Deficits in musical rhythm perception in children with specific learning disabilities.

BACKGROUND: A specific learning disability comes with a cluster of deficits in the neurocognitive domain. Phonological processing deficits have been the core of different types of specific learning disabilities. In addition to difficulties in phonological processing and cognitive deficits, children with specific learning disability (SLD) are known to have deficits in more innate non-language-based skills like musical rhythm processing. OBJECTIVES: This paper reviews studies in the area of musical rhythm perception in children with SLD. An attempt was made to throw light on beneficial effects of music and rhythm-based intervention and their underlying mechanism. METHODS: A hypothesis-driven review of research in the domain of rhythm deficits and rhythm-based intervention in children with SLD was carried out. RESULTS: A summary of the reviewed literature highlights that music and language processing have shared neural underpinnings. Children with SLD in addition to difficulties in language processing and other neurocognitive deficits are known to have deficits in music and rhythm perception. This is explained in the background of deficits in auditory skills, perceptuo-motor skills and timing skills. Attempt has been made in the field to understand the effect of music training on the children's auditory processing and language development. Music and rhythm-based intervention emerges as a powerful intervention method to target language processing and other neurocognitive functions. Future studies in this direction are highly underscored. CONCLUSIONS: Suggestions for future research on music-based interventions have been discussed.

Children's Response Bias and Identification of Misarticulated Words.

Purpose The purpose of this study was to examine whether children's identification of misarticulated words as real objects was influenced by an inherent bias toward selecting real objects or whether a change in experimental conditions could impact children's selections. Method Forty preschool children aged 4 years 0 months to 6 years 11 months across 2 experiments heard accurate productions of real words (e.g., "leaf"), misarticulated words (e.g., "weaf" and "yeaf"), and unrelated nonwords (e.g., "geem"). Within the misarticulated words, the commonness of the substitute was controlled to be "common" or "uncommon." Using the MouseTracker software, children were asked to select between a real object (e.g., a leaf) and a novel object (Experiment 1) or between a real object (e.g., a leaf) and a blank square, which represented a hidden object (Experiment 2). Results Consistent with previous findings, children chose real objects significantly more when they heard accurate productions (e.g., "leaf") than misarticulated productions (e.g., "weaf" or "yeaf") across both experiments. In misarticulation conditions, real object selections were lower than in the previous study; however, children chose real objects significantly more in the common misarticulation condition than in the uncommon misarticulation condition. Conclusions The results of this study are consistent with previous findings. Children's behavioral responses depended upon the task. Despite these differences in the task, children demonstrated ease in integrating variability into their word identification.

Dissociation between speech modalities in a case of altered accent with unknown origin.

We present a case of sudden onset, acquired altered accent in the speech of NL, a 48-year-old, left-handed female. NL's typical Standard Southern British English accent was preserved in singing and reading, but altered in recitation, repetition and spontaneous speech. Neuropsychological investigation, impressionistic and acoustic analysis of accented and unaccented speech are documented. The altered accent displays a slower speech rate and longer duration of consonants and vowels. There is evidence for a shift towards syllable-timed rhythm. NL's altered accent displays atypical coordination between voicing and supra-laryngeal articulation, reduced mean and range of F0, and minor differences in vowel space. These features are broadly consistent with other documented cases of Foreign Accent Syndrome, regardless of aetiology. However, NL's profile of preserved and impaired speech does not fit any pattern typically associated with organic neurological disorder. Moreover, left-handed preference may contribute to differences between singing and reading, versus recitation, repetition and spontaneous speech.

Are children with developmental dyslexia all the same? A cluster analysis with more than 300 cases.

Reading is vital to every aspect of modern life, exacerbated by reliance of the internet, email, and social media on the written medium. Developmental dyslexia (DD) characterizes a disorder in which the core deficit involves reading. Traditionally, DD is thought to be associated with a phonological impairment. However, recent evidence has begun to suggest that the reading impairment in some individuals is provoked by a visual processing deficit. In this paper, we present WISC-IV data from more than 300 Italian children with a diagnosis of DD to investigate the manifestation of phonological and visual subtypes. Our results indicate the existence of two clusters of children with DD. In one cluster, the deficit was more pronounced in the phonological component, while both clusters were impaired in visual processing. These data indicate that DD may be an umbrella term that encompasses different profiles. From a theoretical perspective, our results demonstrate that dyslexia cannot be explained in terms of an isolated phonological deficit alone; visual impairment plays a crucial role. Moreover, general rather than specific accounts of DD are discussed.

