O dispositivo analítico no hospital na clínica com transexuais: entre o ser e o sujeito

Pós-graduação em Psicologia - FCLAS

A legitimação das avaliações em larga escala no discurso sobre gestão educacional

Pós-graduação em Educação - FFC

Focal white matter changes in spasmodic dysphonia: a combined diffusion tensor imaging and neuropathological study.

Spasmodic dysphonia is a neurological disorder characterized by involuntary spasms in the laryngeal muscles during speech production. Although the clinical symptoms are well characterized, the pathophysiology of this voice disorder is unknown. We describe here, for the first time to our knowledge, disorder-specific brain abnormalities in these patients as determined by a combined approach of diffusion tensor imaging (DTI) and postmortem histopathology. We used DTI to identify brain changes and to target those brain regions for neuropathological examination. DTI showed right-sided decrease of fractional anisotropy in the genu of the internal capsule and bilateral increase of overall water diffusivity in the white matter along the corticobulbar/corticospinal tract in 20 spasmodic dysphonia patients compared to 20 healthy subjects. In addition, water diffusivity was bilaterally increased in the lentiform nucleus, ventral thalamus and cerebellar white and grey matter in the patients. These brain changes were substantiated with focal histopathological abnormalities presented as a loss of axonal density and myelin content in the right genu of the internal capsule and clusters of mineral depositions, containing calcium, phosphorus and iron, in the parenchyma and vessel walls of the posterior limb of the internal capsule, putamen, globus pallidus and cerebellum in the postmortem brain tissue from one patient compared to three controls. The specificity of these brain abnormalities is confirmed by their localization, limited only to the corticobulbar/corticospinal tract and its main input/output structures. We also found positive correlation between the diffusivity changes and clinical symptoms of spasmodic dysphonia (r = 0.509, P = 0.037). These brain abnormalities may alter the central control of voluntary voice production and, therefore, may underlie the pathophysiology of this disorder.

Development and Evaluation of a New Tablet Computer Application for the Therapy of Brain-Injured Patients with Aphasia

Introduction Language is the most important mean of communication and plays a central role in our everyday life. Brain damage (e.g. stroke) can lead to acquired disorders of lan- guage affecting the four linguistic modalities (i.e. reading, writing, speech production and comprehension) in different combinations and levels of severity. Every year, more than 5000 people (Aphasie Suisse) are affected by aphasia in Switzerland alone. Since aphasia is highly individual, the level of difficulty and the content of tasks have to be adapted continuously by the speech therapists. Computer-based assignments allow patients to train independently at home and thus increasing the frequency of ther- apy. Recent developments in tablet computers have opened new opportunities to use these devices for rehabilitation purposes. Especially older people, who have no prior experience with computers, can benefit from the new technologies. Methods The aim of this project was to develop an application that enables patients to train language related tasks autonomously and, on the other hand, allows speech therapists to assign exercises to the patients and to track their results online. Seven categories with various types of assignments were implemented. The application has two parts which are separated by a user management system into a patient interface and a therapist interface. Both interfaces were evaluated using the SUS (Subject Usability Scale). The patient interface was tested by 15 healthy controls and 5 patients. For the patients, we also collected tracking data for further analysis. The therapist interface was evaluated by 5 speech therapists. Results The SUS score are xpatients = 98 and xhealthy = 92.7 (median = 95, SD = 7, 95% CI [88.8, 96.6]) in case of the patient interface and xtherapists = 68 in case of the therapist interface. Conclusion Both, the patients and the healthy subjects, attested high SUS scores to the patient interface. These scores are considered as "best imaginable". The therapist interface got a lower SUS score compared to the patient interface, but is still considered as "good" and "usable". The user tracking system and the interviews revealed that there is room for improvements and inspired new ideas for future versions.

Final Syllable Lengthening (FSL) in Infant Vocalizations

Final Syllable Lengthening (FSL) has been extensively examined in infant vocalizations in order to determine whether its basis is biological or learned. Findings suggest there may be a U-shaped developmental trajectory for FSL. The present study sought to verify this pattern and to determine whether vocal maturity and deafness influence FSL. Eight normally hearing infants, aged 0 ; 3 to 1 ; 0, and eight deaf infants, aged 0 ; 8 to 4 ; 0, were examined at three levels of prelinguistic vocal development: precanonical, canonical, and postcanonical. FSL was found at all three levels suggesting a biological basis for this phenomenon. Individual variability was, however, considerable. Reduction in the magnitude of FSL across the three sessions provided some support for a downward trend for FSL in infancy. Findings further indicated that auditory deprivation can significantly affect temporal aspects of infant speech production.

