Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists.

INTRODUCTION: The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. METHOD: In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. RESULTS: Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).

The Ventral Anterior Temporal Lobe has a Necessary Role in Exception Word Reading.

An influential account of reading holds that words with exceptional spelling-to-sound correspondences (e.g., PINT) are read via activation of their lexical-semantic representations, supported by the anterior temporal lobe (ATL). This account has been inconclusive because it is based on neuropsychological evidence, in which lesion-deficit relationships are difficult to localize precisely, and functional neuroimaging data, which is spatially precise but cannot demonstrate whether the ATL activity is necessary for exception word reading. To address these issues, we used a technique with good spatial specificity-repetitive transcranial magnetic stimulation (rTMS)-to demonstrate a necessary role of ATL in exception word reading. Following rTMS to left ventral ATL, healthy Japanese adults made more regularization errors in reading Japanese exception words. We successfully simulated these results in a computational model in which exception word reading was underpinned by semantic activations. The ATL is critically and selectively involved in reading exception words.

The effect of bilingualism on brain development from early childhood to young adulthood.

Bilingualism affects the structure of the brain in adults, as evidenced by experience-dependent grey and white matter changes in brain structures implicated in language learning, processing, and control. However, limited evidence exists on how bilingualism may influence brain development. We examined the developmental patterns of both grey and white matter structures in a cross-sectional study of a large sample (n = 711 for grey matter, n = 637 for white matter) of bilingual and monolingual participants, aged 3-21 years. Metrics of grey matter (thickness, volume, and surface area) and white matter (fractional anisotropy and mean diffusivity) were examined across 41 cortical and subcortical brain structures and 20 tracts, respectively. We used generalized additive modelling to analyze whether, how, and where the developmental trajectories of bilinguals and monolinguals might differ. Bilingual and monolingual participants manifested distinct developmental trajectories in both grey and white matter structures. As compared to monolinguals, bilinguals showed: (a) more grey matter (less developmental loss) starting during late childhood and adolescence, mainly in frontal and parietal regions (particularly in the inferior frontal gyrus pars opercularis, superior frontal cortex, inferior and superior parietal cortex, and precuneus); and (b) higher white matter integrity (greater developmental increase) starting during mid-late adolescence, specifically in striatal-inferior frontal fibers. The data suggest that there may be a developmental basis to the well-documented structural differences in the brain between bilingual and monolingual adults.

Executive control in frontal lesion aphasia: Does verbal load matter?

Executive control impairments in aphasia resulting from frontal lesions are expected, given that integrity of frontal regions is critical to executive control task performance. Yet the consistency of executive control impairments in aphasia is poorly understood. This is due to previous studies using only a brief set of measures or failing to account for the high language processing demands of many executive control tasks. This study investigated performance across a series of specific and broad executive control task, whilst comparing differences between low or high verbal task versions. Ten participants with aphasia secondary to left inferior frontal lesions and fifteen age matched controls completed a battery of verbal and low verbal executive control tasks tapping into the three core domains of inhibiting, switching, and updating of working memory. For both controls and participants with aphasia, there was no consistent influence of verbal load on either reaction time or accuracy performance. When compared to controls, participants with aphasia demonstrate a general slowing of responses across all reaction time tasks, and are less accurate on switching and updating tasks. These findings do suggest that language processing is not essential for executive control task performance, given that verbal load does not matter. Furthermore, tasks which involve holding multiple sources of information in mind, such as during switching or updating, are particularly vulnerable in aphasia.

Early Childhood Predictors of Anxiety in Early Adolescence.

This longitudinal study examined a multitude of early childhood predictors of anxiety symptoms and disorders over an 8-year period. The purpose of the study was to identify early life predictors of anxiety across childhood and early adolescence in a sample of at-risk children. The sample included 202 preschool children initially identified as behaviorally inhibited or uninhibited between the ages of 3 years 2 months and 4 years 5 months. Temperament and familial environment variables were assessed using observation and parent report at baseline. Anxiety symptoms and disorders were assessed using questionnaires and diagnostic interviews at baseline (age 4), and at age 6, 9 and 12 years. In line with our hypotheses, the findings showed that preschool children were more likely to experience anxiety symptoms and disorders over time i) when the child was inhibited, ii) when there was a history of maternal anxiety disorders or iii) when mothers displayed high levels of overinvolvement. Further, the study identified a significant interaction effect between temperament and maternal overvinvolvement such that behaviorally inhibited preschoolers had higher anxiety symptoms at age 12, only in the presence of maternal overinvolvement at age 4. The increased risk of anxiety in inhibited children was mitigated when mothers demonstrated low levels of overinvolvement at age 4. This study provides evidence of both additive and interactive effects of temperament and family environment on the development of anxiety and provides important information for the identification of families who will most likely benefit from targeted early intervention.