Exploring the speech and language of individuals with non-syndromic submucous cleft palate: a preliminary report.

BACKGROUND: Submucous cleft palate (SMCP) has a heterogeneous presentation and is often identified late or misdiagnosed. Diagnosis is prompted by speech, resonance or feeding symptoms associated with velopharyngeal insufficiency. However, the broader impacts of SMCP on communication have rarely been examined and therefore are poorly understood. AIM: To describe the communicative profile of individuals with non-syndromic SMCP by examining speech, language and pragmatics (social language). METHODS & PROCEDURES: Fifteen participants with SMCP aged 5;1-12;8, without a genetic diagnosis, participated in the study. Participants completed standardized assessments examining language, resonance, speech and non-verbal intellect. Parents also completed the Children's Communication Checklist (CCC-2), which provided a measure of overall communicative ability, including pragmatic skills. Formal language outcomes were compared with two cohorts: 36 individuals with overt non-syndromic clefts and 129 individuals with no history of clefting. OUTCOMES & RESULTS: Speech intelligibility was reduced secondary to hypernasality, disordered articulation and/or impaired phonology (n = 7) in children with SMCP. Poorer overall language outcomes were observed for children with SMCP compared with both those with overt clefts and no history of clefting (p < 0.001). Language scores for children with SMCP ranged from impaired (n = 6) to above the standardized mean (n = 4). Receptive and expressive language performance were independently correlated with non-verbal IQ (p < 0.01). Those with severe language impairment (n = 4) also had borderline or impaired non-verbal IQ. Parents reported that speech and semantics were the most affected sub-domains of communication, while scores were the highest for the initiation domain. Speech and language skills were correlated strongly with pragmatics (r = 0.877, p < 0.01). CONCLUSIONS & IMPLICATIONS: Overall, performance was variable within the SMCP group across speech, language and pragmatic assessments. In addition to well-documented speech difficulties, children with SMCP may have language or pragmatic impairments, suggesting that further neurodevelopmental influences may be at play. As such, for individuals with SMCP, additional clinical screening of language and pragmatic abilities may be required to ensure accurate diagnosis and guide both cleft and non-cleft related therapy programmes.

What Our Hands Tell Us: A Two-Year Follow-Up Investigating Outcomes in Subgroups of Children With Language Delay.

Purpose This study followed up children identified with expressive language delay (ELD) or receptive/expressive language delay (R/ELD) at 2 years of age, Time 1 (T1), in order to identify their language profiles at 4-5 years, Time 2 (T2), and explore relationships to T1 language, gesture use, and symbolic comprehension. Method Nineteen of 22 children were seen at follow-up (9 of 10 from R/ELD group, 10 of 12 from ELD group). T1 measures assessed receptive and expressive language, gesture use, and symbolic comprehension. At T2, we assessed receptive and expressive language, sentence repetition, and expressive phonology. Results Outcomes for the R/ELD group were significantly poorer, with all children continuing to have delay in receptive and/or expressive language compared to just 20% of the ELD group. Expressive phonology delay was common in both groups. T1 receptive language showed the most pervasive correlations with T2 language measures, but categorical performance on all three T1 measures correctly predicted language outcomes in 16-17 of the 19 children. Conclusion Findings add to evidence that receptive language is a strong predictor of outcomes. Gesture use and symbolic comprehension are also strong predictors and clinically valuable as part of play-based assessments with implications for theoretical understanding and intervention planning.

Calidad de vida en personas con disartria / Quality of life in people with dysarthria

Introducción: La disartria corresponde a un trastorno adquirido del habla de origen neurológico. Habitualmente, la evaluación se centra en describir los procesos motores del habla afectados, las características perceptuales y determinar el grado de severidad a través de la inteligibilidad del habla. Pocas veces se explora el impacto de este trastorno sobre la calidad de vida de la persona. Método: Se realizó un estudio cuantitativo, no experimental, transversal, descriptivo y correlacional. Se evaluaron 21 personas con disartria (51.04 ± 13.06 años, 13 hombres) con el protocolo de evaluación de habla para pacientes disártricos y el cuestionario autoadministrado de calidad de vida en hablantes disártricos (QOL-Dys). Resultados: Las personas con disartria ven alterada su calidad de vida. Hay una correlación significativa con el grado de severidad de la disartria (r = -.5, p =.02). La inteligibilidad predice de manera significativa el puntaje en el cuestionario de calidad de vida total (R2 =.2, p =.04). El puntaje más bajo se presenta en la percepción de la reacción de los otros (1.66 ± 12.93), y el más alto en enfrentarse a situaciones difíciles (24.38 ± 9.12). Conclusión: La disartria afecta la calidad de vida de las personas. Se recomienda su evaluación para mejorar la intervención en estas personas

