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BACKGROUND: Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes., OBJECTIVE: The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns., METHODS: Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy., RESULTS: Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant., CONCLUSIONS: Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

Purpose: The purpose of this study was to evaluate the efficacy of a treatment program that includes ultrasound biofeedback for children with persisting speech sound errors associated with childhood apraxia of speech (CAS). Method: Six children ages 9-15 years participated in a multiple baseline experiment for 18 treatment sessions during which treatment focused on producing sequences involving lingual sounds. Children were cued to modify their tongue movements using visual feedback from real-time ultrasound images. Probe data were collected before, during, and after treatment to assess word-level accuracy for treated and untreated sound sequences. As participants reached preestablished performance criteria, new sequences were introduced into treatment. Results: All participants met the performance criterion (80% accuracy for 2 consecutive sessions) on at least 2 treated sound sequences. Across the 6 participants, performance criterion was met for 23 of 31 treated sequences in an average of 5 sessions. Some participants showed no improvement in untreated sequences, whereas others showed generalization to untreated sequences that were phonetically similar to the treated sequences. Most gains were maintained 2 months after the end of treatment. The percentage of phonemes correct increased significantly from pretreatment to the 2-month follow-up. Conclusion: A treatment program including ultrasound biofeedback is a viable option for improving speech sound accuracy in children with persisting speech sound errors associated with CAS.

Purpose: This article introduces theoretically driven acoustic measures of /s/ that reflect aerodynamic and articulatory conditions. The measures were evaluated by assessing whether they revealed expected changes over time and labiality effects, along with possible gender differences suggested by past work. Method: Productions of /s/ were extracted from various speaking tasks from typically speaking adolescents (6 boys, 6 girls). Measures were made of relative spectral energies in low-(550-3000 Hz), mid-(3000-7000 Hz), and high-frequency regions (7000-11025 Hz); the mid-frequency amplitude peak; and temporal changes in these parameters. Spectral moments were also obtained to permit comparison with existing work. Results: Spectral balance measures in low-mid and mid-high frequency bands varied over the time course of /s/, capturing the development of sibilance at mid-fricative along with showing some effects of gender and labiality. The mid-frequency spectral peak was significantly higher in nonlabial contexts, and in girls. Temporal variation in the mid-frequency peak differentiated +/- labial contexts while normalizing over gender. Conclusions: The measures showed expected patterns, supporting their validity. Comparison of these data with studies of adults suggests some developmental patterns that call for further study. The measures may also serve to differentiate some cases of typical and misarticulated /s/.

Purpose: To determine if speech error patterns in preschoolers with speech sound disorders (SSDs) predict articulation and phonological awareness (PA) outcomes almost 4 years later. Method: Twenty-five children with histories of preschool SSDs (and normal receptive language) were tested at an average age of 4;6 (years;months) and were followed up at age 8;3. The frequency of occurrence of preschool distortion errors, typical substitution and syllable structure errors, and atypical substitution and syllable structure errors was used to predict later speech sound production, PA, and literacy outcomes. Results: Group averages revealed below-average schoolage articulation scores and low-average PA but ageappropriate reading and spelling. Preschool speech error patterns were related to school-age outcomes. Children for whom >10% of their speech sound errors were atypical had lower PA and literacy scores at school age than children who produced <10% atypical errors. Preschoolers who produced more distortion errors were likely to have lower school-age articulation scores than preschoolers who produced fewer distortion errors. Conclusion: Different preschool speech error patterns predict different school-age clinical outcomes. Many atypical speech sound errors in preschoolers may be indicative of weak phonological representations, leading to long-term PA weaknesses. Preschoolers' distortions may be resistant to change over time, leading to persisting speech sound production problems. © American Speech-Language-Hearing Association.

We employed brain-behavior analyses to explore the relationship between performance on tasks measuring phonological awareness, pseudoword decoding, and rapid auditory processing (all predictors of reading (dis)ability) and brain organization for print and speech in beginning readers. For print-related activation, we observed a shared set of skill-correlated regions, including left hemisphere temporoparietal and occipitotemporal sites, as well as inferior frontal, visual, visual attention, and subcortical components. For speech-related activation, shared variance among reading skill measures was most prominently correlated with activation in left hemisphere inferior frontal gyrus and precuneus. Implications for brain-based models of literacy acquisition are discussed. (C) 2012 Elsevier Inc. All rights reserved.

