The application of neuronavigated rTMS of the supplementary motor area and rhythmic speech training for stuttering intervention.

BACKGROUND: Stuttering, a neurodevelopmental speech fluency disorder, is associated with intermittent disruptions of speech-motor control. Behavioural treatments for adults who stutter (AWS) concentrate on adopting speech patterns that enhance fluency, such as speaking rhythmically or prolonging speech sounds. However, maintaining these treatment benefits can be challenging. Neuroimaging studies suggest that supplementary motor area (SMA) which play a crucial role in speech initiation, planning and internal timing shows aberrant activation in speech production of AWS and may contribute to stuttering. Preliminary evidence suggests that brain stimulation may impact responsiveness to behavioural treatments. AIMS: The present study aims to investigate whether excitatory repetitive transcranial magnetic stimulation (rTMS) of the SMA and rhythmic speech can consistently reduce stuttering severity across various measures. METHODS AND PROCEDURES: Ten self-identified Cantonese-speaking AWS participated in this double-blinded, sham-controlled clinical trial study (NCT05472181). The participants underwent 10 sessions of rhythmic speech training across two phases, combined with either neuronavigated rTMS or sham, with a 2-week washout period between phases. The stuttering severity was assessed through various outcome measures, including the percentage of syllables stuttered, self-perceived stuttering severity, and the brief version of Unhelpful Thoughts and Beliefs About Stuttering before and after each treatment phase. OUTCOMES AND RESULTS: Results demonstrated improved speech fluency in various speaking contexts, with no significant difference between rTMS and sham conditions immediately and 1 week post-treatment. Notably, rTMS specifically led to less stuttering in tongue twister production (d = -0.70). Both treatment conditions effectively reduced self-perceived stuttering severity and negative thoughts and beliefs about stuttering. CONCLUSIONS AND IMPLICATIONS: The findings of this study indicate that stimulating the SMA reduced stuttering, only in the production of tongue twisters that may require greater motor control and coordination. Furthermore, it indicates that rhythmic speech might help alleviate negative beliefs and anxiety related to stuttering. This research contributes to our understanding of neuromodulation in stuttering treatment and the role of the SMA in speech motor control and emphasises the need for more research on the potential benefits and limitations of applying rTMS in this condition. WHAT THIS PAPER ADDS: What is already known on the subject Behavioural treatments for adults who stutter concentrate on adopting speech patterns that enhance fluency, such as speaking rhythmically or prolonging speech sounds. However, maintaining these treatment benefits can be challenging. Neuroimaging studies indicate that aberrant neural activation in speech production regions, like the supplementary motor area (SMA), is involved in stuttering. The SMA plays a crucial role in initiating, planning, and sequencing motor behaviours. Preliminary evidence suggests that brain stimulation (e.g., transcranial direct current stimulation or transcranial magnetic stimulation) may impact responsiveness to behavioural treatments. What this paper adds to existing knowledge There is limited knowledge regarding the potential effects of stimulating the SMA to enhance speech fluency in people who stutter. Existing research primarily consists of single case studies that lack proper control conditions or involve only a single stimulation session. Due to their limited scope and power, these studies may not provide sufficient evidence. The current study expands upon existing research by investigating whether multiple sessions of repetitive transcranial magnetic stimulation over the SMA, combined with rhythmic speech, improve speech fluency in adults who stutter. Furthermore, it addresses the limitations of brain stimulation methods and proposes directions for future research. What are the potential or actual clinical implications of this work? This study implies that the stimulation of SMA reduced stuttering only in speaking contexts that may require greater motor control and coordination such as tongue twisters. Additionally, the research suggests that using rhythmic speech could potentially alleviate negative beliefs and anxiety associated with stuttering.

Manifestation of speech disfluencies in preschool Cantonese-English speaking bilingual children.

