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Diversity in voice characteristics--interaction between genes and environment, use of microarray analysis.

UNLABELLED: Genetic information is used by the cells to make proteins. These proteins are then used to perform cellular and tissue functions. This process is briefly reviewed. Research to identify genes and their expression patterns is a fruitful field in the area of voice disorders. Gene expression studies of vocal lesions illustrates why this type of research is important. The role of microarray analysis (MA) to find genes of interest is discussed. Gene expression may be influenced by various environmental factors. This interaction between environment and genes is constantly manifested in many vocal characteristics and disorders. Since the end result of the gene-environment interaction is the production of cellular and tissue proteins, the field of proteomics is relevant to voice disorders. Some voice disorders have been treated successfully through using proteomic approaches. LEARNING OUTCOMES: (a) Understand the factors that influence genetic expression; (b) display a knowledge of why the study of proteins is important to understand voice characteristics; (c) become familiar with MA, a powerful tool for the study of gene expression; and (d) describe the interaction between genes and environment.

Education, Medical, Continuing↗

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Genes and syndromic hearing loss.

UNLABELLED: Syndromes that are associated with hearing loss include Waardenburg, Stickler (STL), Jervell and Lange-Nielsen, Usher (USH), Alport, mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes, and sensorineural hearing loss (MELAS) and mitochondrial encephalomyopathy, myoclonus epilepsy, ragged-red fibers, and sensorineural hearing loss (MERRF). Waardenburg and STL show an autosomal dominant pattern of inheritance, while Jervell and Lange-Nielsen and USH are autosomal recessive, and Alport is usually X-linked. Mutations in specific genes that are associated with each of these syndromes have been identified, and genetic diagnostic tests are becoming available. The goal of ongoing research is to understand the functions of the proteins encoded by these genes, and develop effective therapies based on knowledge of the underlying causal mutations. LEARNING OUTCOMES: The reader will be introduced to basic genetic principles and will understand that (1) the etiology of hearing loss is usually genetic and many patients should be referred to a clinical geneticist; (2) a negative family history does not mean that the hearing loss is not genetic; (3) hearing loss may be part of a syndrome for which early detection and intervention for associated anomalies is necessary; and (4) many different mutations in a large number of genes underlie hearing loss.

DNA, Mitochondrial↗

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Genetic testing for deafness--GJB2 and SLC26A4 as causes of deafness.

UNLABELLED: Recent advances in the molecular biology of hearing and deafness are being transferred from the research laboratory to the clinical arena. This transfer of knowledge will enhance patient care by making the diagnosis of hereditary deafness easier; however physicians and audiologists must clearly identify that subset of the deaf and hearing populations best served by this knowledge. It is also essential for physicians and audiologists to understand the limitations of genetic testing for deafness, and it is imperative that these limitations be appropriately explained to patients and their families. LEARNING OUTCOMES: The reader will be introduced to the concept of genetic testing for deafness. Two genes that make appreciable contributions to the autosomal recessive non-syndromic deafness (ARNSD) genetic load will be reviewed, GJB2 and SLC26A4. In addition, the unique aspects of genetic counseling for deafness and recurrence chance estimates are explained.

Carrier Proteins↗

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Gender and masculinity-femininity ratings of tracheoesophageal speech.

UNLABELLED: Tracheoesophageal (TE) speech is frequently characterized as low pitched and hoarse. In laryngeal speakers, these features are most often associated with males. Because lower pitch and hoarseness are anticipated for male and female TE speakers, one might predict that females are at risk for being perceived as male. The purposes of this pilot study were to assess the reliability and accuracy of listeners' perceptions of TE speaker gender and to evaluate the relationship between gender ratings and masculinity-femininity ratings. Twenty-five naïve listeners rated the gender and the masculinity-femininity of 12 TE speakers from audio recordings of a reading passage. Listeners were able to reliably rate gender and masculinity-femininity. They accurately identified speaker gender at a high rate that was comparable for males and females. However, female speakers, despite being accurately identified as female, were at an elevated risk of being rated as masculine or neutral on the masculinity-femininity scale. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) describe the reliability and accuracy of listener perceptions of the gender and the degree of masculinity-femininity of TE speakers; and (2) discuss the relationship between TE speaker gender identification and masculinity-femininity ratings for males and females, respectively.