Introduction: Dysarthria is an acquired motor speech disorder of neurological origin. Usually assessment focuses on describing the affected motor processes of speech, perceptual characteristics and determining the degree of severity through speech intelligibility, but rarely explores the impact it has on the quality of life of the person. Method: A quantitative, non-experimental, cross-sectional, descriptive and correlational study was performed. Twenty-one patients with dysarthria (51.04 ± 13.06 years, 13 men) were evaluated with the speech assessment protocol for dysarthric patients and the self-administered quality of life questionnaire for dysarthric speakers (QOL-Dys). Results: The quality of life of people with dysarthria is affected (QOL), which correlates significantly with the degree of severity of the dysarthria (r = -.5, p = .02). Intelligibility significantly predicts the score of the total quality of life questionnaire (R2 =.2, p = .04). The lowest score occurred in the perception of the reaction of the others (16.66 ± 12.93), and the highest in dealing with difficult situations (24.38 ± 9.12). Conclusion: Quality of life is affected in people with dysarthria, its assessment is recommended to improve intervention in these people

Testing the Hyperarticulation and Prosodic Hypotheses of Child-Directed Speech: Insights From the Perceptual and Acoustic Characteristics of Child-Directed Cantonese Tones.

Purpose: The function of child-directed speech has been debated for decades. This study examined the perceptual and acoustic characteristics of child- and adult-directed Cantonese tones to test the hyperarticulation and prosodic hypotheses that have been proposed to account for the acoustic modifications in child-directed speech. Method: Sixty-two mother-child dyads participated in the study. The mothers verbally labeled 30 pictures in monosyllabic isolated words and in the final position of a carrier sentence to the experimenter and their 1- to 5-year-old children. The 8,634 adult- and child-directed productions were low-pass filtered to eliminate lexical information and presented to 5 judges for tone identification. Acoustic analysis was performed on the productions. Results: Acoustically, child-directed tones were produced with an elevated pitch, and the pitch level decreased as the child's age increased. Acoustic contrasts between phonetically similar and more confusing tones were not enhanced in child-directed speech, and unexpectedly, child-directed tones were identified with a lower accuracy than adult-directed tones. The perceptual errors of child-directed tones mirrored the errors found in identifying tones excised from sentence-final position, which had a pitch-lowering effect on the tones. The lower perceptual accuracy, the lack of enhanced acoustic contrasts in confusing tone pairs, and the similarities in the error patterns in identifying tones in child-directed speech and tones in utterance-final position suggest that the acoustic modifications in child-directed tones are prosodic effects serving pragmatic purposes. Conclusion: The findings reject the hyperarticulation hypothesis and support the prosodic hypothesis of child-directed speech.

Actualización de un modelo tentativo del mutismo selectivo / Update of a tentative model of selective mutism

El mutismo selectivo es un trastorno del comportamiento infanto-juvenil de inicio temprano (generalmente entre los 3 y los 5 años) que consiste en la resistencia al habla o su inhibición en situaciones sociales concretas, caracterizadas por la presencia de extraños, personas a las que no se habla o a las que se ha dejado de hablar, lugares en los que no se habla o donde el niño piensa que puede ser escuchado por quien no quiere, etc. Su escasa prevalencia lo convierte en un trastorno de la conducta raro y la revisión de la literatura confirma que la ansiedad es la alteración prominente en quienes lo presentan, lo que ha llevado a que en la última edición del Manual diagnóstico y estadístico de los trastornos mentales (Asociación Americana de Psiquiatría, DSM-5; APA, 2013) haya sido reclasificado como un trastorno de ansiedad. Este hecho, así como los avances en su investigación y los retos que estos plantean respecto de su evaluación y tratamiento hacen necesaria una revisión y actualización de las propuestas explicativas existentes. Este es el marco en el que se inserta el trabajo que presentamos