Stuttering is characterised by disruptions in speech fluency that normally emerges between the ages of 2 to 5 when children start to formulate sentences. Current stuttering identification in children is largely based on speech disfluency criteria (>3% stuttering-like disfluencies, SLDs) developed for monolingual English-speaking children. Research in a Western language context shows that application of the criteria for monolingual to bilingual children may result in false positive diagnosis of stuttering. The applicability of these criteria to children speaking languages typologically distinct from English remains unclear. This preliminary study focused on bilingual Cantonese-English-speaking children, aiming to explore the manifestations of the speech disfluencies in Cantonese (a syllable-timed language) and English (a stress-timed language) while accounting for language dominance/proficiency and speaking task. Nineteen typically fluent Cantonese-English bilingual preschoolers were recruited for this study and their speech samples were collected across different speaking tasks (i.e. conversation and narration), and languages (i.e. Cantonese and English). The types and frequency of speech disfluencies were compared across both languages and the speaking tasks. The results showed that between 21-68% of children showed higher than 3% SLDs across different languages and speaking tasks. Linear mixed-effect analysis revealed that the prevalence of SLDs is higher in English (less dominant language) than Cantonese (more dominant language), and the prevalence is also higher in narration than conversation. These findings suggest the need for tailored stuttering identification criteria for bilingual children speaking diverse languages and emphasise the importance of considering language dominance/proficiency and speaking task when assessing stuttering in bilingual populations.

Reading and listening comprehension in Cantonese-speaking people with right hemisphere versus left hemisphere brain damage.

The problem in language comprehension in people with right hemisphere damage (RHD) is more equivocal than people with left hemisphere damage. This study explores the reading and listening comprehension of Cantonese-speaking individuals with RHD, left hemisphere damage, and neurotypical healthy controls using the Cantonese Computerized Revised Token Test (CRTT-Cantonese) adapted from the English CRTT. Eighteen native Cantonese-speaking individuals with RHD, 32 individuals with left hemisphere damage and aphasia (PWA), and 42 healthy controls participated in this study. All the participants completed the Cantonese Aphasia Battery, Hong Kong Oxford Cognitive Screen, the listening comprehension version of CRTT-Cantonese (CRTT-L-Cantonese), and the reading comprehension version of CRTT-Cantonese (CRTT-R-WF-Cantonese) across different sessions. Linear mixed-effect analysis revealed significant differences among the groups in CRTT-Cantonese tests. However, there were no significant difference between CRTT-L-Cantonese and CRTT-R-WF-Cantonese within the PWA, RHD and healthy control groups. Tukey post-hoc pairwise comparisons showed that PWA scored significantly lower than RHD and healthy control groups (p < 0.0001) in both CRTT-L-Cantonese and CRTT-R-WF-Cantonese, and the RHD group scored significantly lower than healthy control group only on the CRTT-R-WF-Cantonese. The results demonstrate that the CRTT-L-Cantonese and CRTT-R-WF-Cantonese differentiate language comprehension abilities among PWA, RHD and healthy control groups. Although the current findings did not show any diversion between reading and listening comprehension in RHD group, this group showed poorer performance in reading comprehension when compared to healthy controls. The latter findings may support the view that the right hemisphere contributes to reading comprehension in Chinese.

Exogenous verbal response inhibition in adults who do and do not stutter.

INTRODUCTION: Behavioral and questionnaire-based studies suggest that children who stutter (CWS) exhibit poorer response inhibition than children who do not stutter (CWNS). However, the behavioral findings in adults who stutter (AWS) are less unequivocal and mainly based on manual response inhibition. Further study is therefore needed, especially given the lack of studies on verbal response inhibition among these groups. METHODS: Thirteen AWS and 14 adults who do not stutter (AWNS) participated in a verbal stop signal task (SST) in which they were asked to read aloud six Chinese characters as fast as possible during the go-signal and ignore-signal trials and refrain from naming them during the stop-signal trials. RESULTS: The two groups showed a comparable response reaction time in the go-signal and ignore-signal trial conditions. Furthermore, there were no significant differences in terms of the stop-signal reaction time (SSRT) and accuracy. However, a significant positive correlation was found between SSRT and the frequency of stuttering in conversation but not in reading. CONCLUSION: Current findings seem to provide additional support that exogenously triggered response inhibition among AWS does not differ from AWNS. The association between stuttering frequency and SSRT seems to suggest that individuals with more severe stuttering in conversational speech have reduced exogenous response inhibition. However, this finding needs to be further explored in future studies using different measures of stuttering severity.

Impaired Categorical Perception of Speech Sounds Under the Backward Masking Condition in Adults Who Stutter.