Objective: A common clinical complaint among older adults is difficulty hearing in noise, even in those with normal or near-normal peripheral hearing sensitivity. Researchers have demonstrated behavioral hearing in noise deficits in older adults, but to date limited evidence, particularly objective, exists elucidating the effects of age on auditory cortical processing in noise. The purpose of this investigation was to explore age related differences in auditory cortical processing at multiple signal-to-noise ratios (SNRs). Study design: Twenty normal-hearing young adults and 15 normal-hearing older adults participated in the study. Late auditory evoked potential (N1 and P2) latencies and amplitudes were measured in quiet and at three signal-to-noise ratios (SNRs) (+ 20, + 10, and 0 SNR). Repeated measures analyses of variance (ANOVA) were utilized to determine if statistically significant differences existed. Results: Significant group by listening condition interactions existed for N1 and P2 amplitudes. P2 latencies were significantly longer for the older adult group compared to the younger adult group. In addition, N1 and P2 amplitudes were significantly smaller for the younger adult group compared to the older adult group. Conclusion: Results suggest a possibly greater reduction in the synchronous neuronal response from quiet to noisy conditions in older adults than in younger adults. © 2013 Informa Healthcare.

Purpose: To examine neural response to spoken and printed language in children with speech sound errors (SSE). Method: Functional magnetic resonance imaging was used to compare processing of auditorily and visually presented words and pseudowords in 17 children with SSE, ages 8; 6[years; months] through 10; 10, with 17 matched controls. Results: When processing spoken words and pseudowords, the SSE group showed less activation than typically speaking controls in left middle temporal gyrus. They also showed greater activation than controls in several cortical and subcortical regions (e. g., left superior temporal gyrus, globus pallidus, insula, fusiform, and bilateral parietal regions). In response to printed words and pseudowords, children with SSE had greater activation than controls in regions including bilateral fusiform and anterior cingulate. Some differences were found in both speech and print processing that that may be associated with children with SSE failing to show common patterns of task-induced deactivation and/or attentional resource allocation. Conclusion: Compared with controls, children with SSE appear to rely more on several dorsal speech perception regions and less on ventral speech perception regions. When processing print, numerous regions were observed to be activated more for the SSE group than for controls.

Objective: The ability to hear in background noise is related to the processing of the incoming acoustic signal in the peripheral auditory system as well as the central auditory nervous system (CANS). Electrophysiological tests have the ability to demonstrate the underlying neural integrity of the CANS, but to date a lack of literature exists demonstrating the effects of background noise on auditory cortical potentials. Therefore, the purpose of this investigation was to systematically investigate the effects of white noise on tone burst-evoked late auditory evoked potentials (N1, P2, and P3) in normal hearing young adults. Study Design: Twenty young-adult normal-hearing individuals served as subjects. A comparison of the late auditory evoked potentials (N1, P2, and P3) was made at multiple signal-to-noise ratios (SNRs) (quiet, + 20, + 10, 0). N1, P2, and P3 were elicited and both amplitude and latency were measured for each of the potentials. A standard oddball paradigm with binaural stimulation was used to evoke the potentials. Repeated Measures Analyses of Variance (ANOVA) were conducted for both the experimental factors of amplitude and latency with within subjects factors of condition (quiet, + 20, + 10, 0). Results: Results indicated no significant differences in N1, P2, or P3 amplitude or latency between the quiet and + 20 SNR condition; however, at poorer SNRs significant N1, P2, and P3 amplitude and/or latency differences were observed. Conclusion: The results indicate a change in higher-order neural function related to the presence of increased noise in the environment. © 2012 Informa Healthcare.

Potocki-Lupski syndrome (PTLS; OMIM 610883) is a genomic syndrome that arises as a result of a duplication of 17p11.2. Although numerous cases of individuals with PTLS have been presented in the literature, its behavioral characterization is still ambiguous. We present a male child with a de novo dup(17)(p11.2p11.2) and he does not possess any autistic features, but is characterized by severe speech and language impairment. In the context of the analyses of this patient and other cases of PTLS, we argue that the central feature of the syndrome appears to be related to diminished speech and language capacity, rather than the specific social deficits central to autism. © 2011.

Purpose: To explore whether subgroups of children with residual speech sound disorders (R-SSDs) can be identified through multiple measures of token-to-token phonetic variability (changes in one spoken production to the next). Method: Children with R-SSDs were recorded during a rapid multisyllabic picture naming task and an oral diadochokinetic task. Transcription-based and acoustic measures of token-to-token variability were derived. Articulation accuracy and general indices of language skills were measured as well. Results: Low correlations were observed between transcription-based and acoustic measures of phonetic variability, and among the acoustic measures themselves. Children who were the most variable on one measure were not necessarily highly variable on other measures. Transcription-based measures of variability were associated with language skills. Conclusions: Measures of phonetic variability did not identify children in the sample as consistently high or low. Data do not support the notion that clear subgroups based on phonetic variability can be reliably identified in children with R-SSDs. The link between highly variable phonetic output (quantified by transcription-based measures) and lower language skills requires further exploration.

