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Differentiating dialect from disorder: a comparison of two processing tasks and a standardized language test.

UNLABELLED: Previous research has indicated that norm-referenced language assessment protocols are often biased against dialectal speakers. Recently, the use of processing tasks has emerged as one possible means of reducing this bias in language testing. Processing tasks measure a child's ability to process and manipulate language rather than tap previous linguistic knowledge. The present study utilized 40 subjects between the ages of 7;0 and 7;3 in the following equal groupings: White normal language, White language impaired, African American normal language, African American language impaired. The subjects were administered the Test of Language Development-2P (TOLD-2P), the Nonword Repetition Task (NRT), and the Competing Language Processing Task (CLPT). Results indicated that all three measures differentiated normal-language and language-impaired subjects from one another. With regard to cultural group, confirmed speakers of African American English (AAE) with normal language scored significantly lower on the TOLD-2P compared to White normal-language subjects. Scores of the AAE-speaking subjects with normal language on the NRT and CLPT, however, did not differ significantly from the White normal-language subjects. These results suggest that AAE speakers with normally developing language (LN) may be at a disadvantage on tests of prior language knowledge and that processing tasks may be a useful tool in combination with other assessment measures to make less biased clinical decisions. EDUCATIONAL OBJECTIVES: As a result of this activity, the reader will (1) be able to determine the utility of processing tasks in culturally unbiased language assessment. (2) The reader will be able to discriminate the difference between the results of a standardized language test and processing tasks on speakers of AAE.

Child↗

PubMed1992

[The effects of early manual instruction on the oral language development of two deaf children].

The speech and language training for deaf children at our clinic is performed using a multisensory method, which consists of reception and expression training for sign language and fingerspelling as well as auditory training, lip reading, and written language training (the Kanazawa Method). We have already reported that acquisition of written language is not dependent on oral language, and that written language is easier to learn than oral language for deaf children. In the present investigation, we analyzed the acquisition of comprehensible and expressive vocabulary in sign language and fingerspelling. The subjects were two children congenitally deaf at levels higher than 105dB. Recorded language samples by the age of 48 months were analyzed. Acquisition of sign language was found to be significantly easier than acquisition of oral language. The development of expressive noun words, function words, and Wh-question words in sign language at the early period was almost equivalent to that of hearing peers, and then the sign language appeared transfer to the oral language. These results suggest that early presentation of sign language with written and oral language is effective in the acquisition of communicative attitudes, function words and interrogative sentences which are most difficult for the hearing-impaired. It was shown that early presentation of sign language with written and oral language serves to promote acquisition of oral language.

Child↗

PubMed2000

The effect of ventilation tubes on language development in infants with otitis media with effusion: A randomized trial.

OBJECTIVE: To study the effectiveness of ventilation tubes on the language development in infants with persistent otitis media with effusion (OME). All existing studies addressed children 3 years of age or older. Currently, OME is detected and treated with ventilation tubes at a younger age. Because of the critical relationship between age, hearing, and language development, we conducted a study of the effects of ventilation tubes on language development in infants 1 to 2 years old with persistent OME. DESIGN: A multicenter, randomized, controlled trial (embedded in a cohort) with 2 treatment arms: 1) treatment with ventilation tubes (VT group; n = 93); or 2) with a period of watchful waiting (WW group; n = 94). Hearing loss and expressive and comprehensive language were assessed every 6 months, while tympanometry and otoscopy were performed every 3 months. Other factors with potential influence on language development were also included: adenoidectomy, hospital, attending day care, sex, age at randomization, educational level of the mother, upper respiratory infections, and the native country of the parents and older siblings. The trial was designed to allow for the detection of a mean difference in language development of 3 months or more between children allocated to the VT and WW groups. RESULTS: No relevant differences were found in expressive or comprehensive language between the 2 groups after adjustment for educational level of the mother, IQ of the child, and differences at baseline. A principal component analysis showed that in the VT group, the children with frequent complaints improved 1.6 months more in comprehensive language than those with no or some complaints. The children with favorable language stimulation, however, did not improve more than the children with less favorable stimulation. No differences were found for expressive language among the various clusters. The probability to improve >3 months in comprehensive language was.48 (95% confidence interval [CI]:.29-.68) for children with highly educated mothers versus.09 (95% CI:.02-.30) for children whose mothers had a low educational level. In the WW group, these changes were.30 (95% CI:.14-.53) and.14 (95% CI:.04-.35), respectively. The probability to improve >4 months in expressive language was.52 (95% CI:.32-.71) for children with highly educated mothers versus.06 (95% CI:.01-.31) for children whose mothers had a low educational level. In the WW group these changes were.42 (95% CI:.23-.64) and.11 (95% CI:.03-.35), respectively. In addition, there were delays in expressive language in both groups compared with their age expected values. The comprehensive language of the children who were effusion-free during the follow-up (n = 54) improved 1.5 months (95% CI: -.2-3.2) more than that of the children who had persistent effusion during the entire follow-up (n = 28). No differences were found for expressive language development. Disregarding the intervention contrast, improvements in hearing seemed to be related to improvements in language development, especially in verbal comprehension. DISCUSSION: In this study, we used the Reynell, Schlichting, and Lexi tests to study the relation between early persistent OME and language development. These tests are directly related to normal language, widely accepted, and validated. It cannot be ruled out that more specific measures such as auditory perception tests would have produced more differences between groups, but the focus was on general language development. A total of 10 children in the WW group received treatment with ventilation tubes during follow-up. A further 11 children dropped out during the trial. A sensitivity analysis with the 10 children who received ventilation tubes did not change the results, and baseline differences were not found between the 11 children who dropped out and those who completed the trial. CONCLUSIONS: In the total group of infants with persistent OME, ventilation tubes did not h