Aged↗

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Compensating for executive function impairments after TBI: a single case study of functional intervention.

UNLABELLED: The purpose of this study was to demonstrate the effectiveness of compensatory strategies for impairments in executive function. The strategies were designed to enable a client with traumatic brain injury (TBI) to obtain professional employment. In a series of individual speech-language therapy sessions, compensatory strategies were developed, refined, and trained in mock-interview situations. Significant improvements were noted in report-writing accuracy and self-reported stress during report-writing. The client was able to obtain and maintain competitive employment in his chosen profession. The results support the use of strategies aimed at supporting executive function to improve performance on verbal tasks, and were informative regarding the effects of self-perceived efficacy and stress on performance after TBI. They illustrate that intervention based on real-life supports may be effective even many years post-TBI. LEARNING OUTCOMES: At the conclusion of this article, readers will: (1) identify aspects of executive function that relate to communication in the workplace, (2) describe the steps in considering intervention within a single subject research design framework, and (3) consider the effects of stress and perceived self-efficacy on performance of communication tasks.

Brain Injuries↗

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Anatomical risk factors that distinguish dyslexia from SLI predict reading skill in normal children.

UNLABELLED: These studies investigated whether anatomical measures could separate phonologically-based reading disability (PD) from nonphonologically-based learning disabilities such as specific language impairment (SLI). In a previous study. four brain measures (cerebral asymmetry. summed planum temporale and parietale asymmetry, anterior cerebellar asymmetry, and a duplicated left Heschl's gyrus) distinguished a group of PD adults from reading disabled adults without specific phonological deficits (URD). Study 1 found that these measures did not distinguish 14 reading disabled children from 21 children with SLI. Instead, differences were found in cerebral volume, planum temporale asymmetry, and the size of a single left Heschl's gyrus. Study 2 demonstrated that including all seven measures in a discriminant analysis separated the adults and children into two groups: one with 100% of the PD adults and 75% of the reading disabled children and the other with 72% of the SLI children and 75% of the URD adults. Study 3 demonstrated that an anatomical risk factor index (ARF7) generated from the discriminant function with seven brain measures predicted reading in normal children. Children with ARF7 near 0 (normal anatomy) had superior verbal ability and phonological decoding scores that improved with age. Normal children with negative ARF7 the relatively s mall symmetrical structures that characterize SLI)had deficits in verbal ability. Children with positive ARF7 (the asymmetrical structures that characterize PD) had phonological decoding scores that decreased with age. These results suggest that PD and SLI are qualitatively different disorders associated with anatomical deviations in opposite directions from the population mean. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) distinguish the neuroanatomical features that characterize PD and SLI; (2) recognize that PD is associated with large asymmetrical brain structures while SLI is associated with smaller symmetrical brain structures; (3) understand that children with moderate sized brains and whose anatomy is intermediate between symmetry and extreme asymmetry have an enhanced probability of developing good verbal ability; (4) understand that reading disabilities depend on the interaction of neurodevelopment and the environment.

Brain↗

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Toward a better understanding of the perception of self-produced speech.

