A selective morpho-phonological deficit?

We report on an English-speaking, aphasic individual (TB) who showed a striking dissociation in speaking with the different forms (allomorphs) that an inflection can take. Although very accurate in producing the consonantal inflections (-/s/, -/z/, -/d/, -/t/), TB consistently omitted syllabic inflections (-/əz/, -/əd/), therefore correctly saying "dogs" or "walked," but "bench" for benches or "skate" for skated. Results from control tests ruled out that TB's selective difficulties stemmed from problems in selecting the correct inflection for the syntactic context or problems related to phonological or articulatory mechanisms. TB's selective difficulties appeared instead to concern morpho-phonological mechanisms responsible for adapting morphological elements to word phonology. These mechanisms determine whether the plural inflection surfaces in the noun bench as voiced (-/z/), unvoiced (-/s/) or syllabic (-/əz/). Our results have implications for understanding how morphological elements are encoded in the lexicon and the nature of morpho-phonological mechanisms involved in speech production.

It takes two: the role of family-centered practices in communication intervention / Se necesitan 2: el papel de las prácticas centradas en la familia en intervención de la comunicación

Based on an ever-growing body of research, family-centered practices are a recommended, evidence-based principle of early childhood intervention provided by speech-language pathologists and audiologists, as well as by all other disciplines involved in providing supports and services to young children with delays and disabilities and their families. Despite this, research also suggests that (1) the concept of family-centered practices is often misunderstood, and (2) a gap continues to exist between recommended and the actual use of family-centered practices across all disciplines. In this article, we describe the evidence behind family-centered practices, how and why family-centered practices have become a key aspect of evidence-based early childhood communication intervention, and the defining characteristics and components of family-centered practices. In order to accomplish this goal the authors did an extensive research review of the literature. As a result of findings from the studies revised, the role of the SLP in early childhood intervention is calling for a shift from direct work with an individual child to teaching, supporting, and building the capacity of the child's communication partners, with the ultimate goal of the child becoming more successful in how he/she participates and communicates in interactions and routines throughout the day and within natural contexts. These recommendations have been incorporated by important scientific and professional organizations such as the American Speech-Language-Hearing Association in their guidelines for providing early evidence-based communication intervention. Concluding we underlined the importance of viewing family centered practices as a capacity-building endeavor required for quality EI practices (AU)

Apoyadas en un cuerpo cada vez mayor de investigación, las prácticas centradas en la familia y basadas en la evidencia constituyen un principio de intervención recomendado para la logopedia y audiología y otras disciplinas que intervienen proporcionando apoyos y servicios a niños con retrasos y discapacidad y a sus familias. Sin embargo, la investigación sugiere que 1) el concepto de prácticas centradas en la familia es a menudo mal entendido, y 2) continúa existiendo un desfase entre las recomendaciones y el uso real de las prácticas centradas en la familia en todas las disciplinas. En este artículo se describe la evidencia detrás de las prácticas centradas en la familia, cómo y por qué estas prácticas se han convertido en un aspecto clave para la intervención en la comunicación en la primera infancia, y las características que la definen y componen. Con el fin de lograr este objetivo los autores hicieron una extensa revisión de la literatura. Como resultado de los hallazgos de los estudios revisados se está pidiendo un cambio en el papel de los logopedas de atención temprana, que va desde un trabajo directo con un niño a la enseñanza, apoyo y fortalecimiento de la capacidad de comunicación de los padres, con el objetivo final de que el niño tenga cada vez más éxito en la forma en que él/ella participa y se comunica en las interacciones y las rutinas durante el día y en los contextos naturales. Estas recomendaciones han sido incorporadas por las organizaciones científicas y profesionales más importantes, tales como la Asociación Americana de Habla, Lenguaje y Audición, quien las incluye en sus guías para proporcionar intervención temprana basada en la evidencia en la comunicación. Para concluir, se ha subrayado la importancia de considerar las prácticas centradas en la familia como un esfuerzo de construcción de capacidades requerido para una práctica de intervención temprana de calidad (AU)

Lingual frenectomy and alveolar tap production: an acoustic and perceptual study.