Selective mutism is a disorder of early-onset behavior (usually between 3 and 5 years) consisting in a resistance to speech or its inhibition in specific social situations, characterized by the presence of strangers, people who are not spoken to or to whom the child has stopped talking, places where the child doesn't speak or where the child thinks he/she can be heard by unwanted people, etc. Its low prevalence makes it a rare behavior disorder and the review of the literature confirms that anxiety is the prominent alteration in those who present it, which has led to the result that in the last edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, DSM-5; APA, 2013) the behavior has been reclassified as an anxiety disorder. This fact, as well as the advances in its research and the challenges that it poses regarding its evaluation and treatment, make it necessary to review and update the existing explanatory proposals. This is the framework of the work presented here

The Relationship Between Speech, Language, and Phonological Awareness in Preschool-Age Children With Developmental Disabilities.

Purpose: A number of intrinsic factors, including expressive speech skills, have been suggested to place children with developmental disabilities at risk for limited development of reading skills. This study examines the relationship between these factors, speech ability, and children's phonological awareness skills. Method: A nonexperimental study design was used to examine the relationship between intrinsic skills of speech, language, print, and letter-sound knowledge to phonological awareness in 42 children with developmental disabilities between the ages of 48 and 69 months. Hierarchical multiple regression was done to determine if speech ability accounted for a unique amount of variance in phonological awareness skill beyond what would be expected by developmental skills inclusive of receptive language and print and letter-sound knowledge. Results: A range of skill in all areas of direct assessment was found. Children with limited speech were found to have emerging skills in print knowledge, letter-sound knowledge, and phonological awareness. Speech ability did not predict a significant amount of variance in phonological awareness beyond what would be expected by developmental skills of receptive language and print and letter-sound knowledge. Conclusion: Children with limited speech ability were found to have receptive language and letter-sound knowledge that supported the development of phonological awareness skills. This study provides implications for practitioners and researchers concerning the factors related to early reading development in children with limited speech ability and developmental disabilities.

Are RAN deficits in university students with dyslexia due to defective lexical access, impaired anchoring, or slow articulation?

The purpose of this study was to examine different hypotheses in relation to RAN deficits in dyslexia. Thirty university students with dyslexia and 32 chronological-age controls were assessed on RAN Digits and Colors as well as on two versions of RAN Letters and Objects (one with five items repeated 16 times and one with 20 items repeated four times). In addition, participants were tested on discrete letter and object naming, phonological awareness, orthographic knowledge, and speed of processing, and the RAN Letters and Objects total times were partitioned into pause times and articulation times. Results showed first that the dyslexia group was slower than the control group on all RAN tasks and the differences remained significant after controlling for discrete naming time. Second, both groups were slower in the large item set condition (20 × 4) than in the small set condition (5 × 16). Third, the dyslexia group was slower than the control group in both the pause and the articulation times. Although none of the processing skills was sufficient on its own to eliminate group differences in RAN Letters components, phonological awareness, and orthographic processing were sufficient on their own to eliminate group differences in the RAN Objects pause time. Taken together, our findings suggest that the deficits in RAN are not due to impaired anchoring, but rather due to subtle impairments in lexical access (specific to alphanumeric RAN), serial processing, and articulation.

The effects of Thalamic Deep Brain Stimulation on speech dynamics in patients with Essential Tremor: An articulographic study.

Acoustic studies have revealed that patients with Essential Tremor treated with thalamic Deep Brain Stimulation (DBS) may suffer from speech deterioration in terms of imprecise oral articulation and reduced voicing control. Based on the acoustic signal one cannot infer, however, whether this deterioration is due to a general slowing down of the speech motor system (e.g., a target undershoot of a desired articulatory goal resulting from being too slow) or disturbed coordination (e.g., a target undershoot caused by problems with the relative phasing of articulatory movements). To elucidate this issue further, we here investigated both acoustics and articulatory patterns of the labial and lingual system using Electromagnetic Articulography (EMA) in twelve Essential Tremor patients treated with thalamic DBS and twelve age- and sex-matched controls. By comparing patients with activated (DBS-ON) and inactivated stimulation (DBS-OFF) with control speakers, we show that critical changes in speech dynamics occur on two levels: With inactivated stimulation (DBS-OFF), patients showed coordination problems of the labial and lingual system in terms of articulatory imprecision and slowness. These effects of articulatory discoordination worsened under activated stimulation, accompanied by an additional overall slowing down of the speech motor system. This leads to a poor performance of syllables on the acoustic surface, reflecting an aggravation either of pre-existing cerebellar deficits and/or the affection of the upper motor fibers of the internal capsule.