The spatial and linguistic division of the city of Malaga

The city of Malaga underwent considerable growth in the 19th and 20th centuries. The territorial expansion paired with a massive influx of immigrants occurred in three waves and as a consequence the city of Malaga remains divided into three different parts up to today. The differences between these three neighbourhoods of the city lie in the type of houses, different cultural and industrial activities, socioeconomic level, and very interestingly, also in speech. Thus, the aim of this study is an examination of the interrelation between speech (phonetic features) and urban space in Malaga. A combination of quantitative and qualitative analysis was used, based on two types of data: 1) production data stemming from recordings of 120 speakers; 2) perception data (salience, estimated frequency of use, attitude, spatial and social perception, imitation) which was collected from several surveys with 120 participants each. Results show that the speech production data divides the city of Malaga clearly into three different parts. This tripartition is confirmed by the analysis of the perception data. Moreover, the habitants of these three areas are perceived as different social types, to whom a range of social features is attributed. That is, certain linguistic features, the different neighbourhoods of the city and the social characteristics associated with them are undergoing a process of indexicalization and iconization. As a result, the linguistic features in question function as identity markers on the intraurban level.

Monitoring Neurological disease in Phonation

It is well known that many neurological diseases leave a fingerprint in voice and speech production. The dramatic impact of these pathologies in life quality is a growing concert. Many techniques have been designed for the detection, diagnose and monitoring the neurological disease. Most of them are costly or difficult to extend to primary services. The present paper shows that some neurological diseases can be traced a the level of voice production. The detection procedure would be based on a simple voice test. The availability of advanced tools and methodologies to monitor the organic pathology of voice would facilitate the implantation of these tests. The paper hypothesizes some of the underlying mechanisms affecting the production of voice and presents a general description of the methodological foundations for the voice analysis system which can estimate correlates to the neurological disease. A case of study is presented from spasmodic dysphonia to illustrate the possibilities of the methodology to monitor other neurological problems as well.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Recovery of hearing and vocal behavior after hair-cell regeneration

Postmitotic hair-cell regeneration in the inner ear of birds provides an opportunity to study the effect of renewed auditory input on auditory perception, vocal production, and vocal learning in a vertebrate. We used behavioral conditioning to test both perception and vocal production in a small Australian parrot, the budgerigar. Results show that both auditory perception and vocal production are disrupted when hair cells are damaged or lost but that these behaviors return to near normal over time. Precision in vocal production completely recovers well before recovery of full auditory function. These results may have particular relevance for understanding the relation between hearing loss and human speech production especially where there is consideration of an auditory prosthetic device. The present results show, at least for a bird, that even limited recovery of auditory input soon after deafening can support full recovery of vocal precision.

Influência do uso de amostras de referência no julgamento perceptivo-auditivo da oclusiva glotal