UNLABELLED: The subject of how humans hear their own voices while speaking has received sporadic attention. Previous investigations suggest that the voice is heard substantially via bone conduction, implying a different transfer function to the ear--perhaps a low-pass filter--than for purely air-conducted vocalizations. Determining the characteristics of the transfer function of self-produced speech might contribute to a better understanding of self-perception. Such information may have important implications for treating articulation disorders. The efficacy of training discrimination during the remediation of articulation disorders remains unclear, perhaps because clients are asked to discriminate either speech of others or recorded self-speech samples not readily recognized as their own. This study was conducted to determine preference for filtered self-monitored speech in a delayed feedback paradigm. Participants made immediate comparisons of their real-time speech to delayed-recorded filtered self-speech samples. Participants demonstrated a clear preference for low-pass filtered speech, supporting earlier findings, but we were unable to determine the transfer function itself. LEARNING OUTCOMES: As a result of this activity, the learner will be able to describe some reasons why an individual's tape recorded speech typically sounds different to him/her from his/her own, live speech. As a result of this activity, the learner will be able to describe some potential applications for an accurately-characterized transfer function for self-produced speech.

Adult↗

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The production of emotional prosody in varying degrees of severity of apraxia of speech.

UNLABELLED: The purpose of this study was to examine the abilities of subjects with varying degrees of apraxia of speech (AOS) to produce emotional prosody. One subject with mild AOS, one subject with moderate AOS and a control subject were asked to produce sentences with happy, sad and neutral emotional intent in a repetition and a reading experiment and naive listeners were asked to identify the intended emotion of the productions based upon the prosodic structures. Acoustic analyses of the subjects' productions revealed that unlike the control subject, the AOS subjects did not produce differences in FO, duration and amplitude cues within their prosodic structures to convey the different emotions. Naive listeners were able to identify the emotional intent of the control subject's productions but were unable to distinguish between the utterances of the experimental subjects. These findings are discussed in conjunction with suggestions for future research in this area. LEARNING OUTCOMES: The reader will (1) be able to define apraxia of speech and identify speech characteristics associated with apraxia of speech; (2) acquire an understanding of prosodic cues used to signal emotional intent; and (3) develop an understanding of the relationship between apraxia of speech and the production of emotional prosody.

Affect↗

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Effects of toy stimulation on the cognitive, communicative, and emotional functioning of adults in the middle stages of Alzheimer's disease.

UNLABELLED: Although several clinical reports describe the benefits of toy stimulation for dementia patients, there is little empirical support for this sensory stimulation approach. The purpose of this investigation was to examine the effects of toy stimulation on the language, cognition, and emotional state of patients in the middle stages of Alzheimer's disease (AD) during a formal testing situation. Eighteen patients completed a standardized test battery and picture description task twice, once with and once without a toy stimulus present. Three AD patients completed all tasks four times (twice with and twice without the toy) to examine performance consistency. Although some patients improved their performances in the presence of a toy, there were no significant group differences between the toy and no toy conditions for any experimental measure. Of the three patients who completed experimental tasks twice in the presence of a toy, two displayed some consistent improvements whereas the remaining patient's response pattern was variable. Caregiver feedback regarding toy stimulation was positive. Methodological limitations of the current study and suggestions for future research are discussed. LEARNING OUTCOMES: As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding sensory stimulation treatment approaches for patients with Alzheimer's disease or other dementing illnesses; and (2) describe the effects of toy stimulation on the linguistic and cognitive abilities, and emotional status of patients in the middle stages of Alzheimer's disease.

Affect↗

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Similarities in weak syllable omissions between children with specific language impairment and normally developing language: a preliminary report.

UNLABELLED: Two-year-olds with normally developing language (NL) and older children with specific language impairment (SLI) omit initial weak syllables from words (e.g., "banana" approximately "nana"). Previous research revealed a phonetic "trace" of syllables omitted by children with NL (Carter, 1999; Carter & Gerken, submitted for publication). The present study asked whether similar evidence could be found for omissions by children with SLI. Fourteen children with SLI produced sentences containing reduced or unreduced disyllabic proper names (e.g., "Feed_cinda," from "Feed Lucinda" vs. "Feed Cindy"). Acoustic analyses revealed a significantly longer duration for verb-onset to name-onset of sentences containing the reduced name, indicating that although segmental material is omitted, an acoustic trace remains. In addition, a phonological examination showed similarities between groups regarding sentential and syllabic factors that affect omission rates, as well as an interesting difference that suggests different strategies the groups use in acquiring adult targets. LEARNING OUTCOMES: As a result of reading this article, participants should (1) have a better understanding of similarities and differences in the language production of children with specific language impairment and normally developing language, with regard to prosodic development, (2) be familiar with several models of the phenomenon of weak syllable omissions in children's developing language, and (3) recognize the importance of using a combination of linguistic analysis types when studying issues in child language production.

