Language outcomes subsequent to treatment of brainstem tumour in childhood

While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higher-level language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population.

W/O microemulsions for ocular delivery: Evaluation of ocular irritation and precorneal retention

Water-in-oil microemulsions (w/o ME) capable of undergoing a phase-transition to lamellar liquid crystals (LC) or bicontinuous ME upon aqueous dilution were formulated using Crodarnol EO, Crill 1 and Crillet 4, an alkanol or alkanediol as cosurfactant and water. The hypothesis that phase-transition of ME to LC may be induced by tears and serve to prolong precomeal retention was tested. The ocular irritation potential of components and formulations was assessed using a modified hen's egg chorioallantoic membrane test (HET-CAM) and the preocular retention of selected formulations was investigated in rabbit eye using gamma scintigraphy. Results showed that Crill 1, Crillet 4 and Crodamol EO were non-irritant. However, all other cosurfactants investigated were irritant and their irritation was dependent on their carbon chain length. A w/o ME formulated without cosurfactant showed a protective effect when a strong irritant (0.1 M NaOH) was used as the aqueous phase. Precorneal clearance studies revealed that the retention of colloidal and coarse dispersed systems was significantly greater than an aqueous solution with no significant difference between ME systems (containing 5% and 10% water) as well as o/w emulsion containing 85% water. Conversely, a LC system formulated without cosurfactant displayed a significantly greater retention compared to other formulations. (c) 2005 Elsevier B.V. All rights reserved.

Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.

Speaking for others: The pros and cons of group advocates using collective language

We examined how rhetorical style affects evaluations of group advocates, and how these evaluations are moderated by group identification. University students were given a letter to the editor defending student welfare. The argument was either constructed using personal language ('I believe') or collective language ('we believe'). Furthermore, the letter was either attributed to an official advocate (president of the student union) or an unofficial advocate (a rank-and-file member of the student body). Consistent with the social identity perspective, participants who showed strong identification as a university student thought that the group would feel better represented by official advocates using collective rather than personal language. Low identifiers, however, did not rate the rhetorical styles differently on representativeness. Furthermore, low identifiers (but not high identifiers) rated official advocates as more likable and more effective when they used personal rather than collective language. The discussion focuses on the conflict low identifiers might feel between (a) needing to homogenize with other group members in order to maximize the influence and political effectiveness of their message at the collective level, and (b) protecting themselves against categorization threat.

An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study

Purpose: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. Method: Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J.M.Bland and D.G.Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. Results: Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. Conclusions: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Meaning selection and the subcortex: Evidence of reduced lexical ambiguity repetition effects following subcortical lesions

Recent research indicates that individuals with nonthalamic subcortical (NS) lesions call experience difficulties processing lexical ambiguities in a variety of contexts. This study examined how prior processing of a lexical ambiguity influences subsequent meaning activation in 10 individuals with NS lesions and 10 matched healthy controls. Subjects made speeded lexical decisions oil related or unrelated targets following homophone primes. Homophones were repealed with different targets biasing the same or different meanings oil the second presentation. The effects of prime-target relatedness, interstimulus interval (200 or 1250 ms), and same vs different meaning repetition were examined Both the patient and control groups showed printing when the same homophone meaning was biased oil repetition. When a different meaning was biased on the second presentation. no priming was evident in the controls, while facilitation remained present for the NS group, consistent with aberrant meaning selection and deactivation processes. These findings are discussed in terms of age and task-related repetition effects and current conceptions of frontal-subcortical involvement in cognition.

Professionalism and functional outcomes

A foundation principle of professionalism is listening carefully to clients' needs. This paper reviews current studies that have sought to listen to the needs of people with aphasia and their families. The preliminary evidence to date suggests that people with aphasia have goals that cover the bio-psycho-social spectrum but place a lot of importance on functional outcomes such as participation in life's activities, relationships, and personal self-esteem. In contrast, descriptions of current aphasia management practices reflect a predominantly medical model approach that emphasizes impairment-level goals. This paper suggests that a proportion of speech-language pathologists are not truly listening and responding to their clients' needs. This leads to a mismatch between the therapists' and clients' goals in therapy. The concept of person-centred goal-setting is described. This may contribute to greater alignments of goals and better outcomes of rehabilitation. Learning outcomes: As a result of reading this work, the participant will be able to: (a) have knowledge of criticisms of aphasia therapy by people with aphasia; (b) understand the concept of person-centred goal-setting; (c) understand the complexity of mismatched goals between therapist and client. (c) 2006 Elsevier Inc. All rights reserved.

Spelling in adults: The combined influences of language skills and reading experience

One hundred and twelve university students completed 7 tests assessing word-reading accuracy, print exposure, phonological sensitivity, phonological coding and knowledge of English morphology as predictors of spelling accuracy. Together the tests accounted for 71% of the variance in spelling, with phonological skills and morphological knowledge emerging as strong predictors of spelling accuracy for words with both regular and irregular sound-spelling correspondences. The pattern of relationships was consistent with a model in which, as a function of the learning opportunities that are provided by reading experience, phonological skills promote the learning of individual word orthographies and structural relationships among words.