In this phonetic study, productions of the consonant in the stressed syllable position of the word arara as produced by 13 subjects with short and/or anterior lingual frenulum were compared before and after lingual frenectomy. The results from the measurement of the stressed consonant duration and from the identification of the consonant manners of articulation based on the inspection of spectral characteristics are discussed and related to the answers to a perceptual identification test. After surgery, the number of tap productions did not increase, but alveolar productions did. These clinically relevant findings show frenectomy improved tongue mobility, but, as temporal controls were not totally re-established after surgery and 6-month speech therapy sessions, the production of the alveolar tap remained largely unchanged.

Non-focal neurological symptoms associated with classical presentations of transient ischaemic attack: qualitative analysis of interviews with patients.

BACKGROUND: Improving the recognition of transient ischaemic attack (TIA) at initial healthcare contact is essential as urgent specialist assessment and treatment reduces stroke risk. Accurate TIA detection could be achieved with clinical prediction rules but none have been validated in primary care. An alternative approach using qualitative analysis of patients' experiences of TIA may identify novel features of the TIA phenotype that are not detected routinely, as such techniques have revealed novel early features of other important conditions such as meningococcaemia. We sought to determine whether the patient's experience of TIA would reveal additional deficits that can be tested prospectively in cohort studies to determine their additional diagnostic and prognostic utility at the first healthcare contact. METHODOLOGY AND FINDINGS: Qualitative semi-structured interviews with 25 patients who had experienced definite TIA as determined by a stroke specialist; framework analysis to map symptoms and key words or descriptive phrases used against each individual, with close attention to the detail of the language used. All interview transcripts were reviewed by a specialist clinician with experience in TIA/minor stroke. Patients described non-focal symptoms consistent with higher function deficits in spatial perception and awareness of deficit, as well as feelings of disconnection with their immediate surroundings. Of the classical features, weakness and speech disturbance were described in ways that did not meet the readily recognisable phenotype. CONCLUSION/SIGNIFICANCE: Analysis of patients' narrative accounts reveals a set of overlooked features of the experience of TIA which may provide additional diagnostic utility so that providers of first contact healthcare can recognise TIA more easily. Future research is required in a prospective cohort of patients presenting with transient neurological symptoms to determine how frequent these features are, what they add to diagnostic information and whether they can refine measures to predict stroke risk.

Impairment of vowel articulation as a possible marker of disease progression in Parkinson's disease.

PURPOSE: The aim of the current study was to survey if vowel articulation in speakers with Parkinson's disease (PD) shows specific changes in the course of the disease. METHOD: 67 patients with PD (42 male) and 40 healthy speakers (20 male) were tested and retested after an average time interval of 34 months. Participants had to read a given text as source for subsequent calculation of the triangular vowel space area (tVSA) and vowel articulation index (VAI). Measurement of tVSA and VAI were based upon analysis of the first and second formant of the vowels /α/, /i/and /u/ extracted from defined words within the text. RESULTS: At first visit, VAI values were reduced in male and female PD patients as compared to the control group, and showed a further decrease at the second visit. Only in female Parkinsonian speakers, VAI was correlated to overall speech impairment based upon perceptual impression. VAI and tVSA were correlated to gait impairment, but no correlations were seen between VAI and global motor impairment or overall disease duration. tVSA showed a similar reduction in the PD as compared to the control group and was also found to further decline between first and second examination in female, but not in male speakers with PD. CONCLUSIONS: Measurement of VAI seems to be superior to tVSA in the description of impaired vowel articulation and its further decline in the course of the disease in PD. Since impairment of vowel articulation was found to be independent from global motor function but correlated to gait dysfunction, measurement of vowel articulation might have a potential to serve as a marker of axial disease progression.

Semantic interference during object naming in agrammatic and logopenic primary progressive aphasia (PPA).