PURPOSE: Evidence increasingly indicates that people with developmental stuttering have auditory perception deficits. Our previous research has indicated similar but slower performance in categorical perception of the speech sounds under the quiet condition in children who stutter and adults who stutter (AWS) compared with their typically fluent counterparts. We hypothesized that the quiet condition may not be sufficiently sensitive to reveal subtle perceptual deficiencies in people who stutter. This study examined this hypothesis by testing the categorical perception of speech and nonspeech sounds under backward masking condition (i.e., a noise was presented immediately after the target stimuli). METHOD: Fifteen Cantonese-speaking AWS and 15 adults who do not stutter (AWNS) were tested on the categorical perception of four stimulus continua, namely, consonant varying in voice onset time (VOT), vowel, lexical tone, and nonspeech, under the backward masking condition using identification and discrimination tasks. RESULTS: AWS demonstrated a broader boundary width than AWNS in the identification task. AWS also exhibited a worse performance than AWNS in the discrimination of between-category stimuli but a comparable performance in the discrimination of within-category stimuli, indicating reduced sensitivity to sounds that belonged to different phonemic categories among AWS. Moreover, AWS showed similar patterns of impaired categorical perception across the four stimulus types, although the boundary location on the VOT continuum occurred at an earlier point in AWS than in AWNS. CONCLUSIONS: The findings provide robust evidence that AWS exhibit impaired categorical perception of speech and nonspeech sounds under the backward masking condition. Temporal processing (i.e., VOT manipulation), frequency/spectral/formant processing (i.e., lexical tone or vowel manipulations), and nonlinguistic pitch processing were all found to be impaired in AWS. Altogether, the findings support the hypothesis that AWS might be less efficient in accessing the phonemic representations when exposed to a demanding listening condition. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20249718.

Developing psycholinguistic norms for action pictures in Cantonese.

The purpose of this study was to establish psycholinguistic norms for 249 action pictures in Cantonese, a language with few norms available. We provide normative data for rated visual complexity, rated age of acquisition, name agreement, word frequency and rated familiarity in this study. Forty participants were recruited to participate in both timed picture naming and rating experiments. The linear mixed effect analysis revealed that familiarity, visual complexity, and name agreement were significant predictors of action naming in Cantonese. However, AoA did not show any significant effect on action naming, which is consistently observed in previous studies of action picture naming in Chinese. The possible explanation for null effect of AoA on naming latency are discussed. This set of psycholinguistic norms in Cantonese could serve as a valuable resource for future psycholinguistic, neurolinguistic and clinical studies in Cantonese.

Early Auditory Event-Related Potentials Are Modulated by Alphabetic Literacy Skills in Logographic Chinese Readers.

The acquisition of an alphabetic orthography transforms speech processing in the human brain. Behavioral evidence shows that phonological awareness as assessed by meta-phonological tasks like phoneme judgment, is enhanced by alphabetic literacy acquisition. The current study investigates the time-course of the neuro-cognitive operations underlying this enhancement as revealed by event-related potentials (ERPs). Chinese readers with and without proficiency in Jyutping, a Romanization system of Cantonese, were recruited for an auditory onset phoneme judgment task; their behavioral responses and the elicited ERPs were examined. Proficient readers of Jyutping achieved higher response accuracy and exhibited more negative-going ERPs in three early ERP time-windows corresponding to the P1, N1, and P2 components. The phonological mismatch negativity component exhibited sensitivity to both onset and rhyme mismatch in the speech stimuli, but it was not modulated by alphabetic literacy skills. The sustained negativity in the P1-N1-P2 time-windows is interpreted as reflecting enhanced phonetic/phonological processing or attentional/awareness modulation associated with alphabetic literacy and phonological awareness skills.

The Effect of Orthographic Transparency on Auditory Word Recognition Across the Development of Reading Proficiency.

A question under debate in psycholinguistics is the nature of the relationship between spoken and written languages. Although it has been extensively shown that orthographic transparency, which varies across writing systems, strongly affects reading performance, its role in speech processing is much less investigated. The present study addressed this issue in Persian, whose writing system provides a possibility to assess the impact of orthographic transparency on spoken word recognition in young children at different stages of reading acquisition. In Persian, the long vowels are systematically present in the script, whereas the spelling correspondence of short vowels is progressively omitted from the script in the course of reading acquisition, thus, turning transparent into opaque spelling. Based on this unique characteristic, we tested 144 monolingual Persian-speaking nonreaders (i.e., preschoolers) and readers (second graders to fifth graders and young adults) in an auditory lexical decision task using transparent and opaque words. Overall, the results showed that, in accordance with the fact that the diacritics of short vowels are progressively omitted during the second year of schooling, the stimuli containing short vowels (opaque words) were recognized more slowly than transparent ones in third graders. Interestingly, there is a hint that the emergence of the transparency effect in the third graders was associated with an overall slower recognition speed in this group compared to their younger peers. These findings indicate that learning opaque spelling-sound correspondence might not only generate interference between the two language codes but also induce a general processing cost in the entire spoken language system.

