by the tongue in posterior direction and normal deglutition took place. Repeat magnetic resonance imaging (MRI) during follow-up disclosed mild structural abnormalities as the sequelae of the perinatal intraventricular bleeding, but this could not explain impaired mastication behavior. Quantified Tc-99m-ethylcysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT), however, revealed decreased perfusion in the left cerebellar hemisphere, as well as in both inferior lateral frontal regions, both motor cortices, and the right anterior and lateral temporal areas. Anatomoclinical findings in this patient with DCD not only indicate that the functional integrity of the cerebellocerebral network is crucially important in the planning and execution of skilled actions, but also seem to show for the first time that mastication deficits may be of true apraxic origin. As a result, it is hypothesized that "mastication dyspraxia" may have to be considered as a distinct nosological entity within the group of the developmental dyspraxias following a disruption of the cerebellocerebral network involved in planned actions.