This study examined the time course of object naming in 21 individuals with primary progressive aphasia (PPA) (8 agrammatic (PPA-G); 13 logopenic (PPA-L)) and healthy age-matched speakers (n=17) using a semantic interference paradigm with related and unrelated interfering stimuli presented at stimulus onset asynchronies (SOAs) of -1000, -500, -100 and 0 ms. Results showed semantic interference (SI) (i.e. significantly slower RTs in related compared to unrelated conditions) for all groups at -500, -100 and 0 ms, indicating timely spreading activation to semantic competitors. However, both PPA groups showed a greater magnitude of SI than normal across SOAs. The PPA-L group and six PPA-G participants also evinced SI at -1000 ms, suggesting an abnormal time course of semantic interference resolution, and concomitant left hemisphere cortical atrophy in brain regions associated with semantic processing. These subtle semantic mapping impairments in non-semantic variants of PPA may contribute to the anomia of these patients.

Brain basis of phonological awareness for spoken language in children and its disruption in dyslexia.

Phonological awareness, knowledge that speech is composed of syllables and phonemes, is critical for learning to read. Phonological awareness precedes and predicts successful transition from language to literacy, and weakness in phonological awareness is a leading cause of dyslexia, but the brain basis of phonological awareness for spoken language in children is unknown. We used functional magnetic resonance imaging to identify the neural correlates of phonological awareness using an auditory word-rhyming task in children who were typical readers or who had dyslexia (ages 7-13) and a younger group of kindergarteners (ages 5-6). Typically developing children, but not children with dyslexia, recruited left dorsolateral prefrontal cortex (DLPFC) when making explicit phonological judgments. Kindergarteners, who were matched to the older children with dyslexia on standardized tests of phonological awareness, also recruited left DLPFC. Left DLPFC may play a critical role in the development of phonological awareness for spoken language critical for reading and in the etiology of dyslexia.

Maxillary dental arch dimensions in 6-year-old children with articulatory speech disorders.

AIMS: To evaluate maxillary dental arch dimensions in 6-year-old children with articulatory speech disorders and to compare their dental arch dimensions with age- and sex-matched controls without speech disorders. METHODS: Fifty-two children (15 girls) with errors in the articulation of the sounds /r/, /s/ or /l/ were compared retrospectively with age- and sex-matched controls from dental casts taken at a mean age of 6.4 years (range 5.0-8.4). All children with articulatory speech disorders had been referred to City of Helsinki Health Care, Dental Care Department by a phoniatrician or a speech therapist in order to get oral-motor activators (removable palatal plates) to be used in their speech therapy. A χ2-test and paired Student's t tests were used in the statistical analyses. RESULTS: The children with articulatory speech disorders had similar maxillary dental arch widths but smaller maxillary dental arch length than the controls. CONCLUSION: This small series suggests that 6-year-old children with articulatory speech disorders may have decreased maxillary dental arch length.

Phonological development in children with obstructive sleep-disordered breathing.

Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

A case of foreign accent syndrome resulting in regional dialect.

BACKGROUND: Foreign Accent Syndrome (FAS) is a rare acquired syndrome following neurological damage that results in articulatory distortions that are commonly perceived as a "foreign" accent. The nature of the underlying deficit of FAS remains controversial. We present the first reported Canadian case study of FAS following a stroke. We describe a stroke patient, RD, who suffered an acute infarction to the left internal capsule, basal ganglia and frontal corona radiata. She was diagnosed as having FAS without any persistent aphasic symptoms. Family, friends, and health care professionals similarly described her speech as sounding like she had a Canadian East Coast accent, a reported change from her native Southern Ontario accent. METHOD: An investigation of this case was pursued, incorporating neuroimaging, neuropsychological and speech pathology assessments, and formalized linguistic analyses. RESULTS: Linguistic analyses confirmed that RD's speech does in fact have salient aspects of Atlantic Canadian English in terms of both prosodic and segmental characteristics. However, her speech is not entirely consistent with an Atlantic Canadian English accent. INTERPRETATION: The fact that RD's speech is perceived as a regional variant of her native language, rather than the "generic foreign accent" of FAS described elsewhere, suggests that the perceived "foreignness" in FAS is not primarily due to dysfluencies which indicate a non-native speaker, but rather due to very subtle motor-planning deficits which give rise to systemic changes in specific phonological segments. This has implications for the role of the basal ganglia in speech production.