Child↗

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Co-occurring disorders in children who stutter.

UNLABELLED: This study used a mail survey to determine the (a) percentage of children who stutter with co-occurring non-speech disorders, speech disorders, and language disorders, and (b) frequency, length of sessions, and type of treatment services provided for children who stutter with co-occurring disorders. Respondents from a nationwide sample included 1184 speech-language pathologists (SLPs). Of the 2628 children who stuttered, 62.8% had other co-occurring speech disorders, language disorders, or non-speech-language disorders. Articulation disorders (33.5%) and phonology disorders (12.7%) were the most frequently reported co-occurring speech disorders. Only 34.3% of the children who stuttered had co-occurring non-speech-language disorders. Of those children with co-occurring non-speech-language disorders, learning disabilities (15.2%), literacy disorders (8.2%), and attention deficit disorders (ADD) (5.9%) were the most frequently reported. Chi-square analyses revealed that males were more likely to exhibit co-occurring speech disorders than females, especially articulation and phonology. Co-occurring non-speech-language disorders were also significantly higher in males than females. Treatment decisions by SLPs are also discussed. LEARNING OUTCOMES: As a result of this activity, the participant should: (1) have a better understanding of the co-occurring speech disorders, language disorders, and non-speech disorders in children who stutter; (2) identify the speech disorders, language disorders, and non-speech disorders with the highest frequency of occurrence in children who stutter; and (3) be aware of the subgroups of children with co-occurring disorders and their potential impact on assessment and treatment.

Child↗

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Perceptual effects of a flattened fundamental frequency at the sentence level under different listening conditions.

UNLABELLED: The purpose of this series of experiments was to examine the effect of a flattened fundamental frequency (F0) contour on the intelligibility of sentence length material in different listening environments. Eight speakers of different genders and ages produced sentences from the Speech Perception in Noise Test (SPIN). Each utterance was subjected to a resynthesis technique that allowed flattening of the fundamental frequency while maintaining the timing and spectral characteristics of the utterances. To avoid learning effects two groups of listeners were chosen to complete word transcription and interval scaling tasks of the unmodified and flattened F0 utterances under different listening conditions (competing white noise or multi-speaker babble) to obtain measures of speech intelligibility. Results were that a flattened fundamental frequency contour negatively influences speech intelligibility regardless of the nature of the competing background noise. LEARNING OUTCOMES: (1) To appreciate the role fundamental frequency variation plays in speech intelligibility. (2) To understand the importance of considering environmental noise in clinical speech intelligibility testing.

Adult↗

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The word length effect in children with language impairment.

UNLABELLED: Two types of serial word recall tasks (full verbal recall and probed recall) were administered to 11 children with language impairment and 22 language-normal children matched for productive language or chronological age. The methods were designed to take into account age-related differences in the use of subvocal rehearsal, as measured by the word length effect. The word length effect was significant for all three groups in full recall, but not in probed recall, supporting the hypothesis that children with language impairment demonstrate limited capacity for processing verbal output. Discussion focuses on the importance of considering developmental factors in measuring short-term memory effects in children with language impairment. LEARNING OUTCOMES: As a result of this activity, the participant will be able to describe the phonological loop hypothesis and discuss the interactions between working memory and language performance in children with language disorders.