What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia.

Purpose: Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of phonological and semantic cues in picture naming for a group of individuals with aphasia. To establish the locus of effective cueing, we also tested whether cue type interacted with lexical and image properties of the targets. Method: Individuals with aphasia (n = 10) were tested with a within-subject design. They named a large set of items (n = 175) 4 times. Each presentation of the items was accompanied by a different cueing condition (phonological, semantic, nonassociated word and tone). Item level variables for the targets (i.e., phoneme length, frequency, imageability, name agreement, and visual complexity) were used to test the interaction of cue type and item variables. Naming accuracy data were analyzed using generalized linear mixed effects models. Results: Phonological cues were more effective than semantic cues, improving accuracy across individuals. However, phonological cues did not interact with phonological or lexical aspects of the picture names (e.g., phoneme length, frequency). Instead, they interacted with properties of the picture itself (i.e., visual complexity), such that phonological cues improved naming accuracy for items with low visual complexity. Conclusions: The findings challenge the theoretical assumptions that phonological cues map to phonological processes. Instead, phonological information benefits the earliest stages of picture recognition, aiding the initial categorization of the target. The data help to explain why patterns of cueing are not consistent in aphasia; that is, it is not the case that phonological impairments always benefit from phonological cues and semantic impairments form semantic cues. A substantial amount of the literature in naming therapy focuses on picture naming paradigms. Therefore, the results are also critically important for rehabilitation, allowing for therapy development to be more rooted in the true mechanisms through which cues are processed.

TMS SMART - Scalp mapping of annoyance ratings and twitches caused by Transcranial Magnetic Stimulation.

BACKGROUND: The magnetic pulse generated during transcranial magnetic stimulation (TMS) also stimulates cutaneous nerves and muscle fibres, with the most commonly reported side effect being muscle twitches and sometimes painful sensations. These sensations affect behaviour during experimental tasks, presenting a potential confound for 'online' TMS studies. NEW METHOD: Our objective was to systematically map the degree of disturbance (ratings of annoyance, pain, and muscle twitches) caused by TMS at 43 locations across the scalp. Ten participants provided ratings whilst completing a choice reaction time task, and ten different participants provided ratings whilst completing a 'flanker' reaction time task. RESULTS: TMS over frontal and inferior regions resulted in the highest ratings of annoyance, pain, and muscle twitches caused by TMS. We predicted the difference in reaction times (RT) under TMS by scalp location and subjective ratings. Frontal and inferior scalp locations showed the greatest cost to RTs under TMS (i.e., slowing), with midline sites showing no or minimal slowing. Increases in subjective ratings of disturbance predicted longer RTs under TMS. Critically, ratings were a better predictor of the cost of TMS than scalp location or scalp-to-cortex distance. The more difficult 'flanker' task showed a greater effect of subjective disturbance. COMPARISON WITH EXISTING METHODS: We provide the data as an online resource (www.tms-smart.info) so that researchers can select control sites that account for the level of general interference in task performance caused by online single-pulse TMS. CONCLUSIONS: The peripheral sensations and discomfort caused by TMS pulses significantly and systematically influence RTs during single-pulse, online TMS experiments.

Stuttering generalization self-measure: Preliminary development of a self-measuring tool.

