A Multilinguistic Spelling Analysis of Children who are Hard of Hearing.

Spelling in writing samples was compared between children who are hard of hearing (HH) (n = 142) and their peers with typical hearing (TH) (n = 72) in second and fourth grade. The same analyses were then conducted comparing groups of children who are HH with different levels of aided audibility. Compared to children with TH, children who are HH produced fewer misspelled words (p = .041, d = .42) at second grade but performed similarly in fourth grade (p = .943, d = .02). Compared to peers with TH, children who are HH demonstrated similar distributions of errors in roots but some differences in the distribution of errors for affixes. Different levels of aided audibility among children who are HH were not associated with significant differences in spelling accuracy at both grades. However, second-grade children with poorer aided audibility produced significantly more phonological omissions (p = .005, r = .32) and orthographic consonant errors for monomorphemic words (p = .001, r = .37), as well as more orthographic consonant errors for and affixes (p = .015, r = .28).

A Hearing Screening Pilot Study With Students With Significant Cognitive Disabilities.

Purpose Many children with severe intellectual and developmental disabilities are at a higher risk for hearing loss than their peers who are typically developing. Unfortunately, they do not consistently participate in routine school-based hearing screenings. The current study investigated the feasibility of increasing their participation using an otoacoustic emissions protocol and documented results relative to student educational profiles. Method A total of 43 students with significant cognitive disabilities enrolled at a public school exclusively serving this population participated in the study. All but 9, who were excluded because of known hearing loss, were screened by a licensed audiologist assisted by audiology doctoral students. The protocol included otoscopy, tympanometry, distortion product otoacoustic emissions (DPOAEs), and teacher surveys. Results DPOAE screening was attempted on 33 students without previously diagnosed hearing loss and successfully completed for 26 (78.8%). Two students (4.6%) with absent otoacoustic emissions and normal tympanograms were referred for further assessment due to concerns about possible sensorineural hearing loss in one or both ears, and 10 (23.3%) had abnormal tympanograms in one or both ears. Conclusions Considering the high risk of sensorineural hearing loss for children with significant disabilities, it is important for them to be included in school hearing screenings. The results of this study demonstrate the feasibility of using DPOAEs for school-based hearing screenings with this population with an interprofessional team of licensed audiologists, educators, and speech-language pathologists. The results further suggest that students with significant disabilities and hearing loss may be unidentified and underserved. Given the complex needs of this population, an interprofessional practice model for hearing screenings and intervention services is recommended.

The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input.

Transactional theories of communication development focus on the interplay among child, caregiver, and environmental variables. Typically, this interplay involves symmetry between receptive and expressive modes (i.e., speech), but is asymmetrical for children with complex communication needs who hear speech but use graphic symbols expressively. Aided input, during which a communication partner points to graphic symbols while talking, may increase symmetry, but it is challenging to determine which words to represent with graphic symbols to ensure adequate aided input is provided. In this study, secondary analysis of transcripts of 16 mothers who interacted with their children with typical development across six time points (between 9 and 15 months) revealed 267 words that comprised 80% of the 257,480 words the mothers used. This list of words that mothers used most frequently was compared to three existing lists of the expressive vocabulary used most frequently by 65 toddlers and preschoolers with typical development, indicating substantial overlap. The results suggest that there is a common set of frequently occurring words that mothers use in their daily interactions with infants and toddlers, and that these same words also comprise a significant proportion of the words most frequently used by young children. Implications for representing these frequently occurring words with graphic symbols on the communication systems of children with complex communication needs are discussed.

A multilinguistic analysis of spelling among children with cochlear implants.

This study examines the spelling of nine elementary school children with cochlear implants (CIs) who use spoken language, and compares their performance with children who have typical hearing and children who are hard of hearing (HH). Compared to children with typical hearing, children with CIs did not produce a significantly different percentage of misspelled words (p = 0.431, d = 0.38), but their spelling errors comprised significantly lower percentages of homophone substitutions (p = 0.019, r = 0.61) and legal vowel errors (p = 0.011, r = 0.61). Children with CIs and children who are HH did not produce a significantly different percentage of misspelled words (p = 0.521, d = 0.31) or a significantly different distribution of categorical spelling errors. Results suggest that children with CIs utilize similar linguistic strategies as their peers who are HH but different strategies than peers with typical hearing when attempting to spell unfamiliar words.

