Content and Perceived Utility of Mental Imagery by Older Adults in a Peer-Delivered Physical Activity Intervention.

Imagery interventions intended to increase exercise behavior are rare. The Active Adult Mentoring Program (AAMP) was a randomized controlled trial with imagery content. The purposes of this study were to examine the content and perceived utility of mental imagery with 24 AAMP participants (Mage = 65.00, SD = 8.79 years). Digital recordings of AAMP sessions and post-intervention interviews were content-analyzed. Emergent themes included images of the physical activity context and negative impressions about imagery. Post-intervention interviews revealed that 13 participants reported positive experiences using mental imagery while 9 would not engage in further use. Important implications are discussed.

Tongue reduction for macroglossia in Beckwith Wiedemann syndrome: review and application of new technique.

Beckwith Wiedemann syndrome (BWS) is a rare, congenital overgrowth disorder that is characterized by macroglossia, anterior abdominal wall defects, visceromegaly, gigantism, and neonatal hypoglycaemia. Macroglossia may contribute to anterior open bite malocclusion with prognathism, speech articulation disturbances, drooling and the perception of intellectual disability. It was the purpose of this study to review a series of BWS patients who underwent surgical reduction of the tongue by a modified technique with respect to aesthetic and functional outcomes. Seven BWS patients, age 6 months to 21 months, had a 'stellate/anterior wedge' reduction with an anterior rotation flap and were followed up from 4 months to 9 years postoperatively. Assessment of aesthetics together with tongue morphology and mobility were recorded and a postoperative speech evaluation was performed. Minor contour deformities were present in two patients during function but all parents were satisfied with the results. The speech pathology assessment results indicated positive outcomes for speech, oral structure and function, and feeding for all children assessed. This modified technique allows for an adequate reduction of tongue volume with conservation of motor and sensory function as well as preservation of anatomical contour.

Endophenotypes of FOXP2: dysfunction within the human articulatory network.

The identification of the first gene involved in a speech-language disorder was made possible through the study of a British multi-generational family (the "KE family") in whom half the members have an inherited speech-language disorder caused by a FOXP2 mutation. Neuroimaging investigations in the affected members of the KE family have revealed structural and functional abnormalities in a wide cortical-subcortical network. Functional imaging studies have confirmed dysfunction of this network by revealing abnormal activation in several areas including Broca's area and the putamen during language-related tasks, such as word repetition and generation. Repeating nonsense words is particularly challenging for the affected members of the family, as well as in other individuals suffering from idiopathic developmental specific language impairments; yet, thus far the neural correlates of the nonword repetition task have not been examined in individuals with developmental speech and language disorders. Here, four affected members of the KE family and four unrelated age-matched healthy participants repeated nonsense words aloud during functional MRI scanning. Relative to control participants, repetition in the affected members was severely impaired, and brain activation was significantly reduced in the premotor, supplementary and primary motor cortices, as well as in the cerebellum and basal ganglia. We suggest that nonword repetition is the optimal endophenotype for FOXP2 disruption in humans because this task recruits brain regions involved in the imitation and vocal learning of novel sequences of speech sounds.

Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour.

Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time post-surgery=6y10m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children.

Re-thinking diagnostic classification of the dysarthrias: a developmental perspective.

Acquired childhood dysarthria (ACD) receives little attention in the research literature in contrast with the adult correlate of the disorder. Speech language pathologists working in this field find diagnosis and management challenging, arguably because there is no child-based dysarthria diagnostic classification. Clinicians are either dependent upon developmental speech models that are not specific to dysarthria and that ignore the neural basis of the disorder, or on adult-based neurobehavioural classification systems. Here we consider the necessary elements for developing a clinically useful and empirically driven diagnostic classification system for ACD. The paper is divided into 2 parts. First, we question whether an adult diagnostic model can be validly applied to children. Second, we propose a methodological approach to develop a classification system for ACD. Specifically, we propose that advancing knowledge in neurobehavioural correlations of ACD is contingent upon large-scale studies, likely requiring international collaboration, which pool brain and speech outcome data. Ideally, researchers across centres would apply standard protocols to: (1) characterize speech behaviour, and (2) brain structure, function and connectivity. When enough data is available to achieve statistical power, analysis could determine subgroups of dysarthria defined by speech behaviour. The commonalities of neural profiles of subgroups could then be examined to create an empirically driven theory of brain-behaviour relationships in ACD to underpin the classification system. Clinical diagnosis for children with ACD will remain limited until such data become available.

Incidence and clinical presentation of dysarthria and dysphagia in the acute setting following paediatric traumatic brain injury.