Picture naming in bilingual and monolingual Chinese speakers: Capturing similarity and variability.

Picture-naming latency differs across languages in bilingual speakers. We compared the effects of key psycholinguistic variables on picture naming among two groups of Chinese bilingual speakers and Mandarin monolingual speakers. First, we asked bilingual and monolingual speakers to estimate the age of acquisition, familiarity, visual complexity, name agreement, and imageability of a set of object and action pictures in Mandarin and Cantonese. Next, we recruited 60 Cantonese-English speakers, 50 Mandarin-Cantonese bilingual speakers, and 30 monolingual speakers who named the object and action pictures in Cantonese and Mandarin, respectively. We observed variability in the effects of item-level characteristics among groups, suggesting an interaction between item-level and individual-level characteristics as predicted. This variability was higher in bilingual speakers who spoke similar languages (Mandarin-Cantonese) in comparison to those speaking more distant languages (Cantonese-English). Our results suggest that monolingual norms and bilingual norms capture the same amount of variability; however, grammatical class interactions with other variables are explained differentially by the bilingual and monolingual norms. We discuss the implications of our findings in terms of norming studies for timed picture naming and effects of bilingualism on language processing.

Categorical perception of speech sounds in adults who stutter.

Stuttering is often attributed to the impaired speech production system, however, there is growing evidence implicating issues in speech perception. Our previous research showed that children who stutter have similar patterns but slower categorical perception (i.e. the ability to categorise different acoustic variations of the speech sounds into the same or different phonemic categories) compared to the children who do not stutter. This study aimed to extend our previous research to adults who stutter (AWS) using the same categorical perception paradigm. Fifteen AWS and 15 adults who do not stutter (A WNS) were recruited to complete identification and discrimination tasks involving acoustic variations of Cantonese speech sounds in four stimulus contexts: consonants (varying in voice onset times, VOTs), lexical tones, vowels and pure tones. The results showed similar categorical perception between the two groups in terms of the boundary position and width in the identification task and between-category benefits in the discrimination task. However, there were some trends for lower discrimination accuracy (overall d' scores) and slower discrimination of the between-category stimuli versus within-category stimuli for AWS than AWNS. These results partially confirm our previous finding on children in terms of a comparable pattern of categorical perception between the two groups, but slower processing speed to access the phoneme representations in speech perception among AWS than AWNS.

Development of the English Listening and Reading Computerized Revised Token Test Into Cantonese: Validity, Reliability, and Sensitivity/Specificity in People With Aphasia and Healthy Controls.

Purpose This study reports the psychometric development of the Cantonese versions of the English Computerized Revised Token Test (CRTT) for persons with aphasia (PWAs) and healthy controls (HCs). Method The English CRTT was translated into standard Chinese for the Reading-Word Fade version (CRTT-R-WF-Cantonese) and into formal Cantonese for the Listening version (CRTT-L-Cantonese). Thirty-two adult native Cantonese PWAs and 42 HCs were tested on both versions of CRTT-Cantonese tests and on the Cantonese Aphasia Battery to measure the construct and concurrent validity of CRTT-Cantonese tests. The HCs were retested on both versions of the CRTT-Cantonese tests, whereas the PWAs were randomly assigned for retesting on either version to measure the test-retest reliability. Results A two-way, Group × Modality, repeated-measures analysis of variance revealed significantly lower scores for the PWA group than the HC group for both reading and listening. Other comparisons were not significant. A high and significant correlation was found between the CRTT-R-WF-Cantonese and the CRTT-L-Cantonese in PWAs, and 87% of the PWAs showed nonsignificantly different performance across the CRTT-Cantonese tests based on the Revised Standardized Difference Test. The CRTT-R-WF-Cantonese provided better aphasia diagnostic sensitivity (100%) and specificity (83.30%) values than the CRTT-L-Cantonese. Pearson correlation coefficients revealed significant moderate correlations between the Cantonese Aphasia Battery scores and the CRTT-Cantonese tests in PWAs, supporting adequate concurrent validity. Intraclass correlation coefficient showed high test-retest reliability (between .82 and .96, p < .001) for both CRTT-Cantonese tests for both groups. Conclusions Results support that the validly translated CRTT-R-WF-Cantonese and CRTT-L-Cantonese tests significantly differentiate the reading and listening comprehension of PWAs from HCs and provides acceptable concurrent validity and high test-retest reliability for both tests. Furthermore, favorable PWA versus HC sensitivity and specificity cutoff scores are presented for both CRTT-Cantonese listening and reading tests.