A Multilinguistic Approach to Evaluating Student Spelling in Writing Samples.

Purpose: Spelling is a critical component of literacy and language arts that can negatively influence other aspects of written composition. This clinical focus article describes a spelling error classification system that can be used to identify underlying linguistic deficits that contribute to students' spelling errors. The system is designed to take advantage of the linguistic expertise of speech-language pathologists to efficiently assess student errors in written compositions that are generated as a component of everyday classroom instruction. Method: A review of the literature was conducted regarding spelling as a component of literacy and language arts, the development of spelling, and the linguistic contributions to spelling. Then, existing criterion-referenced measures of spelling simple and morphologically complex words were reviewed, and a new, manual technique for analyzing spelling in student written compositions was created. Conclusions: The language expertise of speech-language pathologists enables them to readily evaluate the phonological, orthographic, and morphological errors in student misspellings, in order to identify specific underlying linguistic deficits and plan targeted interventions. The error classification system provides speech-language pathologists with a tool that is both simple and time efficient and, thus, may help increase their confidence and ability in addressing the spelling needs of students.

The Profiles of Students With Significant Cognitive Disabilities and Known Hearing Loss.

The present study describes the characteristics of students in Grades 3-12 with significant cognitive disabilities (SCD) and known hearing loss. The study analyzed results of a survey of teachers of students with SCD (n = 38,367) who were slated to participate in an alternate assessment based on alternate achievement standards in 14 states in the United States. Analysis revealed similar profiles in academic achievement and symbolic language use combined with an increased incidence of additional sensory impairments among students with SCD and known hearing loss compared to their peers without known hearing loss. Results suggest that hearing loss may be underidentified and underserved among students with SCD and point to the need for improved hearing screenings and evaluations combined with services delivered by teams that follow a model of interprofessional practice.

Alternative foot placements for individuals with spinal cord injuries standing with the assistance of functional neuromuscular stimulation.

This study investigated the effects of altering foot placement for two individuals with spinal cord injuries (SCI) that stood using functional neuromuscular stimulation (FNS) as compared to an able-bodied subject group. FNS-assisted standers used parallel bars as needed for support, while the able-bodied group stood hands-free. Three different foot placements were tested: side-by-side, wide, and modified tandem. For SCI subjects, the percentage of body weight loaded on the feet was not greatly affected by foot placement, which potentially could be altered to provide postural benefits during functional tasks. Anterior/posterior (A/P) center of pressure (COP) origins tended to be located more anterior in the base of support for SCI subjects as compared to able-bodied subjects. SCI subjects also tended to have medial/lateral (M/L) COP excursions that were larger than able-bodied subjects. The sacrum appeared to hold some promise as a sensor location for monitoring A/P postural sway, but movements in the M/L direction were inconsistent and will require additional study. General guidelines such as positioning the A/P COP more posterior in the base of support and feedback concerning excessive M/L COP displacements may be useful to improve standing performance for SCI subjects. In addition, the modified tandem placement was an effective alternative for making postural adjustments in one SCI subject who experienced excessive right knee flexion with other foot placements.

The effect of a single treatment of the Protonics system on lower extremity kinematics during gait and the lateral step up exercise.

INTRODUCTION: Patellofemoral pain (PFP) is often attributed to abnormal patellar tracking. The Protonics knee orthosis was developed to reduce femoral internal rotation by altering pelvic alignment via hamstring activation. The purpose of this research was to determine if a single treatment with the orthosis improved lower extremity alignment during gait and the lateral step up exercise. We hypothesized that anterior pelvic tilt, hip internal rotation and adduction, and external rotation of the tibia with respect to the femur would decrease after use of the brace. METHODS: Nineteen females (23.4+/-3.1 year, 1.66+/-0.05 m, 65.3+/-20.4 kg) with chronic PFP participated. Three-dimensional kinematic data were collected for each subject at 60 Hz during pre-treatment (PRE), after a placebo condition with the orthosis set at zero resistance (PLAC), and post-treatment (POST). Treatment consisted of having the subject perform the rehabilitation exercises recommended by the Protonics manufacturer. A repeated measures ANOVA was performed on each dependent variable (alpha=0.05). RESULTS: This investigation did not verify the changes in alignment proposed by the manufacturer as a result of acute application of the Protonics system. However, after the use of the brace, pelvic rotation and hip hike were decreased during the lateral step up exercise. CONCLUSION: Based on the results of this study, it was concluded that a single application of the Protonics system did not alter anterior pelvic tilt, hip internal rotation and adduction, or tibial external rotation during the lateral step up and gait.