Child Language↗

PubMed1987

Autonomous languages of twins.

Twins are regularly reported to invent languages of their own, unintelligible to others. These languages are known as autonomous languages, cryptophasia or idioglossia. Despite current belief, this is not a rare phenomenon. Autonomous languages exist in about 40% of all twins, but often disappear soon. In this study, nine autonomous languages are compared: the circumstances in which they emerge, how these languages relate to the parents' language (the model language) and how they are structured. The prototypical situation is one in which two or more close siblings (not necessarily twins) grow up closely together during the language acquisition period. If an adult model language is frequently absent, the children use each other as a model and acquire the language imperfectly. The language may stabilise at that level. If a model is completely absent, the children probably do not create a language. In all cases known, the language consists of onomatopoeic expressions, some invented words, but for the greatest part of words from the adult language adopted to the constrained phonological possibilities of young children. These words being hardly recognizable, the language may turn out to be completely unintelligible to speakers of the model languages, but they resemble each other in that they lack morphology and that word order is based on pragmatic principles such as saliency and the semantic scope of words. Neither the structure of the languages nor its emergence can be explained by other than situational factors.

Child Language↗

PubMed2006

Intraoperative language localization in multilingual patients with gliomas.

OBJECTIVE: Intraoperative localization of speech is problematic in patients who are fluent in different languages. Previous studies have generated various results depending on the series of patients studied, the type of language, and the sensitivity of the tasks applied. It is not clear whether languages are mediated by multiple and separate cortical areas or shared by common areas. Globally considered, previous studies recommended performing a multiple intraoperative mapping for all the languages in which the patient is fluent. The aim of this work was to study the feasibility of performing an intraoperative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal and to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve patients' functional language. METHODS: Seven late, highly proficient multilingual patients with a left frontal glioma were submitted preoperatively to a battery of tests to evaluate oral language production, comprehension, and repetition. Each language was tested serially starting from the first acquired language. Items that were correctly named during these tests were used to build personalized blocks to be used intraoperatively. Language mapping was undertaken during awake craniotomies by the use of an Ojemann cortical stimulator during counting and oral naming tasks. Subcortical stimulation by using the same current threshold was applied during tumor resection, in a back and forth fashion, and the same tests. RESULTS: Cortical sites essential for oral naming were found in 87.5% of patients, those for the first acquired language in one to four sites, those for the other languages in one to three sites. Sites for each language were distinct and separate. Number and location of sites were not predictable, being randomly and widely distributed in the cortex around or less frequently over the tumor area. Subcortical stimulations found tracts for the first acquired language in four patients and for the other languages in three patients. Three of these patients decreased their fluency immediately after surgery, affecting the first acquired language, which fully recovered in two patients and partially in one. The procedure was agile and well tolerated by the patients. CONCLUSION: These findings show that multiple cortical and subcortical language mapping during awake craniotomy for tumor removal is a feasible procedure. They support the concept that intraoperative mapping should be performed for all the languages in which the patient is fluent in to preserve functional integrity.