Impaired processing speed in categorical perception: Speech perception of children who stutter.

There have been controversial debates across multiple disciplines regarding the underlying mechanism of developmental stuttering. Stuttering is often related to issues in the speech production system; however, the presence and extent of a speech perception deficit is less clear. This study aimed to investigate the speech perception of children who stutter (CWS) using the categorical perception paradigm to examine their ability to categorize different acoustic variations of speech sounds into the same or different phonemic categories. In this study, 15 CWS and 16 children who do not stutter (CWNS) completed identification and discrimination tasks involving acoustic variations of Cantonese speech sounds in three stimulus contexts: consonants (voice onset times, VOTs), lexical tones, and vowels. The results showed similar categorical perception performance in boundary position and width in the identification task and similar d' scores in the discrimination task between the CWS and CWNS groups. However, the reaction times (RTs) were slower in the CWS group compared with the CWNS group in both tasks. Moreover, the CWS group had slower RTs in identifying stimuli located across categorical boundaries compared with stimuli located away from categorical boundaries. Overall, the data implied that the phoneme representation evaluated in speech perception might be intact in CWS as revealed by similar patterns in categorical perception as those in CWNS. However, the CWS group had slower processing speeds during categorical perception, which may indicate an insufficiency in accessing the phonemic representations in a timely manner, especially when the acoustic stimuli were ambiguous.

Aphasia in Persian: Implications for cognitive models of lexical processing.

Current models of oral reading assume that different routes (sublexical, lexical, and semantic) mediate oral reading performance and reliance on different routes during oral reading depends on the characteristics of print to sound mappings. Studies of single cases of acquired dyslexia in aphasia have contributed to the development of such models by revealing patterns of double dissociation in object naming and oral reading skill that follow brain damage in Indo-European and Sino-Tibetan languages. Print to sound mapping in Persian varies in transparency because orthography to phonology translation depends uniquely on the presence or absence of vowel letters in print. Here a hypothesis is tested that oral reading in Persian requires a semantic reading pathway that is independent of a direct non-semantic reading pathway, by investigating whether Persian speakers with aphasia show selective impairments to object naming and reading aloud. A sample of 21 Persian speakers with aphasia ranging in age from 18 to 77 (mean = 53, SD = 16.9) was asked to name a same set of 200 objects and to read aloud the printed names of these objects in different sessions. As an additional measure of sublexical reading, patients were asked to read aloud 30 non-word stimuli. Results showed that oral reading is significantly more preserved than object naming in Persian speakers with aphasia. However, more preserved object naming than oral reading was also observed in some cases. There was a moderate positive correlation between picture naming and oral reading success (p < .05). Mixed-effects logistic regression revealed that word frequency, age of acquisition and imageability predict success across both tasks and there is an interaction between these variables and orthographic transparency in oral reading. Furthermore, opaque words were read less accurately than transparent words. The results reveal different patterns of acquired dyslexia in some cases that closely resemble phonological, deep, and surface dyslexia in other scripts - reported here in Persian for the first time.

Lexico-semantic effects on word naming in Persian: does age of acquisition have an effect?