Use of porous polyethylene implant for augmentation of the posterior pharynx in young adult patients with borderline velopharyngeal insufficiency.

In the current study, we evaluated the efficiency of using porous polyethylene implant to correct velopharyngeal insufficiency (VPI) in young adult patients. Ten male patients with VPI, aged 21 to 27 years, underwent posterior pharyngeal wall augmentation with porous polyethylene implant. The evaluations for VPI on all patients in the study included speech evaluation of nasality and articulation, mirror test, nasopharyngoscopy, and magnetic resonance (MR) imaging. Evaluation of the methods for correcting VPI was done preoperatively and 6 months after surgery, and the results were compared. According to preoperative speech evaluation, 7 patients had severe hypernasal speech and 3 patients had moderate hypernasal speech. Follow-up evaluations demonstrated that 7 patients had normal speech without hypernasal resonance. Although all patients had nasal escape on mirror test preoperatively, only 2 had nasal escape postoperatively. When the preoperative and postoperative results of the Multi-Dimensional Voice Programme were analyzed, there was a statistically significant improvement in all parameters. The distance between the posterior pharyngeal wall and the velum during phonation observed preoperatively had disappeared in the postoperative period in all of the patients' sagittal-plane MR scans. In the axial views of the MR scans, the velopharyngeal gap area calculated preoperatively was reduced in the postoperative period. We conclude that posterior pharyngeal wall augmentation with porous polyethylene implant is an effective method in the correction of mild VPI in adult patients.

Primary face motor area as the motor representation of articulation.

No clinical data have yet been presented to show that a lesion localized to the primary motor area (M1) can cause severe transient impairment of articulation, although a motor representation for articulation has been suggested to exist within M1. Here we describe three cases of patients who developed severe dysarthria, temporarily mimicking speech arrest or aphemia, due to a localized brain lesion near the left face representation of the human primary motor cortex (face-M1). Speech was slow, effortful, lacking normal prosody, and more affected than expected from the degree of facial or tongue palsy. There was a mild deficit in tongue movements in the sagittal plane that impaired palatolingual contact and rapid tongue movements. The speech disturbance was limited to verbal output, without aphasia or orofacial apraxia. Overlay of magnetic resonance images revealed a localized cortical region near face-M1, which displayed high intensity on diffusion weighted images, while the main portion of the corticobulbar fibers arising from the lower third of the motor cortex was preserved. The cases suggest the existence of a localized brain region specialized for articulation near face-M1. Cortico-cortical fibers connecting face-M1 with the lower premotor areas including Broca's area may also be important for articulatory control.

A comparison of oral structure and oral-motor function in young males with fragile X syndrome and Down syndrome.

This study compared the oral structure and oral-motor skills of 59 boys with fragile X syndrome (FXS), 34 boys with Down syndrome (DS), and 36 developmentally similar typically developing (TD) boys. An adaptation of the J. Robbins and T. Klee (1987) Oral Speech Motor Protocol was administered to participants and their scores on measures of oral structure and accuracy on speech motor and oral-motor tasks were analyzed. Boys with FXS scored lower than TD boys on oral structure, most oral function tasks, and all speech function tasks. Boys with DS scored lower than boys with FXS and TD boys on oral structure, and lower than TD boys on 1 oral function task and all speech function tasks. Boys with FXS and TD boys scored higher on speech function than oral function tasks, while boys with DS scored higher on oral function than speech function tasks. Boys with FXS and boys with DS repeated single syllable words with greater accuracy than multiple syllable words, while the TD boys produced both types of words with equal accuracy. These results suggest that boys with FXS and boys with DS exhibit atypical oral structure and motor function, yet differ in specific oral-motor patterns.