Adult↗

PubMed2003

Language skills of children with early cochlear implantation.

OBJECTIVE: This study investigated factors contributing to the comprehension and production of English language by children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. The analysis controlled for the effects of child and family characteristics so that educational factors most conducive to maximum implant benefit could be identified. DESIGN: A battery of language tests were administered to 181 8- and 9 yr-old children from across the United States and Canada who received a cochlear implant by age 5. Tests of comprehension, verbal reasoning, narrative ability and spontaneous language production were administered either in speech and sign or in the child's preferred communication mode. These constituted the Total Language measures. Spoken Language measures were derived from a speech-only language sample. Type and amount of educational intervention since implantation constituted the independent variables. Characteristics of the child and the family were considered intervening variables. A series of multiple regression analyses determined the amount of variance in Total Language and Spoken Language ability accounted for by the intervening variables and the amount of additional variance attributable to the independent variables. RESULTS: More than half of the children (with performance intelligence quotients in the average range) exhibited language skills that were similar to those of hearing 8 to 9 yr olds on measures of verbal reasoning, narrative ability, utterance length, and lexical diversity. Significant predictors of language ability were similar for Total and for Spoken Language outcomes and included greater nonverbal intelligence, smaller family size, higher socio-economic status and female gender. Age at receiving an implant did not affect language outcome. After the variance due to these variables was controlled, the primary rehabilitative factors associated with linguistic outcome were amount of mainstream class placement and an educational emphasis on speech and auditory skills. CONCLUSIONS: Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills.

Canada↗

PubMed2000

Language impairment in dementia of the Alzheimer type: a hierarchical decline?

OBJECTIVE: Progressive memory impairment is the primary cognitive feature of Alzheimer's disease. Systematic attention to progressive language impairment is under-appreciated. The purpose of this article is to apply the semiotic language framework to organize the disparate findings on language impairment in DAT. METHOD: The semiotic system is hierarchical, going from simple to more complex units of language, with the hierarchical ranks of phonology, morphology, syntax, semantics. This language hierarchy is used as an organizing tool to provide a context for the discrete data on language decline in DAT. Studies relating to language impairment in DAT were identified through an exhaustive computerized search (Medline and Psych Info Database) of available literature spanning the last forty years in which 615 references were examined. Papers were selected for review if reference were made to any one or more of the language parameters of phonology, morphology, syntax, semantics, or to any components or indicators of these parameters, such as sound production, naming, grammar, sentence processing, verbal comprehension in Alzheimer patients. RESULTS: There appears to be an overall relation between language decline and complexity of language both across and within the hierarchical ranks. There also appears to be an associated negative relation between sequence in language development and language decline. Language forms learned last in the sequence of language development are the most complex and appear to be first to deteriorate. CONCLUSIONS: The decline of language in DAT appears to be hierarchical in nature. Further understanding of this hierarchical language decline depends in part on nosologic clarification and subtyping of DAT.

Aging↗

PubMed1997

Deafness, language skills, and rehearsal: a model for the development of a memory strategy.

We review a series of studies that evaluate the role of developing language skills as a prerequisite to spontaneous rehearsal use in deaf populations. We propose a theoretical model that summarizes the contribution of language skills by highlighting the interrelations among age, language proficiency, and automatized language skills. In an initial test of the model, an index of deaf children's language experience was found to be an almost complete mediator of strategy use. Increasing language proficiency, therefore, was implicated as a critical variable in predicting children's spontaneous rehearsal use, minimizing any direct contribution from age per se. In a more direct assessment of the link between general language proficiency and rehearsal use, pragmatic language skills (as measured by the Language Proficiency Profile: LPP-I) were found to be a nearly complete mediator of rehearsal use, with the remaining contributions of age and language experience being nonsignificant. Language proficiency, therefore, was identified as a strong and necessary prerequisite for rehearsal to be used spontaneously as a memory strategy. The additional hypothesis that the automatization of these general language skills, measured by a rapid automatized naming task (RAN), contributes to spontaneous rehearsal was also evaluated. Automatized language emerged as a partial mediator of the language proficiency → rehearsal use relation but additional language-processing variables were implicated. We discuss these findings as they relate to issues around the nature of language proficiency and the identification of those automatized language skills involved in rehearsal.

Journal Article↗

PubMed2000

Language processing modulated by literacy: a network analysis of verbal repetition in literate and illiterate subjects.