The effect of auditory and visual distracters on the useful field of view: Implications for the driving task

PURPOSE. The driving environment is becoming increasingly complex, including both visual and auditory distractions within the in- vehicle and external driving environments. This study was designed to investigate the effect of visual and auditory distractions on a performance measure that has been shown to be related to driving safety, the useful field of view. METHODS. A laboratory study recorded the useful field of view in 28 young visually normal adults (mean 22.6 +/- 2.2 years). The useful field of view was measured in the presence and absence of visual distracters (of the same angular subtense as the target) and with three levels of auditory distraction (none, listening only, listening and responding). RESULTS. Central errors increased significantly (P < 0.05) in the presence of auditory but not visual distracters, while peripheral errors increased in the presence of both visual and auditory distracters. Peripheral errors increased with eccentricity and were greatest in the inferior region in the presence of distracters. CONCLUSIONS. Visual and auditory distracters reduce the extent of the useful field of view, and these effects are exacerbated in inferior and peripheral locations. This result has significant ramifications for road safety in an increasingly complex in-vehicle and driving environment.

A comparison of picture description abilities in individuals with vascular subcortical lesions and Huntington's Disease

The lexical-semantic and syntactic abilities of a group of individuals with chronic nonthalamic subcortical (NS) lesions following stroke (n = 6) were investigated using the Western Aphasia Battery (WAB) picture description task [Kertesz, A. (1982). The Western aphasia battery. New York: Grune and Stratton] and compared with those of a group of subjects with Huntington's Disease (HD) (n = 6) and a nonneurologically impaired control group (n = 6) matched for age, sex, and educational level. The performance of the NS and HD subjects did not differ significantly from the well controls on measures of lexical-semantic abilities. NS and HD subjects provided as much information about the target picture as control subjects, but produced fewer action information units. Analysis of syntactic abilities revealed that the HD subjects produced significantly more grammatical errors than both the NS and control subjects and that the NS group performed in a similar manner to control subjects. These findings are considered in terms of current theories of subcortical language function Learning outcomes: As a result of this activity, the reader will obtain information about the debate surrounding the role of subcortical language mechanisms and be provided with new information on the comparative picture description abilities of individuals with known vascular and degenerative subcortical pathologies and healthy control participants. (c) 2005 Elsevier Inc. All rights reserved.

Reflexive optokinetic nystagmus in younger and older observers under photopic and mesopic viewing conditions

PURPOSE. To investigate the effect of age on optokinetic nystagmus (OKN) in response to stimuli designed to preferentially stimulate the M-pathway. METHOD. OKN was recorded in 10 younger (32.3 +/- 5.98 years) and 10 older (65.6 +/- 6.53) subjects with normal vision. Vertical gratings of 0.43 or 1.08 cpd drifting at 5 degrees/s or 20 degrees/s and presented at either 8% or 80% contrast were displayed on a large screen as full-field stimulation, central stimulation within a central Gaussian-blurred window of 15 diameter, or peripheral stimulation outside this window. All conditions apart from the high-contrast condition were presented in a random order at two light levels, mesopic (1.8 cdm(-2)) and photopic (71.5 cdm(-2)). RESULTS. Partial-field data indicated that central stimulation, mesopic light levels, and lower temporal frequency each significantly increased slow-phase velocity (SPV). Although there was no overall difference between groups for partial-field stimulation, full-field stimulation, or low-contrast stimulation, a change in illumination revealed a significant interaction with age: there was a larger decrease in SPV going from photopic to mesopic conditions for the older group than the younger group, especially for higher temporal frequency stimulation. CONCLUSIONS. OKN becomes reflexive in conditions conducive to M-pathway stimulation, and this rOKN response is significantly diminished in older healthy adults than in younger healthy adults, indicative of decreased M-pathway sensitivity.

Self-paced reading and sentence comprehension in Parkinson's disease

Parkinson's disease (PD) is associated with disturbances in sentence processing, particularly for noncanonical sentences. The present study aimed to analyse sentence processing in PD patients and healthy control participants, using a word-by-word self-paced reading task and an auditory comprehension task. Both tasks consisted of subject relative (SR) and object relative (OR) sentences, with comprehension accuracy measured for each sentence type. For the self-paced reading task, reading times (RTs) were also recorded for the non-critical and critical processing regions of each sentence. Analysis of RTs using mixed linear model statistics revealed a delayed sensitivity to the critical processing region of OR sentences in the PD group. In addition, only the PD group demonstrated significantly poorer comprehension of OR sentences compared to SR sentences during an auditory comprehension task. These results may be consistent with slower lexical retrieval in PD, and its influence on the processing of noncanonical sentences. (c) 2005 Elsevier Ltd. All rights reserved.

A core vocabulary approach for management of inconsistent speech disorder

Developmental speech disorder is accounted for by theories derived from psychology, psycholinguistics, linguistics and medicine, with researchers developing assessment protocols that reflect their theoretical perspective. How theory and data analyses lead to different therapy approaches, however, is sometimes unclear. Here, we present a case management plan for a 7 year old boy with unintelligible speech. Assessment data were analysed to address seven case management questions regarding need for intervention, service delivery, differential diagnosis, intervention goals, generalization of therapeutic gains, discharge criteria and evaluation of efficacy. Jarrod was diagnosed as having inconsistent speech disorder that required intervention. He pronounced 88% of words differently when asked to name each word in the 25 word inconsistency test of the Diagnostic Evaluation of Articulation and Phonology three times, each trial separated by another activity. Other standardized assessments supported the diagnosis of inconsistent speech disorder that, according to previous research, is associated with a deficit in phonological assembly. Core vocabulary intervention was chosen as the most appropriate therapy technique. Its nature and a possible protocol for implementation is described.