BACKGROUND: A lack of data on dysarthria and dysphagia outcomes for children following traumatic brain injury (TBI) limits our clinical evidence base, and poses daily challenges for the speech language pathologist (SLP) managing this group. The present study aimed to examine dysarthria and dysphagia incidence and the clinical presentation of children with these disorders in the acute phase following TBI. METHODS: Incidence and characteristics were determined via a comprehensive retrospective medical chart review of children consecutively referred to a tertiary paediatric hospital over an 8-year period. Cases (n= 22 dysarthria, n= 72 dysphagia) and matched controls were compared across ancillary variables (e.g. age, severity of TBI, motor impairment). RESULTS: Incidence across the entire cohort was low [i.e. dysarthria (1.2%, 22/1895), dysphagia (3.8%, 72/1895)], but was markedly higher for the sub-category of children with severe TBI [e.g. dysphagia (76%, 63/83)]. Speech deficits were reported across respiration, phonation, resonance, articulation and prosody. Swallowing deficits included reduced lip closure, delayed swallow initiation, wet voice and coughing. Language and swallowing deficits were often co-morbid with dysarthria. Motor impairment was frequently co-morbid with both dysarthria and dysphagia. Cases had longer periods of hospitalization, ventilation and supplementary feeding compared with controls. CONCLUSION: Despite the low incidence of dysarthria and dysphagia across the entire TBI cohort, this sub-group may place longer-term burden on SLP services, having prolonged periods of ventilation, extended periods of hospitalization and a complex co-morbid clinical presentation compared with controls. The prevalence of co-morbid communication and swallowing impairments suggests a need for integrated rather than single discipline (i.e. dysphagia stream only) SLP services.

A Cochrane review of treatment for dysarthria following acquired brain injury in children and adolescents.

BACKGROUND: The expression ''acquired brain injury'' (ABI) incorporates a range of etiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the pediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children. OBJECTIVES: The aim of this study was to assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury. METHODS: Several electronic databases were searched up to January 2007. The review considered randomised controlled trials (RCTs) and quasi-randomised studies of children aged 3 to 16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident). Both authors independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria. RESULTS: Of 2091 titles and abstracts identified, full text versions of only three were obtained. The remaining 2 088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. All obtained articles were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria. CONCLUSIONS: The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include 1) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; 2) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and 3) the heterogeneity of both the etiologies and resultant possible dysarthria types of pediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialled in multicentre collaborations using quasi-randomised or RCT methodology.

A Cochrane review of treatment for childhood apraxia of speech.

BACKGROUND: The diagnosis of Childhood Apraxia of Speech (CAS) remains heavily debated, and there is no agreement upon the etiology for the disorder. Whilst there is some consensus on the potential broad array of presenting features of children with CAS, only three key features are recognised as ubiquitous for diagnosis: 1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words; 2) lengthened and impaired coarticulatory transitions between sounds and syllables; and 3) inappropriate prosody. Despite the typically severe and complex presentation of CAS, there is little evidence reported on intervention approaches for the disorder, perhaps as a result of the ongoing deliberation over etiology and diagnosis. OBJECTIVES: The aim of this paper was to assess the efficacy of intervention delivered by Speech and Language Pathologists(s)/Speech and Language Therapists targeting CAS in children and adolescents. METHOD: Several electronic databases were searched up to January 2007. The review considered randomised controlled trials (RCTs) and quasi-randomised studies of children aged 3 to 16 years with CAS, grouped by treatment types (e.g., perceptual and instrumentally-based biofeedback treatment techniques). Two authors independently assessed references identified from the searches and obtained full text versions of all potentially relevant articles. RESULTS: Of 825 titles and abstracts searched, only 31 abstracts appeared to meet inclusion criteria. The remaining 794 papers were excluded predominantly on the basis of not including participants with CAS (e.g., focused on other developmental speech disorders or adult acquired apraxia of speech), or for not being intervention studies (i.e. being diagnostic or descriptive). All 31 full text articles obtained were excluded following evaluation as they did not meet inclusion criteria on design. CONCLUSION: The review demonstrates a critical lack of well controlled treatment studies addressing treatment efficacy for CAS, making it impossible for conclusions to be drawn about which interventions are most effective for treating CAS in children or adolescents.

The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia.

PURPOSE: Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding. METHODS: Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9; 7-15; 11 years) and nine control participants matched for age (9; 5-16; 0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry. RESULTS: A statistically significant difference was found in SpO2 levels between the two groups (p < 0.001) during oral feeding only (sensitivity, 88.9%; specificity, 88.9%). Only three children with dysphagia experienced 'events' of SpO2 desaturation during feeding. CONCLUSION: Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.

Electropalatography treatment for articulation impairment in children with dysarthria post-traumatic brain injury.

PRIMARY OBJECTIVE: Dysarthria with severe articulatory impairment is a common and debilitating sequelae following severe traumatic brain injury (TBI). Eectropalatography (EPG) is an instrumental treatment technique allowing visual feedback of tongue to palate movement during real time articulation. The present study investigated the effectiveness of EPG in treating the articulatory component of dysarthria post-TBI. STUDY DESIGN/METHODS: The articulatory component of dysarthria post-TBI was treated once per week with EPG over a 10-week period in three adolescents (aged 14 years 10 months-15 years 1 month). A multiple case series ABA treatment design was used. Perceptual (articulation, intelligibility) and EPG (spatial, durational) assessments were conducted pre- and post-treatment to determine outcome. RESULTS/DISCUSSION: Perceptual improvement was noted for phoneme precision and length. Spatial EPG measures confirmed increased precision of phoneme production. No clear pattern of change for phoneme duration occurred. Intelligibility increased at word and sentence level, with little change reported in everyday speech intelligibility. CONCLUSION: This preliminary study indicates that EPG treatment may be effective for improving speech at the isolated phoneme, word or sentence level of articulation. These preliminary results are encouraging, being the first study to report speech changes post-treatment in participants with severe TBI and persistent dysarthria. Further research is required, however, in order to understand the regenerative capacity of articulatory function post-brain injury and to determine optimal treatment parameters for achieving generalization of therapy to everyday connected speech.