Previous behavioral and functional neuroimaging data indicate that certain aspects of phonological processing may not be acquired spontaneously, but are modulated by learning an alphabetic written language, that is, learning to read and write. It appears that learning an alphabetic written language modifies the auditory-verbal (spoken) language processing competence in a nontrivial way. We have previously suggested, based on behavioral and functional neuroimaging data, that auditory-verbal and written language interact not only during certain language tasks, but that learning and developing alphabetic written language capacities significantly modulates the spoken language system. Specifically, the acquisition of alphabetic orthographic knowledge has a modulatory influence on sublexical phonological processing and the awareness of sublexical phonological structure. We have suggested that developing an orthographic representation system for an alphabetic written language, and integrating a phoneme-grapheme correspondence with an existing infrastructure for auditory-verbal language processing, will result in a modified language network. Specifically, we suggest that the parallel interactive processing characteristics of the underlying language-processing brain network differ in literate and illiterate subjects. Therefore, the pattern of interactions between the regions of a suitably defined large-scale functional-anatomical network for language processing will differ between literate and illiterate subjects during certain language tasks. In order to investigate this hypothesis further, we analyzed the observed covariance structure in a PET data set from a simple auditory-verbal repetition paradigm in literate and illiterate subjects, with a network approach based on structural equation modeling (SEM). Based on a simple network model for language processing, the results of the present network analysis indicate that the network interactions during word and pseudoword repetition in the illiterate group differ, while there were no significant differences in the literate group. The differences between the two tasks in the illiterate group may reflect differences in attentional modulation of the language network, executive aspects of verbal working memory and the articulatory organization of verbal output. There were no significant differences between the literate and illiterate group during word repetition. In contrast, the network interactions differed between the literate and illiterate group during pseudoword repetition. In addition to differences similar to those observed in the illiterate group between word and pseudoword repetition, there were differences related to the interactions of the phonological loop between the groups. In particular, these differences related to the interaction between Broca's area and the inferior parietal cortex as well as the posterior-midinsula bridge between Wernicke's and Broca's area. In conclusion, the results of this network analysis are consistent with our previously presented results and support the hypothesis that learning to read and write during childhood influences the functional architecture of the adult human brain. In particular, the basic auditory-verbal language network in the human brain is modified as a consequence of acquiring orthographic language skills.

Adult↗

PubMed1993

Language development in low birth weight infants: the first two years of life.

The four main aims of this cohort study were to (1) determine the number of consecutively referred low birth weight (LBW) infants presenting with delayed language at 12 and 24 months of age, (2) examine language profiles by measuring both functional and spontaneous language ability in 24-month-olds, (3) examine the relationship between perinatal medical history and language status at 12 and 24 months, and (4) examine the clinical validity of the Early Language Milestone (ELM) scale, a brief language screening instrument. Only infants without serious sensory impairment or mental handicap were included in the final sample. Seventy-one LBW infants (36 12-month-olds, 35 24-month-olds) were seen for developmental and language assessments. The findings suggest that within the first 2 years of life, low to moderate rates of language delay are evident in LBW infants who have already been screened for serious sensory or mental handicap. At 12 months of age, 8.3% of the infants had delayed expressive language; none had delayed receptive language. At 24 months of age, 28% of the infants had delayed expressive language; 5.7% had delayed receptive language. Furthermore, only 32% of those with normal expressive language and sufficient language sample had a mean length of response within the normal range. Language status was not related to a specific perinatal medical variable. Additional study into the clinical validity of the ELM as a screening measure for the LBW population is warranted. The ELM specificity for both receptive and expressive language domains was good at both ages (80 to 100%), but sensitivity was low to moderate (0 to 68%).

Child, Preschool↗

PubMed2004

Functional connectivity in the human language system: a cortico-cortical evoked potential study.