Visual stimuli in intervention approaches for pre-schoolers diagnosed with phonological delay.

The aim of this study was to develop and content validate specific speech and language intervention picture cards: The Letter-Sound (L&S) cards. The present study was also focused on assessing the influence of these cards on letter-sound correspondences and speech sound production. An expert panel of six speech and language therapists analysed and discussed the L&S cards based on several criteria previously established. A Speech and Language Therapist carried out a 6-week therapeutic intervention with a group of seven Portuguese phonologically delayed pre-schoolers aged 5;3 to 6;5. The modified Bland-Altman method revealed good agreement among evaluators, that is the majority of the values was between the agreement limits. Additional outcome measures were collected before and after the therapeutic intervention process. Results indicate that the L&S cards facilitate the acquisition of letter-sound correspondences. Regarding speech sound production, some improvements were also observed at word level. The L&S cards are therefore likely to give phonetic cues, which are crucial for the correct production of therapeutic targets. These visual cues seemed to have helped children with phonological delay develop the above-mentioned skills.

Efficacy of Electropalatography for Treating Misarticulation of /r/.

PURPOSE: The purpose of the present study was to document the efficacy of electropalatography (EPG) for the treatment of rhotic errors in school-age children. Despite a growing body of literature using EPG for the treatment of speech sound errors, there is little systematic evidence about the relative efficacy of EPG for rhotic errors. METHOD: Participants were 5 English-speaking children aged 6;10 to 9;10, who produced /r/ at the word level with < 30% accuracy but otherwise showed typical speech, language, and hearing abilities. Therapy was delivered in twice-weekly 30-min sessions for 8 weeks. RESULTS: Four out of 5 participants were successful in achieving perceptually and acoustically accurate /r/ productions during within-treatment trials. Two participants demonstrated generalization of /r/ productions to nontreated targets, per blinded listener ratings. CONCLUSIONS: The present findings support the hypothesis that EPG can improve production accuracy in some children with rhotic errors. However, the utility of EPG is likely to remain variable across individuals. For rhotics, EPG training emphasizes one possible tongue configuration consistent with accurate rhotic production (lateral tongue contact). Although some speakers respond well to this cue, the narrow focus may limit lingual exploration of other acceptable tongue shapes known to facilitate rhotic productions.

Modeling Alphabet Skills as Instructive Feedback Within a Phonological Awareness Intervention.

PURPOSE: This study evaluated the efficacy of an instructive feedback strategy for modeling letter names and sounds during presentation of positive feedback within a small-group phonological awareness intervention for preschoolers. METHOD: Two experiments were conducted using multiple-baseline designs across children and behaviors. Letter name and sound identification and performance on a phonological awareness fluency measure served as the primary outcome variables. Six children completed Experiment 1. A progressive time delay was added to instructive feedback to elicit a response from the 9 children in the second experiment. RESULTS: In the first experiment, 6 children demonstrated gains on phonological awareness but not alphabet knowledge. With the addition of progressive time delay in the second experiment, all 9 children demonstrated gains on letter name and sound identification as well as phonological awareness skills. CONCLUSIONS: Progressive time delay to prompt children's responses appears to bolster the effects of instructive feedback as an efficient strategy for modeling alphabet skills within a broader early literacy curriculum. Modeling alphabet skills did not detract from, and may have enhanced, phonological awareness instruction for preschoolers.

Phonological Treatment Approaches for Spoken Word Production in Aphasia.

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation.