Objetivos: estabelecer amostras de referência constituídas por gravações julgadas com consenso como representativas da presença ou ausência da oclusiva glotal (OG) e comparar julgamentos perceptivo-auditivos da presença e ausência da OG com e sem o uso de amostras de referência. Metodologia: o estudo foi dividido em duas etapas. Durante a ETAPA 1, 480 frases referentes aos sons oclusivos e fricativos produzidas por falantes com história de fissura labiopalatina foram julgadas por três fonoaudiólogas experientes quanto à identificação da OG. As frases foram julgadas individualmente e aquelas que não apresentaram consenso inicial foram julgadas novamente de maneira simultânea. As amostras julgadas com consenso com relação à presença ou ausência da OG durante produção das seis consoantes-alvo oclusivas e seis fricativas foram selecionadas para estabelecer um Banco de Amostras Representativas da OG. A ETAPA 2 consistiu na seleção de 48 amostras de referência referentes aos 12 sons de interesse e 120 amostras experimentais e, o julgamento dessas amostras experimentais por três grupos de juízes, cada grupo com três juízes com experiências distintas com relação ao julgamento de fala na fissura de palato. Os juízes julgaram as amostras experimentais duas vezes, primeiro sem acesso às referências e, após uma semana, com acesso às referências. Resultados: os julgamentos realizados na ETAPA 1 evidenciaram consenso com relação a OG em 352 amostras, sendo 120 frases com produção adequada para os sons de interesse e 232 representativas do uso da OG. Essas 352 amostras constituíram o Banco de amostras Representativas da OG. Os resultados da ETAPA 2 indicaram que ao comparar a média do valor de Kappa obtida para os 12 sons de interesse em cada um dos grupos nos julgamentos sem e com acesso às amostras de referência a concordância para o grupo 1 (G1) passou de regular (K=0,35) para moderada (K=0,55), para o grupo 2 (G2) passou de moderada (K=0,44) para substancial (K=0,76) e para o grupo 3 (G3) passou de substancial (K=0,72) para quase perfeita (K=0,83). Observou-se que as melhores concordâncias ocorreram para o grupo dos fonoaudiólogos experientes (G3), seguido dos fonoaudiólogos recém-formados (G2), com as piores observadas para o grupo de alunos de graduação (G1). Conclusão: um Banco de Amostras de Referência Representativas da OG foi estabelecido e os julgamentos perceptivo-auditivos de juízes com uso das amostras de referência foram obtidos com concordância inter-juízes e porcentagem de acertos melhor do que os julgamentos sem acesso às referências. Os resultados sugerem a importância do uso de amostras de referência para minimizar a subjetividade da avaliação perceptivo auditiva da fala.

‘Neutral, native-like or authentic’ : Investigating attitudes and beliefs of expanding circle speakers of English

The status of English as the language of international communication is by now well-established. However, in the past 16 years, research has tried to emphasize the fact that the English spoken in international contact situations and between people with other first languages than English has different needs than the English spoken locally amongst native speakers, resulting in the emergence of English as a lingua franca (ELF) as a scholarly field. However, the impact of findings in ELF has so far only led to a moderate shift in English language teaching. Especially in expanding circle countries, where ELF should have the biggest impact, change is only gradually becoming palpable. Accent and pronunciation, as one of the biggest factors on both identity and mutual intelligibility (Jenkins 2000; 2007) are at the root of discussion. The scope of this study is therefore to examine accent choices and the extent to which native speaker ideology informs the preferences of ten speakers of ELF and 27 German natives with experience in international communication. Both ethnographical and sociolinguistic methods, as well as auditory analysis have been applied and conducted. The auditory analysis of six variables in the recorded speech production of the ten speakers suggests that there is no significant preference of one norm-giving variety over the other. Rather, speakers tend to mix-and-match General American- and Standard Southern British English-like features in their pronunciation. When reporting their accent ideals, the idea of a ‘neutral’ English accent is mentioned by four participants. Neutral accents seem to have been understood as ‘unmarked accents’. Expressed beliefs on their own English pronunciation show a comparatively high level of reflection on and confidence in their own production. Results from a rating task and a survey given to 27 German participants reveal attitudes that are more negatively stacked. While Germans reported openness towards NNS (non-native speaker) accents and showed awareness of the priority of intelligibility over accent choice in both their own and others’ pronunciation, they still largely reported NS accent preference. The ratings of the production from ten ELF speakers confirmed this and showed that ‘neutral’ is equated with native-like. In the light of these findings, issues are discussed that ultimately relate to the influence of NS Englishes, identity and the development of English as an international language.

Articulatory imprecision in dysarthria following childhood cerebellar tumor: A perceptual and acoustic investigation of three male participants

Articulatory imprecision has been documented as a key perceptual feature of the dysarthria associated with childhood cerebellar tumor (CCT). As yet the underlying acoustic and physiological characteristics of motor speech production that contribute to this perceptual feature have not been identified. The aim of the current study was to describe perceptual and acoustic characteristics of consonant production in three children with dysarthria associated with CCT The results indicated that in all three cases the timing of articulatory movements during stop consonant production differed from that measured in a control group of same-age peers. The impact of cerebellar lesions in adulthood on articulatory gestures is used as a reference for discussing the findings of the current study with similarities evident. Also discussed are future research directions for examining the underlying acoustic or physiological basis for articulatory imprecision in children with dysarthria associated with CCT.