A better understanding of the mechanisms involved in human higher cortical functions requires a detailed knowledge of neuronal connectivity between functional cortical regions. Currently no good method for tracking in vivo neuronal connectivity exists. We investigated the inter-areal connections in vivo in the human language system using a new method, which we termed 'cortico-cortical evoked potentials' (CCEPs). Eight patients with epilepsy (age 13-42 years) underwent invasive monitoring with subdural electrodes for epilepsy surgery. Six patients had language dominance on the side of grid implantation and two had bilateral language representation by the intracarotid amobarbital test. Conventional cortical electrical stimulation was performed to identify the anterior and posterior language areas. Single pulse electrical stimuli were delivered to the anterior language (eight patients), posterior language (four patients) or face motor (two patients) area, and CCEPs were obtained by averaging electrocorticograms (ECoGs) recorded from the perisylvian and extrasylvian basal temporal language areas time-locked to the stimulus. The subjects were not asked to perform any tasks during the study. Stimulation at the anterior language area elicited CCEPs in the lateral temporo-parietal area (seven of eight patients) in the middle and posterior part of the superior temporal gyrus, the adjacent part of the middle temporal gyrus and the supramarginal gyrus. CCEPs were recorded in 3-21 electrodes per patient. CCEPs occurred at or around the particular electrodes in the posterior language area which, when stimulated, produced speech arrest. Similar early and late CCEPs were obtained from the basal temporal area by stimulating the anterior language area (three of three patients). In contrast, stimulation of the adjacent face motor area did not elicit CCEPs in language areas but rather in the postcentral gyrus. Stimulation of the posterior language area produced CCEPs in the anterior language (three of four patients) as well as in the basal temporal area (one of two patients). These CCEPs were less well defined. These findings suggest that perisylvian and extrasylvian language areas participate in the language system as components of a network by means of feed-forward and feed-back projections. Different from the classical Wernicke-Geschwind model, the present study revealed a bidirectional connection between Broca's and Wernicke's areas probably through the arcuate fasciculus and/or the cortico-subcortico-cortical pathway. CCEPs were recorded from a larger area than the posterior language area identified by electrical stimulation. This suggests the existence of a rather broad neuronal network surrounding the previously recognized core region of this area.

Adolescent↗

PubMed1994

Cortical localization of temporal lobe language sites in patients with gliomas.

In a series of 40 patients undergoing an awake craniotomy for the removal of a glioma of the dominant hemisphere temporal lobe, cortical stimulation mapping was used to localize essential language sites. These sites were localized to distinct temporal lobe sectors and compared with 83 patients without tumors who had undergone language mapping for the treatment of intractable epilepsy. In patients with and without temporal lobe gliomas, the superior temporal gyrus contained significantly more language sites than the middle temporal gyrus. Both patient populations also had language sites anterior to the central sulcus in the superior temporal gyrus (12-16%). The patients without tumors had significantly more language sites in the superior temporal gyrus, compared with the superior temporal gyrus of patients with temporal lobe tumors. Multiple variables were studied for their effect on preoperative and postoperative language deficits and included age, sex, number of language sites, histology, size of the tumor, and the distance of tumor resection margins from the nearest language site. The distance of the resection margin from the nearest language site was the most important variable in determining the improvement in preoperative language deficits, the duration of postoperative language deficits, and whether the postoperative language deficits were permanent. If the distance of the resection margin from the nearest language site was > 1 cm, significantly fewer permanent language deficits occurred. Cortical stimulation mapping for the identification of essential language sites in patients with gliomas of the dominant hemisphere temporal lobe will maximize the extent of tumor resection and minimize permanent language deficits.

Adolescent↗

PubMed1995

Differential receptive and expressive language functioning of children with symptomatic HIV disease and relation to CT scan brain abnormalities.

OBJECTIVES: To investigate the effect of HIV disease on the receptive and expressive language of children and the relationship between CT scan brain abnormalities and language functioning. METHODS: Thirty-six children (mean age, 5.5 years; range, 1 through 10 years; 75% vertical transmission; 58% classified as encephalopathic) with symptomatic HIV infection and 20 uninfected siblings (mean age, 7.8 years; range, 3 through 15 years) were administered an age-appropriate comprehensive language test assessing both receptive and expressive language (Reynell Developmental Language Scales or Clinical Evaluation of Language Fundamentals--Revised). Each HIV-infected child had a CT scan of the brain as part of the baseline evaluation, which was rated independently and blindly by two neurologists, for presence and severity of brain abnormalities using a semiquantitative rating system. RESULTS: Expressive language was significantly more impaired than receptive language in the overall sample of HIV-infected children. The encephalopathic children scored significantly lower than the non-encephalopathic children, however, the degree of discrepancy between mean receptive and expressive language scores was not significantly different between these two groups. The uninfected sibling control group did not have a significant discrepancy between receptive and expressive language, and they scored significantly higher than the infected patient group. Greater severity of CT scan abnormalities was significantly correlated with poorer receptive and expressive language functioning in the overall HIV-infected sample and a higher discrepancy between receptive and expressive language in the encephalopathic group. CONCLUSION: Pediatric HIV disease is associated with differential receptive and expressive language functioning in which expressive language is significantly more impaired than receptive language. The sibling data and CT scan correlations suggest that the observed language impairments are associated with the direct effects of HIV-related central nervous system disease.