The effect of a single treatment of the Protonics system on biceps femoris and gluteus medius activation during gait and the lateral step up exercise.

INTRODUCTION: Patellofemoral pain, a frequent complaint among women, is attributed in part to excessive femoral internal rotation, leading to patellofemoral malalignment. The Protonics resistive dynamic knee orthosis was designed to facilitate hamstring activation, leading to a less anteriorly tilted pelvis and less femoral internal rotation. This decrease in femoral internal rotation is thought to improve patellofemoral joint alignment, thereby reducing knee pain. In this position, the gluteus medius (GM) would be more effective against the force of gravity. Therefore, this study's purpose was to determine the effects of a single application of the Protonics orthosis on knee pain and biceps femoris (BF) and GM activation. METHODS: 21 females (23.4+/-3.1 years, 1.66+/-0.05 m, 65.3+/-20.4 kg) with a history of chronic PFP participated in the study. Data were collected during level walking and a lateral-step up exercise in three conditions: pre-treatment (PRE), a placebo condition collected after the orthosis was set at zero resistance (PLAC), and post-treatment (POST). PLAC and POST were performed after the orthosis had been removed from the subject's leg. Percent of gait cycle activated, integrated EMG (IEMG), and level of pain (VAS scale) were measured in each condition. An ANOVA was used to determine significance between conditions (alpha=0.05). RESULTS: Use of the Protonics orthosis did not result in any change in the level of knee pain, IEMG or duration of activation for the BF or GM. SUMMARY: Our results do not support an increase in hamstring activation or decrease in GM activation following a single treatment with the Protonics orthosis.

Center of pressure measures to assess standing performance.

Functional neuromuscular stimulation (FNS) systems have provided individuals with spinal cord injury (SCI) varying levels of standing capability. Our long-term goal is to enhance an FNS user's ability to perform activities of daily living by providing sufficient standing stability. However, control of standing posture with complete SCI is compromised by a lack of sensory feedback from receptors in the feet. The goals of this study were: a) to document a variety of center of pressure (COP) measures during standing, b) to compare able-bodied and FNS standing, and c) to relate various measures to overall quality of standing performance. Two subjects with complete SCI that stand with FNS (one with a surface system and one with an implanted stimulation system) and five able-bodied subjects stood quietly on force platforms. Reduced hand support forces were coincident with anterior/posterior (A/P) mean COPs that were further posterior in the base of support and medial/lateral (M/L) mean COPs that were more centered between the feet. In addition, M/L COP excursions, maximum A/P COP velocities, and maximum M/L COP velocities were all significantly greater for FNS users than for able-bodied standers. Furthermore, maximum A/P COP velocities and mean A/P COP frequencies were significantly greater during FNS standing trails that required increased support from the hands. COP measures such as these may be useful tools to assess standing performance and to determine strategies for adjusting posture that can reduce an FNS user's reliance on upper extremity support while maintaining stable balance.

Acute effects of the Protonics system on patellofemoral alignment: an MRI study.

This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral alignment occur after initial treatment with the Protonics exercise device. The first scan was obtained before the device was used. After performing a set of exercises with no resistance on the device the device was removed, and a second scan was obtained. The same set of exercises was again performed with resistance on the device set at the appropriate level, and a final scan was obtained with the device removed. An isometric leg press was maintained as each image was obtained to simulate more closely a functional weight-bearing activity. Subjects were 26 women with complaints of patellofemoral pain. The main outcome measures were: patellar tilt angle, bisect offset, and lateral facet angle. Nonparametric repeated measures analysis of variance tests showed no differences between test conditions for any of the three measures of patellofemoral alignment. We conclude that after an initial treatment session using the Protonics system there is no change in patellofemoral alignment as determined by MRI.