Speech apraxia without oral apraxia: can normal brain function explain the physiopathology?

Apraxia of speech, usually associated with stroke, refers to the inability to perform speech motor movements typically with an intact ability to execute non-speech oral movements. It is uncertain whether apraxia of speech results from damage affecting the insula or the inferior frontal gyrus. The controversy started because of conflicting results from studies investigating patients with disrupted brain structure, when dysfunction of both sites can coexist. We conducted a functional magnetic resonance imaging study of individuals without neurological disorders comparing speech and non-speech movements. Speech movements did not recruit the insula, but activated the left inferior frontal gyrus, suggesting that Broca's area, but not the insula, is critical for speech articulation.

Artritis séptica como manifestación inicial de endocarditis bacteriana por Staphylococcus aureus / Septic arthritis as an initial manifestation of bacterial endocarditis caused by Staphylococcus aureus

Comunicamos un caso de endocarditis bacteriana por Staphylococcusaureus, sobre válvula mitral nativa, en un varón de 80 años, que debutó con una monoartritis séptica, de la articulación glenohumeral, sin manifestaciones cardiológicas iniciales. La respuesta clínica inicial tras drenaje articular y tratamiento antibiótico fue apropiada, pero la aparición de insuficiencia cardiaca recomendó el recambio quirúrgico de la válvula mitral. El paciente falleció súbitamente, el día previo a la intervención. En la literatura médica (Index Medicus, Medline, Embase, Excerpta Medica hasta 08/2005) están descritos 26 casos, de endocarditis bacteriana con afectación articular inicial, ninguno de ellos séptica, y solamente uno en la articulación glenohumeral. Queremos incidir en la necesidad de investigar la existencia de endocarditis bacteriana en toda artritis séptica, sin factores de riesgo evidentes,dadas las implicaciones pronosticas y terapéuticas

We describe a case of Staphylococcus aureus mitral valve endocarditis, in a 80-year-old man who presented with abrupt onset of septic arthritis of the glenohumeral joint, whithout cardiac sintomatology. Fever and articular infection recovery after articular drainage and antimicrobial therapy, but worsening caused by heart failure made valve replacement surgery urgent. He died sudendly before surgery could be done, Until august 2005, in medical literature (Index Medicus, Medline, Embase, Excerpta Medica), we have found 26 cases of bacterial endocarditis with articular infection, as initial manifestation, but none whith septic arthritis and only one in the glenohumeral joint. This report highligths that unexplained arthritis should alert us to the possibility of bacterial endocarditis because their influence on the clinical management and pronostic implications

Speech-language characteristics of children with Sotos syndrome.

The purpose of this research study was to evaluate the communication of individuals with Sotos syndrome in order to better characterize common speech and language patterns. Sixteen children with Sotos syndrome received an in-depth communication assessment using standardized procedures. Assessments of speech skills, language skills, voice, fluency, and social-pragmatic interactions were completed. Results of the evaluations indicated that individuals with Sotos syndrome are prone to: (a) language impairments (particularly expressive), (b) speech sound production impairments, (c) voice impairments, (d) dysfluencies (stuttering), and (e) average social-behavioral pragmatic interaction characteristics.

Selective alteration of native, but not second language articulation in a patient with foreign accent syndrome.

The present study deals with a right-handed female polyglot suffering from a Foreign Accent Syndrome (FAS) which affects her native language (L1), but not her other languages learnt since the age of 12. She had a small infarct in the left corona radiata as the result of a carotid occlusion. Her L1 was Spanish, but she also had a good command of French, English and Catalan (L2). Aphasia tests did not reveal any other significant alteration in any language. Analyses of pre-morbid and post-morbid voice recordings revealed that FAS affected Spanish dramatically, but no important changes were observed for French. Results were interpreted as showing that different brain areas control articulation of L1 and L2 learnt after a critical period.