AIDS Dementia Complex↗

PubMed2006

Language awareness in the bilingual healthcare setting: a national survey.

BACKGROUND: The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. OBJECTIVES: This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. DESIGN: The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. PARTICIPANTS: A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. RESULTS: A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (p<.01); language attitudes (p<.01); and language region (p<.01). Mean language attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. CONCLUSIONS: In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is therefore recommended as a way of enhancing care delivery for minority language speakers.

Adult↗

PubMed1998

Early language development in children exposed to or infected with human immunodeficiency virus.

OBJECTIVES: To compare language development in infants and young children with human immunodeficiency virus (HIV) infection to language development in children who had been exposed to HIV but were uninfected, and (among subjects with HIV infection) to compare language development with cognitive and neurologic status. DESIGN: Prospective evaluation of language development in infected and in exposed but uninfected infants and young children. SETTING: Pediatric Infectious Disease Clinic, State University of New York-Health Science Center at Syracuse. SUBJECTS: Nine infants and young children infected with HIV and 69 seropositive but uninfected infants and children, age 6 weeks to 45 months. RESULTS: Mean Early Language Milestone Scale, 2nd edition (ELM-2) Global Language scores were significantly lower for subjects with HIV infection, compared with uninfected subjects (89.3 vs 96.2, Mann-Whitney U test). The proportion of subjects scoring >2 SD below the mean on the ELM-2 on at least one occasion also was significantly greater for subjects with HIV infection, compared with uninfected subjects (4 of 9 infected subjects, but only 5 of 69 uninfected subjects; Fisher's exact test). Seven of the 9 subjects with HIV infection manifested deterioration of language function. Four manifested unremitting deterioration; only 1 of these 4 demonstrated unequivocal abnormality on neurologic examination. Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment. Magnetic resonance imaging or computed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration, and findings were normal in all 6. ELM-2 Global Language scaled scores showed good agreement with the Bayley Mental Developmental Index or the McCarthy Global Cognitive Index (r = 0. 70). Language deterioration, or improvement in language after initiation of drug therapy, coincided with or preceded changes in global cognitive function, at times by intervals of up to 12 months. CONCLUSIONS: Language deterioration occurs commonly in infants and young children with HIV infection, is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imaging, and may precede evidence of deterioration in global cognitive ability. Periodic assessment of language development should be added to the developmental monitoring of infants and young children with HIV infection as a means of monitoring disease progression and the efficacy of drug treatment.

Child, Preschool↗

PubMed2003

Phonetic, phonological, and language skills of children with a cleft palate.

OBJECTIVE: To evaluate the language, phonetic, and phonological skills at age 3 years of two groups of young children with a cleft palate, with different expressive language proficiency at 2 years of age. DESIGN: Two groups of children with a cleft palate with differing abilities in early expressive language skills were identified at age 2 years. Comparisons across groups were made over a range of speech and language measures at age 3 years. PARTICIPANTS: Twenty children with cleft palate were allocated to two groups dependent on expressive language abilities at age 2 years. One group had normal language development, and the second group had been identified as having significantly delayed (8 to 12 months' delay) expressive language development. MAIN OUTCOME MEASURES: The children were assessed at 3 years of age using standardized assessments and spontaneous speech samples. Comparisons between the two groups were made on a range of language measures including comprehension, expressive language, and speech. RESULTS: Group differences were found on both language and speech abilities at age 3 years. Significant group differences were found in expressive language, percentage of consonants correct, phonetic inventory, and phonological process usage. The group with delayed early expressive language abilities at 2 years continued to have expressive language difficulties at 3 years of age and had more disordered speech development, compared with the nondelayed group. CONCLUSIONS: A subgroup of children with a cleft palate was identified who exhibited delays in early expressive language and continued to have delayed language and disordered phonological patterns at a later age. Support for three possible etiologies including a structural/anatomical deficit, cognitive/linguistic delay, or language/phonological disorder are discussed.