Purpose: To describe (a) the assessment of residual speech sound disorders (SSDs) in bilinguals by distinguishing speech patterns associated with second language acquisition from patterns associated with misarticulations and (b) how assessment of domains such as speech motor control and phonological awareness can provide a more complete understanding of SSDs in bilinguals. Method: A review of Japanese phonology is provided to offer a context for understanding the transfer of Japanese to English productions. A case study of an 11-year-old is presented, demonstrating parallel speech assessments in English and Japanese. Speech motor and phonological awareness tasks were conducted in both languages. Results: Several patterns were observed in the participant's English that could be plausibly explained by the influence of Japanese phonology. However, errors indicating a residual SSD were observed in both Japanese and English. A speech motor assessment suggested possible speech motor control problems, and phonological awareness was judged to be within the typical range of performance in both languages. Conclusion: Understanding the phonological characteristics of the native language can help clinicians recognize speech patterns in the second language associated with transfer. Once these differences are understood, patterns associated with a residual SSD can be identified. Supplementing a relational speech analysis with measures of speech motor control and phonological awareness can provide a more comprehensive understanding of a client's strengths and needs.

PURPOSE: Using a sample of 20,445 Dutch twins, this study examined the relationship between speech fluency and attentional regulation in children. A secondary objective was to identify etiological overlap between nonfluency and poor attention using fluency-discordant twin pairs., METHOD: Three fluency groups were created at age 5 using a parent questionnaire: (a) probable stuttering (PS; N=826; 4.0%), highly nonfluent (HNF; N=547; 2.7%), and typically fluent (TF; N=19,072; 93%). Multiple scales assessing attention, primarily self-regulation/inhibition, were obtained from both parents when children were ages 5 and 7 and from teachers when children were age 7., RESULTS: When compared with the TF controls, both the PS and HNF children received higher (i.e., more problematic) scores on parental attention ratings at both ages (p<.002). Effect sizes were moderate for both groups. Teacher and parent ratings were generally comparable. The discordant co-twin analyses suggested that nonfluency and attention were influenced by potentially overlapping genetic and shared environmental factors., CONCLUSIONS: The liability to express both high nonfluency and problems with self-regulation/inhibition may arise from a common set of pathogenic mechanisms. This supports emerging models of stuttering, which propose that poor fluency may be part of a broader network of impaired self-regulatory processes.

PURPOSE: The purpose of this investigation was to examine the impact of Chromosome 4p- syndrome on the communication and expressive language phenotype of a large cross-cultural population of children, adolescents, and adults., METHOD: A large-scale survey study was conducted and a descriptive research design was used to analyze quantitative and qualitative data regarding the communication and expressive language manifestations of 200 children, youth, and adults from 16 countries and Puerto Rico who had been diagnosed with 4p conditions, including Wolf-Hirschhorn syndrome (WHS), Pitt-Rogers-Danks syndrome (PRDS), Proximal 4p Deletion syndrome, and complex chromosomal rearrangements associated with 4p-., RESULTS: Individuals with Chromosome 4p- syndrome represent a heterogeneous population with complex phenotypic profiles. The majority of the participants exhibited communication and expressive language skills below the 36-month developmental functioning level. A relatively small cohort of the study population exhibited advanced expressive language skills, a finding not reported in the professional literature., CONCLUSION: Results broaden the spectrum of expressive language skills associated with Chromosome 4p- syndrome and highlight the communication potential of a subset of individuals with 4p abnormalities for development of advanced language structures. It is hypothesized that the largest 4p deletion, which includes the 4p16.3 band and contiguous gene regions, results in the most severely affected expressive language phenotype.

Purpose: Behavioral genetic studies of speech fluency have focused on participants who present with clinical stuttering. Knowledge about genetic influences on the development and regulation of normal speech fluency is limited. The primary aims of this study were to identify the heritability of stuttering and high nonfluency and to assess the relative contribution of genetic and environmental factors to the correlation between these 2 fluency phenotypes. Method: Information on 6 specific speech fluency behaviors was obtained by maternal report for over 10,500 5-year-old Dutch twin pairs. Results: Genetic analyses revealed that both fluency phenotypes were moderately heritable, with heritability estimates of 42% and 45% for probable stuttering and high nonfluency, respectively. Shared environmental factors were also significant, explaining 44% of the individual differences in probable stuttering and 32% in nonfluency. For both phenotypes, the magnitude of the genetic and environmental influences did not differ between boys and girls. The overlap between the 2 traits was substantial (tetrachoric correlation was .72). A bivariate genetic analysis showed that this overlap was due to both overlapping genetic and environmental influences. Conclusions: These findings provide a foundation to justify further studies in normal fluency control, a scientific area that has received little cross-disciplinary attention.

This investigation examined the listening comprehension (LC) performance of two groups of adolescent struggling readers, one group with word-finding difficulties (WFD) and one with no word-finding difficulties (NWFD). Of interest was whether the expressive language difficulties of the WFD group would interfere with their success on a LC assessment that requires oral responses to complete. Findings indicated that whereas the performance of the WFD group was comparable with the NWFD group when LC was measured using a multiple-choice response format, their performance was significantly poorer when LC was measured using an open-ended verbal response format, suggesting that learners' WFD could interfere with their success on such assessments. Practical implications of these findings for the assessment of LC as part of adolescents' reading evaluations are discussed. © 2010 Hammill Institute on Disabilities.