The age of acquisition (AoA) of a word has an effect on skilled reading performance. According to the arbitrary-mapping (AM) hypothesis, AoA effects on word naming are a consequence of arbitrary mappings between input and output in the lexical network. The AM hypothesis predicts that effects of AoA will be observed when words have unpredictable orthography-to-phonology (OP) mappings. The Persian writing system is characterized by a degree of consistency between OP mappings, making words transparent. However, the omission of vowels in the script used by skilled readers makes the OP mappings of many words unpredictable or opaque. In this study, we used factor analysis to test which lexico-semantic variables, including AoA, predict the reading aloud of monosyllabic Persian words with different spelling transparencies (transparent or opaque). Linear mixed-effect regression analysis revealed that a Lexical factor (loading on word familiarity, spoken frequency, and written frequency) and a Semantic factor (loading on AoA, imageability, and familiarity) significantly predict word-naming latencies in Persian. Further analysis revealed a significant interaction between AoA and transparency, with larger effects of AoA for opaque than for transparent words and a significant interaction between imageability and AoA on reading opaque words; that is, AoA effects are more pronounced for low-imageability opaque words than for high-imageability opaque words. Interactions between these factors and spelling transparency suggest that late-acquired opaque words receive greater input from the semantic reading route. Implications for understanding the AoA effects on word naming in Persian are discussed.

Predictors of timed picture naming in Persian.

In this study, we report normative data by native Persian speakers for concept familiarity, age of acquisition (AoA), imageability, image agreement, name agreement, and visual complexity, as well as values for word frequency, word length, and naming latency for 200 of the colored Snodgrass and Vanderwart (Journal of Experimental Psychology: Human Learning and Memory 6:174-215, 1980) pictures created by Rossion and Pourtois (Perception 33:217-236, 2004). Using multiple regression analysis, we found independent effects of name agreement, image agreement, word frequency, and AoA on picture naming by native Persian speakers from Iran. We concluded that the psycholinguistic properties identified in studies of picture naming in many other languages also predict timed picture naming in Persian. Normative data for the ratings and picture-naming latencies for the 200 Persian object nouns are provided as an Excel file in the Supplemental materials.

Objective vocal parameters in Farsi-speaking adults with Down syndrome.

Previous studies have indicated significant differences in vocal parameters between children with Down syndrome and normal children. This study was performed to see whether there is a significant dissociation between normal adults and adults with Down syndrome in terms of some vocal parameters. The participants were 22 adults with Down syndrome and 22 normal adults matched for age and gender. We measured jitter, shimmer, fundamental frequency (F0), and maximum phonation time (MPT). The results showed a significantly higher F0 and a significantly lower jitter in the Down syndrome group compared to the control group, while the average amounts of MPT and shimmer were not different. Moreover, the shimmer and jitter of females in both groups were lower than those of males. These findings might be the result of a physiological retardation of the larynx rather than mental retardation in the Down syndrome population.

Diagnostic Yield of Transbronchial Needle Aspiration (TBNA) for Cases with Intra-Thoracic Lymphadenopathies.

BACKGROUND: Evaluation of the lymph nodes in cases with lung cancer for diagnosis or staging has been considered since many years ago. Various methods have been developed for obtaining a sample from lymph nodes. This study was conducted in a research institute with high patient turnover and aimed at evaluating the diagnostic yield of TBNA and effective factors on diagnosis and related complications in patients with pulmonary lesions. MATERIALS AND METHODS: Our understudy population included all patients suffering from undiagnosed intrathoracic lymphadenopathies with no accompanying pulmonary lesions on chest CT scan who had been hospitalized in Masih Daneshvari Hospital or referred to its bronchoscopy unit. After determining the anatomic location of lymphadenopathy (LAP), patients underwent fiberoptic bronchoscopy (FOB) and TBNA using 19-gauge eXcelon aspiration needle. Four samples were taken from each patient from the same LAP location. In this study, 39 patients were evaluated. RESULTS: The most common anatomic location of lymph node involvement among our understudy patients was the paratracheal area which was involved in 14 (45.2%) patients followed by subcarinal area in 12 cases (38.7%) and hilar involvement also in 12 cases (38.7%). Five patients (15.6%) had lymphadenopathies in other anatomical locations. Evaluation of the aspirates obtained by TBNA showed that the sample was adequate and diagnostic in 21 patients (55.26%), adequate but non-diagnostic in 9 patients (23.68%) and inadequate in 8 cases (21.06%). Definite diagnosis was made in 22 patients among which the most common diagnosis was atypical and malignant lesions in 11 cases (50%) followed by sarcoidosis in 8 (36.36%), tuberculosis (TB) in 2 (9.09%) and other diagnoses in 1 (4.55%) case. CONCLUSION: Based on our study results, TBNA was diagnostic in more than half the cases. Various studies have reported a wide range of results in this respect but all of them including ours emphasize on the acceptable diagnostic yield of this technique.

