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Illiteracy and brain damage. 3: A contribution to the study of speech and language disorders in illiterates with unilateral brain damage (initial testing).

This report bears on the behavior of 188 unilateral stroke subjects when administered an aphasia screening test comprising a short interview as well as naming, repetition, word-picture matching and sentence-picture matching tasks. All subjects were unilingual lusophone adult (40 yr of age or older) right-handers. Furthermore, they were either totally unschooled illiterates or they had received school education and thereafter retained writing skills and reading habits. Subjects were tested less than 2 months after a first unilateral stroke. In all tasks, global error scores were greater among left and right brain-damaged illiterate and literate subjects than among their controls. In repetition and matching, these differences were statistically significant for the left but not for the right-stroke groups, irrespective of the literacy factor. In naming, on the other hand, significant differences were found not only for the two left-stroke groups but also for the right-stroke illiterate group although not for the right-stroke literate one. Likewise, some degree of word-finding difficulty and of reduction in speech output as well as sizeable production of phonemic paraphasias were observed in the interviews of several right-stroke illiterates, clearly less in those of right-stroke literates. These findings lead us to suggest that cerebral representation of language is more ambilateral in illiterates than it is in school educated subjects although left cerebral "dominance" remains the rule in both.

Aphasia↗

The relationship between auditory temporal analysis and receptive language development: evidence from studies of developmental language disorder.

The relationship between sensory, perceptual and motor abilities and receptive language abilities was studied in developmental dysphasic children. The tests administered included experimental auditory, visual and cross-modal perceptual tests. In addition, a battery of neurodevelopmental "soft sign" sensory, perceptual and motor tests were also given. Demographic and case history data were collected. Receptive language was derived based upon a battery of standardized language tests. Multivariate analyses were employed to examine the relationship between receptive language and sensory, perceptual and motor abilities. Results demonstrated that auditory perceptual variables, specifically those requiring rapid temporal analysis, were most highly correlated with the degree of receptive language deficit of the dysphasic children.

Aphasia↗

Precursors to speech in infancy: the prediction of speech and language disorders.

During the canonical stage of infant babbling, infants produce well-formed syllables, often in reduplicated sequences such as "bababa." Although nearly all infants with normal hearing begin the canonical stage by 10 months of age, a few are delayed, and these infants may be of special interest. Recent studies indicate that late onset of canonical babbling may be a predictor of disorders. A simple screening procedure that focuses on canonical babbling was used to evaluate over 3400 infants at risk who were about 10 months of age. Among infants who showed late onset of canonical babbling, fewer than half had been previously diagnosed as having a significant medical problem that might have accounted for the delay. A follow-up study indicated that infants with delayed canonical babbling had smaller production vocabularies at 18, 24, and 30 months than did infants in the control group. The results suggest that late onset of canonical babbling, a factor that can be monitored effectively through an interview with a parent, can predict delay in the onset of speech production.

Age Factors↗

Speech and language disorders in patients with high grade glioma and its influence on prognosis.

One hundred and sixteen patients with high grade glioma were entered into a prospective phase two study and treated with accelerated radiotherapy from 1988 to 1993. In this cohort of patients we analysed speech deficit as a subdivision of global functional status in terms of incidence, category and prognosis for survival. Forty three patients (37%) had a speech deficit at presentation. Eighty percent of these had a component of expressive dysphasia, associated with considerable degree of awareness and distress. The overall median survival was 9.5 months. On univariate analysis, median survival in patients with speech difficulties (6 months) was worse than patients with normal speech (10.5 months) (log rang p = 0.005). Multivariate analysis established independent significance from age, Karnofsky Performance Status (KPS), gender, histological grade, extent of surgery and seizures. This paper highlights the importance of assessing individual categories of functional disability which in patients with high grade glioma include mobility, cognitive function and communication. Each of these factors may seriously affect an individual's activities of daily living, hence quality of life and separate analysis has a number of clinical implications. Firstly, with over a third of patients suffering speech difficulties, adequate speech therapy facilities should be freely available to score the degree of deficit, devise coping strategies and institute communication therapy. Secondly, an understanding of prognostic factors aids the critical analysis of phase two studies and the design and stratification of future prospective trials which should include an analysis of speech deficit. Thirdly, separating individual patients into good and bad prognostic groups can assist strategic management decisions.

Adult↗

Handedness, clumsiness and developmental language disorders.

Hand preference and relative hand skill were assessed in 83 8 1/2-year-olds who had first been enrolled in a longitudinal study of specific language impairment at 4 years of age. There was no evidence that hand preference or relative skill of the two hands differed from normal in this population, although skill of both hands was poor in children with persisting language difficulties.

Child↗

Gradual emergence of developmental language disorders.