Perspectiva de las prácticas de atención temprana centradas en la familia desde la logopedia / Speech pathologist perspective in family centered practices

En España, en los últimos años, la atención temprana está viviendo un proceso de transformación. Se empiezan a conocer experiencias que van haciendo la transición desde un modelo de intervención ambulatorio, clínico, centrado fundamentalmente en el niño, a uno más social, en el cual la familia y el entorno cobran especial relevancia y protagonismo. En este proceso de cambio los logopedas tienen un papel relevante. Por un lado, por el mero hecho de ser parte integrante de los equipos de intervención. Por otro, por ser los responsables de velar por el desarrollo de capacidades fundamentales en la evolución del niño como son la comunicación, el habla y el lenguaje. Por este motivo es necesario llevar a cabo una reflexión acerca de cómo se está produciendo esta transformación de los servicios, lo que implica y cómo debe ser asumida por los logopedas. En este artículo se delimita el concepto de prácticas centradas en la familia en atención temprana, se repasan los elementos clave que las han impulsado desde su aparición, así como los componentes que las caracterizan y diferencian de otras prácticas que también pueden incluir la participación familiar. A partir de todo ello, se resalta la importancia del logopeda en los equipos transdisciplinares de atención temprana que han de desarrollar las prácticas centradas en la familia (AU)

In Spain, in recent years, early intervention is undergoing a process of transformation. Experiences begin to be known that are making the transition from a model of outpatient intervention, clinical, focused primarily on the child; towards one more social, where the family and the environment are particularly relevant and prominent. In this process of change, speech therapists play an important role. On the one hand, by the mere fact of being an integral part of the intervention teams. On the other, being responsible for ensuring the development of core competencies in the development of the child as is communication, speech and language. It is therefore necessary to carry out a reflection on how this transformation is occurring in services, what it means, and how it should be assumed by speech therapists. This article defines the concept of family-centered in Early Care Practices, outlines the key elements that have driven it since its inception, and it also reviews components that characterize and differentiate it from other practices that may also include family involvement. From all this, the importance of the speech therapist in transdisciplinary early intervention teams, where they must develop family-centered practices, is highlighted (AU)

Is Language a Factor in the Perception of Foreign Accent Syndrome?

Neurogenic foreign accent syndrome (FAS) is diagnosed when listeners perceive speech associated with motor speech impairments as foreign rather than disordered. Speakers with foreign accent syndrome typically have aphasia. It remains unclear how far language changes might contribute to the perception of foreign accent syndrome independent of accent. Judges with and without training in language analysis rated orthographic transcriptions of speech from people with foreign accent syndrome, speech-language disorder and no foreign accent syndrome, foreign accent without neurological impairment and healthy controls on scales of foreignness, normalness and disorderedness. Control speakers were judged as significantly more normal, less disordered and less foreign than other groups. Foreign accent syndrome speakers' transcriptions consistently profiled most closely to those of foreign speakers and significantly different to speakers with speech-language disorder. On normalness and foreignness ratings there were no significant differences between foreign and foreign accent syndrome speakers. For disorderedness, foreign accent syndrome participants fell midway between foreign speakers and those with speech-language impairment only. Slower rate, more hesitations, pauses within and between utterances influenced judgments, delineating control scripts from others. Word-level syntactic and morphological deviations and reduced syntactic and semantic repertoire linked strongly with foreignness perceptions. Greater disordered ratings related to word fragments, poorly intelligible grammatical structures and inappropriate word selection. Language changes influence foreignness perception. Clinical and theoretical issues are addressed.

Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation.

Structural, neurological and muscular diseases can lead to impairments of articulation. These impairments can severely impact social life. To judge health status comprehensively, this impact must be adequately quantified. For this purpose, the articulation handicap index (AHI) has been developed. Psychometric analyses referring to this index are presented here. The AHI was completed by 113 patients who had undergone treatment of tumours of the head or neck. The patients also gave a general self-assessment of their impairments due to articulation problems. Furthermore, tumour size, tumour location and kind of therapy were recorded. Missing data were analysed and replaced by multiple imputation. Internal structure was investigated using principal component analysis (PCA); reliability using Cronbach's alpha. Validity was investigated by analysing the relationship between AHI and general self-assessment of impairments. Moreover, the relationships with tumour size, tumour location and kind of therapy were analysed. Only 0.12 % of the answers to the AHI were missing. The Scree test performed with the PCA results suggested one-dimensionality with the first component explaining 49.6 % of the item variance. Cronbach's alpha was 0.96. Kendall's tau between the AHI sum score and the general self-assessment was 0.69. The intervals of AHI sum scores for the self-assessment categories were determined with 0-13 for no, 14-44 for mild, 46-76 for moderate, and 77-120 for severe impairment. The AHI sum score did not systematically relate to tumour size, tumour location or kind of therapy. The results are evidence for high acceptance, reliability and validity.

Sensitive periods and language in cochlear implant users.

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.