INTRODUCTION: Generalization of treatment is considered a difficult task for clinicians and people who stutter (PWS), and can constitute a barrier to long-term treatment success. To our knowledge, there are no standardized tests that collect measurement of the behavioral and cognitive aspects alongside the client's self-perception in real-life speaking situations. PURPOSE: This paper describes the preliminary development of a Stuttering Generalization Self-Measure (SGSM). The purpose of SGSM is to assess 1) stuttering severity and 2) speech-anxiety level during real-life situations as perceived by PWS. Additionally, this measurement aims to 3) investigate correlations between stuttering severity and speech-anxiety level within the same real-life situation. METHOD: The SGSM initially reported includes nine speaking situations designed that are developed to cover a variety of frequent speaking scenario situations. However, two of these were less commonly encountered by participants and subsequently not included in the final analyses. Items were created according to five listener categories (family and close friends, acquaintances, strangers, persons of authority, and giving a short speech to small audience). Forty-three participants (22 PWS, and 21 control) aged 18 to 53 years were asked to complete the assessment in real-life situations. RESULTS: Analyses indicated that test-retest reliability was high for both groups. Discriminant validity was also achieved as the SGSM scores significantly differed between the controls and PWS two groups for stuttering and speech-anxiety. Convergent validity was confirmed by significant correlations between the SGSM and other speech-related anxiety measures.

MaLT - Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect.

BACKGROUND: The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and "integrated", treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high intersystem connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks. OBJECTIVES: The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients' engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate. METHODS: MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique gameplay every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group. RESULTS: Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients' performance is monitored through MaLT's reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made. CONCLUSION: MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials.

When semantics aids phonology: A processing advantage for iconic word forms in aphasia.

Iconicity is the non-arbitrary relation between properties of a phonological form and semantic content (e.g. "moo", "splash"). It is a common feature of both spoken and signed languages, and recent evidence shows that iconic forms confer an advantage during word learning. We explored whether iconic forms conferred a processing advantage for 13 individuals with aphasia following left-hemisphere stroke. Iconic and control words were compared in four different tasks: repetition, reading aloud, auditory lexical decision and visual lexical decision. An advantage for iconic words was seen for some individuals in all tasks, with consistent group effects emerging in reading aloud and auditory lexical decision. Both these tasks rely on mapping between semantics and phonology. We conclude that iconicity aids spoken word processing for individuals with aphasia. This advantage is due to a stronger connection between semantic information and phonological forms.

Ever decreasing circles: Speech production in semantic dementia.

We explored the impact of a degraded semantic system on lexical, morphological and syntactic complexity in language production. We analysed transcripts from connected speech samples from eight patients with semantic dementia (SD) and eight age-matched healthy speakers. The frequency distributions of nouns and verbs were compared for hand-scored data and data extracted using text-analysis software. Lexical measures showed the predicted pattern for nouns and verbs in hand-scored data, and for nouns in software-extracted data, with fewer low frequency items in the speech of the patients relative to controls. The distribution of complex morpho-syntactic forms for the SD group showed a reduced range, with fewer constructions that required multiple auxiliaries and inflections. Finally, the distribution of syntactic constructions also differed between groups, with a pattern that reflects the patients' characteristic anomia and constraints on morpho-syntactic complexity. The data are in line with previous findings of an absence of gross syntactic errors or violations in SD speech. Alterations in the distributions of morphology and syntax, however, support constraint satisfaction models of speech production in which there is no hard boundary between lexical retrieval and grammatical encoding.

Broadly speaking: vocabulary in semantic dementia shifts towards general, semantically diverse words.

One of the cardinal features of semantic dementia (SD) is a steady reduction in expressive vocabulary. We investigated the nature of this breakdown by assessing the psycholinguistic characteristics of words produced spontaneously by SD patients during an autobiographical memory interview. Speech was analysed with respect to frequency and imageability, and a recently-developed measure called semantic diversity. This measure quantifies the degree to which a word can be used in a broad range of different linguistic contexts. We used this measure in a formal exploration of the tendency for SD patients to replace specific terms with more vague and general words, on the assumption that more specific words are used in a more constrained set of contexts. Relative to healthy controls, patients were less likely to produce low-frequency, high-imageability words, and more likely to produce highly frequent, abstract words. These changes in the lexical-semantic landscape were related to semantic diversity: the highly frequent and abstract words most prevalent in the patients' speech were also the most semantically diverse. In fact, when the speech samples of healthy controls were artificially engineered such that low semantic diversity words (e.g., garage, spanner) were replaced with broader terms (e.g., place, thing), the characteristics of their speech production came to closely resemble that of SD patients. A similar simulation in which low-frequency words were replaced was less successful in replicating the patient data. These findings indicate systematic biases in the deterioration of lexical-semantic space in SD. As conceptual knowledge degrades, speech increasingly consists of general terms that can be applied in a broad range of linguistic contexts and convey less specific information.