Investigation of the reliability of the SSI-3 for preschool Persian-speaking children who stutter.

UNLABELLED: There is a pressing need in Iran for the translation of widely used speech-language assessment tools into Persian. This study reports the interjudge and intrajudge reliability of a Persian translation of the Stuttering Severity Instrument-3 (SSI-3) (Riley, 1994). There was greater than 80% interjudge and intrajudge agreement on scale scores for Frequency and Duration, 54% interjudge and 62.2% intrajudge agreement for "Physical Concomitants" and greater than 80% interjudge and intrajudge agreement for the Overall score. In conclusion, although percentage agreement for Physical Concomitant Behaviors was low, the Persian translation of SSI-3 shows otherwise acceptable interjudge and intrajudge reliability when performed under ideal conditions. EDUCATIONAL OBJECTIVES: The reader of this article will be able to: (1) explain the process of test translation from the original language to another language; (2) summarize the process of determining interjudge and intrajudge reliability of the SSI-3 in preschoolers.

Objective voice analysis of Iranian speakers with normal voices.

OBJECTIVES: Objective measurements in general and acoustic measurements in particular have become a substantial aspect of voice assessment during the last few decades and studies have established that normative data is necessary for acoustic analysis. Voice acoustic analysis including fundamental frequency (F(0)), jitter, shimmer, harmonics-to-noise ratio (HNR), and maximum phonation time (MPT) can now be easily recorded and analyzed using a computer. Because these systems are widely used in clinical practice, this study was designed to establish the normal acoustic analysis parameters in normal Iranian adults. METHODS: A group of 90 unpaid, healthy, randomly selected subjects with normal voices (45 Iranian men and 45 Iranian women), was selected for this study. Data collection was carried out, using the Dr. Speech Software (subprogram: vocal assessment version 4.0 from Tiger Electronics) at the speech therapy clinic under comfortable phonation. Each gender was separated equally into three age subgroups. Then differences between gender and age subgroups were investigated by statistics software SPSS 13.0. RESULTS: The value of (vowels /â/ and /i/) was greater for females (214.64+/-1.16; 228.06+/-1.5 Hz) than for males (112.82+/-0.94; 126.13+/-1.49 Hz). Conversely, the value of MPT was greater for males (26.30+/-1.29 s) than for females (18.56+/-0.88 s). There were no significant differences in average shimmer and jitter between females (1.21+/-0.03%; 0.22+/-0.01%) and males (1.22+/-0.02%; 0.23+/-0.02%). However, the value of HNR was greater for females (18.81+/-0.96 dB) than for males (18.42+/-0.57 dB). CONCLUSIONS: The present study developed a body of normal data for various parameters of acoustic analysis in different age groups and genders of normal Iranian adults. It seems that the majority of voice characteristics of adults was relatively stable and did not change with aging between 20 and 50 years. However, the voice characteristics of adults older than 50 years were not recorded in this study and therefore require further investigation.

Intervention with the Lidcombe Program for a bilingual school-age child who stutters in Iran.

OBJECTIVE: In this study, the immediate and extended effects of the Lidcombe Program were investigated for the first time in Iran. Treatment in the Lidcombe Program is carried out by the child's parent (or carer) in the child's everyday environment. The program has been shown to be effective with preschool children who stutter (i.e. younger than 6 years) and to a lesser extent with older children. PARTICIPANT AND METHOD: The participant was a bilingual (Baluchi-Persian) boy aged 8 years 11 months. Treatment was conducted in both languages. Stuttering severity was measured in Baluchi with the parental rating scale, and in Persian with percentage of syllables stuttered (%SS). RESULTS: The child completed stage 1 of the program in 13 weeks. %SS was less than 1 during the last 3 clinic visits and severity ratings made by the parent indicated no stuttering (severity rating = 1) for all days of the final week. Speech recordings made beyond the clinic in both languages also indicated stuttering at below 1%SS. The child met all criteria for stage 2 in both languages, over 10 months. CONCLUSION: This case report suggests that the Lidcombe Program could be suitable for bilingual Iranian children who stutter.