Articulation Disorders↗

PubMed2007

Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas.

OBJECTIVE: Subcortical stimulation can be used to identify functional language tracts during resection of gliomas located close to or within language areas or pathways. The objective of the present study was to investigate the feasibility of the routine use of subcortical stimulation for identification of language tracts in a large series of patients with gliomas and to determine the influence that subcortical language tract identification exerted on the extent of surgery and on the appearance of immediate and definitive postoperative deficits. METHODS: Subcortical stimulation for language tract identification was systematically used during surgical removal of 88 gliomas (44 high-grade and 44 low-grade gliomas) involving language pathways. Procedures were performed during asleep/awake craniotomy. Subcortical stimulation was continuously alternated with surgical resection in a back-and-forth fashion. Language performances were tested by neuropsychological language evaluation preoperatively and at 3, 30, and 90 days after surgery. RESULTS: Language tracts were identified in 59% of patients, with differences according to tumor location but not according to histological grade. Language tract identification influenced the ability to reach a complete tumor removal in low-grade gliomas, in which tracts were documented inside the peripheral mass of the tumor. Identification of language tracts was associated with a higher occurrence of transient postoperative deficits (67.3% of cases), but a low occurrence of definitive morbidity (2.3% of cases). A pattern of typical language disturbances related to the phonological and semantic system can be identified according to tumor location, with preservation being important for the maintenance of language integrity. CONCLUSION: Our study supports the routine use of subcortical stimulation for language tract identification as a reliable tool for guiding surgical removal of gliomas in or in close proximity to language areas or pathways.

Adult↗

PubMed2003

The inclusion of reports of randomised trials published in languages other than English in systematic reviews.

OBJECTIVE: To assemble a large dataset of language restricted and language inclusive systematic reviews, including both conventional medicinal (CM) and complementary and alternative medicine (CAM) interventions. To then assess the quality of these reports by considering and comparing different types of systematic reviews and their associated RCTs; CM and CAM interventions; the effect of language restrictions compared with language inclusions, and whether these results are influenced by other issues, including statistical heterogeneity and publication bias, in the systematic review process. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and the Centralised Information Service for Complementary Medicine. REVIEW METHODS: Three types of systematic reviews were included: language restricted; language inclusive/English language (EL) reviews that searched RCTs in languages other than English (LOE) but did not find any and, hence, could not include any, in the quantitative data synthesis; and systematic reviews that searched for RCTs in LOE and included them in the quantitative data synthesis. Fisher's exact test was applied to compare the three different types of systematic reviews with respect to their reporting characteristics and the systematic review quality assessment tool. The odds ratio of LOE trials versus EL trials was computed for each review and this information was pooled across the reviews to examine the influence that language of publication and type of intervention (CM, CAM) have on the estimates of intervention effect. Several sensitivity analyses were performed. RESULTS: The LOE RCTs were predominantly in French and German. Language inclusive/LOE systematic reviews were of the highest quality compared with the other types of reviews. The CAM reviews were of higher quality compared with the CM reviews. There were only minor differences in the quality of reports of EL RCTs compared with the eight other languages considered. However, there are inconsistent differences in the quality of LOE reports depending on the intervention type. The results, and those reported previously, suggest that excluding reports of RCTs in LOE from the analytical part of a systematic review is reasonable. Because the present research and previous efforts have not included every type of CM RCT and the resulting possibility of the uncertainty as to when bias will be present by excluding LOE, it is always prudent to perform a comprehensive search for all evidence. This result only applies to reviews investigating the benefits of CM interventions. This does not imply that systematic reviewers should neglect reports in LOE. We recommend that systematic reviewers search for reports regardless of the language. There may be merit in including them in some aspects of the review process although this decision is likely to depend on several factors, including fiscal and other resources being available. Language restrictions significantly shift the estimates of an intervention's effectiveness when the intervention is CAM. Here, excluding trials reported in LOE, compared with their inclusion, resulted in a reduced intervention effect. The present results do not appear to be influenced by statistical heterogeneity and publication bias. CONCLUSIONS: With the exception of CAM systematic reviews, the quality of recently published systematic reviews is less than optimal. Language inclusive/LOE systematic reviews appear to be a marker for a better quality systematic review. Language restrictions do not appear to bias the estimates of a conventional intervention's effectiveness. However, there is substantial bias in the results of a CAM systematic review if LOE reports are excluded from it.

Complementary Therapies↗