Lesions impairing regular versus irregular past tense production.

We investigated selective impairments in the production of regular and irregular past tense by examining language performance and lesion sites in a sample of twelve stroke patients. A disadvantage in regular past tense production was observed in six patients when phonological complexity was greater for regular than irregular verbs, and in three patients when phonological complexity was closely matched across regularity. These deficits were not consistently related to grammatical difficulties or phonological errors but were consistently related to lesion site. All six patients with a regular past tense disadvantage had damage to the left ventral pars opercularis (in the inferior frontal cortex), an area associated with articulatory sequencing in prior functional imaging studies. In addition, those that maintained a disadvantage for regular verbs when phonological complexity was controlled had damage to the left ventral supramarginal gyrus (in the inferior parietal lobe), an area associated with phonological short-term memory. When these frontal and parietal regions were spared in patients who had damage to subcortical (n = 2) or posterior temporo-parietal regions (n = 3), past tense production was relatively unimpaired for both regular and irregular forms. The remaining (12th) patient was impaired in producing regular past tense but was significantly less accurate when producing irregular past tense. This patient had frontal, parietal, subcortical and posterior temporo-parietal damage, but was distinguished from the other patients by damage to the left anterior temporal cortex, an area associated with semantic processing. We consider how our lesion site and behavioral observations have implications for theoretical accounts of past tense production.

Coming of age: a review of embodiment and the neuroscience of semantics.

Over the last decade, there has been an increasing body of work that explores whether sensory and motor information is a necessary part of semantic representation and processing. This is the embodiment hypothesis. This paper presents a theoretical review of this work that is intended to be useful for researchers in the neurosciences and neuropsychology. Beginning with a historical perspective, relevant theories are placed on a continuum from strongly embodied to completely unembodied representations. Predictions are derived and neuroscientific and neuropsychological evidence that could support different theories is reviewed; finally, criticisms of embodiment are discussed. We conclude that strongly embodied and completely disembodied theories are not supported, and that the remaining theories agree that semantic representation involves some form of convergence zones (Damasio, 1989) and the activation of modal content. For the future, research must carefully define the boundaries of semantic processing and tackle the representation of abstract entities.

Verbs in space: axis and direction of motion norms for 299 English verbs.

A strong body of work has explored the interaction between visual perception and language comprehension; for example, recent studies exploring predictions from embodied cognition have focused particularly on the common representation of sensory-motor and semantic information. Motivated by this background, we provide a set of norms for the axis and direction of motion implied in 299 English verbs, collected from approximately 100 native speakers of British English. Until now, there have been no freely available norms of this kind for a large set of verbs that can be used in any area of language research investigating the semantic representation of motion. We have used these norms to investigate the interaction between language comprehension and low-level visual processes involved in motion perception, validating the norming procedure's ability to capture the motion content of individual verbs. Supplemental materials for this study may be downloaded from brm.psychonomic-journals.org/content/supplemental.

The relation between content and structure in language production: an analysis of speech errors in semantic dementia.

In order to explore the impact of a degraded semantic system on the structure of language production, we analysed transcripts from autobiographical memory interviews to identify naturally-occurring speech errors by eight patients with semantic dementia (SD) and eight age-matched normal speakers. Relative to controls, patients were significantly more likely to (a) substitute and omit open class words, (b) substitute (but not omit) closed class words, (c) substitute incorrect complex morphological forms and (d) produce semantically and/or syntactically anomalous sentences. Phonological errors were scarce in both groups. The study confirms previous evidence of SD patients' problems with open class content words which are replaced by higher frequency, less specific terms. It presents the first evidence that SD patients have problems with closed class items and make syntactic as well as semantic speech errors, although these grammatical abnormalities are mostly subtle rather than gross. The results can be explained by the semantic deficit which disrupts the representation of a pre-verbal message, lexical retrieval and the early stages of grammatical encoding.