Borrowing from models of motor control to translate cognitive processes: Evidence for hypokinetic-hyperkinetic linguistic homologues?

In relation to motor control, the basal ganglia have been implicated in both the scaling and focusing of movement. Hypokinetic and hyperkinetic movement disorders manifest as a consequence of overshooting and undershooting GPi (globus pallidus internus) activity thresholds, respectively. Recently, models of motor control have been borrowed to translate cognitive processes relating to the overshooting and undershooting of GPi activity, including attention and executive function. Linguistic correlates, however, are yet to be extrapolated in sufficient detail. The aims of the present investigation were to: (1) characterise cognitive-linguistic processes within hypokinetic and hyperkinetic neural systems, as defined by motor disturbances; (2) investigate the impact of surgically-induced GPi lesions upon language abilities. Two Parkinsonian cases with opposing motor symptoms (akinetic versus dystonic/dyskinetic) served as experimental subjects in this research. Assessments were conducted both prior to as well as 3 and 12 months following bilateral posteroventral pallidotomy (PVP). Reliable changes in performance (i.e. both improvements and decrements) were typically restricted to tasks demanding complex linguistic operations across subjects. Hyperkinetic motor symptoms were associated with an initial overall improvement in complex language function as a consequence of bilateral PVP, which diminished over time, suggesting a decrescendo effect relative to surgical beneficence. In contrast, hypokinetic symptoms were associated with a more stable longitudinal linguistic profile, albeit defined by higher proportions of reliable decline versus improvement in postoperative assessment scores. The above findings endorsed the integration of the GPi within cognitive mechanisms involved in the arbitration of complex language functions. In relation to models of motor control, 'focusing' was postulated to represent the neural processes underpinning lexical-semantic manipulation, and 'scaling' the potential allocation of cognitive resources during the mediation of high-level linguistic tasks. (c) 2005 Elsevier Ltd. All rights reserved.

Beyond verbal fluency: Investigating the long-term effects of bilateral subthalamic (STN) deep brain stimulation (DBS) on language in two cases

Cognitive functioning has been described as largely impervious to chronic STN-DBS administered over 12-month periods. In relation to the domain of language, however, the effects of STN-DBS are yet to be thoroughly delineated. Verbal fluency tasks represent an almost exclusively applied index of linguistic proficiency relative to neuropsychological research within this population. Comprehensive investigations of the impact of STN-DBS on language function, however, have never been undertaken. The more precise elucidation of the role of the STN in the mediation of language processes, by way of assessments which probe language comprehension and production mechanisms, served as the primary focus of this research. Longitudinal analysis also afforded consideration of the way in which cognitive-linguistic circuits respond to STN-DBS over time. Bilateral STN-DBS primarily effected clinically reliable fluctuations (i.e., both improvements and declines) in performance in both subjects on tasks demanding cognitive-linguistic flexibility in the formulation and comprehension of complex language. Of particular note, both subjects demonstrated a cumulative increase in the proportion of reliable post-operative improvements achieved over time. The findings of this research lend support to models of subcortical participation in language which endorse a role for the STN, and suggest that bilateral STN-DBS may serve to enhance the proficiency of basal ganglia-thalamocortical linguistic circuits over time.

Summation of semantic priming and complex sentence comprehension in Parkinson's disease

Research has suggested that the integrity of semantic processing may be compromised in Parkinson's disease (PD), which may account for difficulties in complex sentence comprehension. In order to investigate the time course and integrity of semantic activation in PD, 20 patients with PD and 23 healthy controls performed a lexical decision task based on the multi-priming paradigm. Semantic priming effects were measured across stimulus onset asynchronies of 250 ms, 600 ms, and 1200 ms. Further, PD participants performed an auditory comprehension task. The results revealed significantly different patterns of semantic priming for the PD group at the 250-ms and 1200-ms SOAs. In addition, a delayed time course of semantic activation was evident for PD patients with poor comprehension of complex sentences. These results provide further support to suggest that both automatic and controlled aspects of semantic activation may be compromised in PD. Furthermore, the results also suggest that some sentence comprehension deficits in PD may be related to a reduction in information processing speed.