This article presents a theory of normal and delayed development of language. According to the theory, linguistic capacity develops in critically timed phases that occur gradually and sequentially. Normally, the rapid accumulation of stored utterances activates analytical mechanisms that are needed for the development of linguistic grammar. Children with slowly developing brains have delays in the socially cognitive systems that store utterances, and a critical period for activation of experience-dependent grammatical mechanisms declines without optimal result. Continuing efforts to speak induct species-atypical allocations of neural resources into linguistic service. It is speculated that this compensatory activity leads to compensatory growth, which may ultimately be revealed as volumetric symmetry of perisylvian areas. Because rate of brain maturation is under genetic as well as environmental control, the stage is thus set for an impairment that will seem to be specific and a brain that will appear to be abnormal.

Brain↗

Dyslexia: oral and written language disorder. A new look at old links.

It is now generally accepted that written language attainment is directly associated with oral language ability, and that deficits in oral language will be reflected in written language. This paper examines the links that exist between these two modes of communication from a historical perspective, as well as from current research. The concept and terminology of dyslexia - written language disability - are explored. The impact of deficits in phonology, vocabulary, semantics and syntax on the acquisition of written language is discussed.

Child↗

[Specific developmental language disorder: a theoretical approach to its diagnosis, aetiology and clinical symptoms].

AIM: This article presents an updated review about the definition, diagnostic criteria, classifications, etiology and the evolution of the specific language impairment (SLI). DEVELOPMENT: The specific language impairment is characterized by a developmental language delay and an impaired language, that persist over time and it is not explained by sensorial, motor and mental disabilities, neither by psycopathological disorders, socio-emotional deprivation, nor brain injury. The diagnosis is based on exclusional criteria. Some researchers propose different classifications considering the children performance in language comprehension and language production. Genetical linkage to the FOXP2 gen in the SPCH1 region of the chromosome 7 and to the chromosomes 13, 16 y 19 has been reported. The neuroimage studies have shown alterations in the volume and perfusion of some brain structures related to language. The manifestations of SLI may change during the development of the children and may disturb the self-esteem, the academic performance and the social abilities. CONCLUSIONS: The variability in the linguistic and cognitive performance, and the variety in the etiological findings in children with SLI, don't allow to settle the affected population as an homogeneous group. Different theoretical positions have emerged as a consequence of this condition.

Cognition↗

Functional genetic analysis of mutations implicated in a human speech and language disorder.

Mutations in the FOXP2 gene cause a severe communication disorder involving speech deficits (developmental verbal dyspraxia), accompanied by wide-ranging impairments in expressive and receptive language. The protein encoded by FOXP2 belongs to a divergent subgroup of forkhead-box transcription factors, with a distinctive DNA-binding domain and motifs that mediate hetero- and homodimerization. Here we report the first direct functional genetic investigation of missense and nonsense mutations in FOXP2 using human cell-lines, including a well-established neuronal model system. We focused on three unusual FOXP2 coding variants, uniquely identified in cases of verbal dyspraxia, assessing expression, subcellular localization, DNA-binding and transactivation properties. Analysis of the R553H forkhead-box substitution, found in all affected members of a large three-generation family, indicated that it severely affects FOXP2 function, chiefly by disrupting nuclear localization and DNA-binding properties. The R328X truncation mutation, segregating with speech/language disorder in a second family, yields an unstable, predominantly cytoplasmic product that lacks transactivation capacity. A third coding variant (Q17L) observed in a single affected child did not have any detectable functional effect in the present study. In addition, we used the same systems to explore the properties of different isoforms of FOXP2, resulting from alternative splicing in human brain. Notably, one such isoform, FOXP2.10+, contains dimerization domains, but no DNA-binding domain, and displayed increased cytoplasmic localization, coupled with aggresome formation. We hypothesize that expression of alternative isoforms of FOXP2 may provide mechanisms for post-translational regulation of transcription factor function.

Alternative Splicing↗

[Analysis and quantitative study of language disorders in lesions of the left thalamus: thalamic aphasia].

We have studied 5 patients having a language disturbance associated with a left thalamic lesion documented by computerized tomography. These patients were submitted to a french adaptation of the Boston Diagnostic Aphasia Examination, originally designed by Goodglass and Kaplan. A quantitative analysis of these language disturbances has shown that they are characterized by reduction of fluency, resembling that of dynamic aphasia, with impaired volume, tone and articulation of speech. There is also a difficulty at finding word categories. Perseverations are frequent while paraphasias are scarce, being then mostly incoherences. Comprehension is impaired, but only at a complex level. Reading and writing are inconsistently affected. This symptom-complex is coherent enough from case to case to be considered as a recognizable type of aphasia, and specially since it is invariably associated with a left thalamic lesion.

Adult↗

Detecting language disorders in 4-year-old French children. An application of the ERTL-4.

This paper discusses the development of the ERTL-4 (Epreuve de repérage des troubles du langage lors du bilan medical de l'enfant de quatre ans), a measure developed in Nancy, France specifically for the purpose of identifying children with language difficulties in the 3.9-4.6 years age range. The test has been designed to identify 10-15% of the population and allows the assessing primary care doctor to ascertain whether difficulties occur in language, voice, fluency, hearing or perception on the basis of a 5-min assessment.

Child, Preschool↗