Child↗

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Phonological processing and oral language abilities in fourth-grade poor readers.

UNLABELLED: This study investigated the contribution of phonological processing and oral language skills to reading abilities (word attack, word recognition, and comprehension) in 17 fourth graders identified as poor readers. Participants were assessed in the areas of phonological awareness, verbal working memory, and rapid naming, in addition to oral language abilities as predictors of poor reading skills. Results indicated that the strongest predictors of word attack skills were phonological awareness and grammaticality judgment. The combination of phonological awareness, grammaticality judgment, phoneme manipulation, and rapid naming of digits accounted for more than half of the variance in word recognition. Furthermore, the amount of discrepancy between IQ scores and reading achievement did not distinguish groups of poor readers. The results support the importance of metalinguistic skills to support reading ability. Phonological processing and oral language abilities may vary in children with poor reading skills as processing demands change with age and task. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) identify phonological processing and oral language skills that are most predictive of specific reading skills in poor readers; (2) describe further evidence of the lack of utility of the discrepancy model to define reading disorders in children.

Awareness↗

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Recognition of vocal and facial cues to affect in language-impaired and normally-developing preschoolers.

UNLABELLED: The current study was designed to investigate whether reported difficulties in language-impaired children's ability to identify vocal and facial cues to emotion could be explained at least partially by nonparalinguistic factors. Children with specific language impairment (SLI) and control participants received an affect discrimination task, which consisted of the following cue situations: (1) facial expression and unfiltered speech; (2) lowpass-filtered speech only; (3) facial expression only; and (4) facial expression and filtered speech. The results of the study indicated that impaired and nonimpaired group performance differed only for the items including facial expression and nonfiltered speech. Developmental and investigative implications of this finding are addressed. LEARNING OUTCOMES: As a result of this activity, the participant will be able to summarize the findings from existing research on affect comprehension in children with language impairments (LI). As a result of this activity, the participant will be able to discuss ways in which language impairment and difficulties in understanding emotion cues are associated and propose how these associations might influence social interactions.

Affect↗

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Influences on perceived function of a nursing home resident.

UNLABELLED: This article describes a typical, yet fictionalized woman with Alzheimer's disease during her first week at a nursing home. Readers are challenged to ask themselves in what areas of difficulty a speech-language pathologist may or may not be able to contribute to the success of this resident. The authors use the World Health Organization's International Classification of Functioning, Disability, and Health [International Classification of Functioning, Disability, and Health, 2001, Geneva, Switzerland] as the framework for assessments and the resident-centered interventions for this case study. LEARNING OUTCOMES: 1. The reader will be able to identify the four main constructs of the ICF classification system. 2. The reader will be able to identify three environmental factors that may influence the functioning of a person with Alzheimer's disease. 3. The reader will be able to discuss at least four interventions that can be implemented by a speech-language pathologist to improve a nursing home resident's participation in daily activities.

Activities of Daily Living↗

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Stuttering and the International Classification of Functioning, Disability, and Health: an update.

UNLABELLED: The World Health Organization (WHO) recently presented a multidimensional classification scheme for describing health status and the experience of disablement. This new framework, the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), is a revision of WHO's prior framework for describing the consequences of disorders, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; WHO, 1980). In previous papers, Yaruss had shown how the original ICIDH could be adapted to describe the consequences of stuttering at several levels that are relevant to the communication and life experiences of the person who stutters. The current manuscript presents an update of the Yaruss (1998) model that accounts for the new structure of the ICF. A comparison of the WHO's ICIDH and ICF frameworks is presented, followed by an analysis of how the ICF can be adapted to describe the speaker's experience of the stuttering disorder. Emphasis is placed on the fact that stuttering involves more than just observable behaviors. Specifically, the speaker's experience of stuttering can involve negative affective, behavioral, and cognitive reactions (both from the speaker and the environment), as well as significant limitations in the speaker's ability to participate in daily activities and a negative impact on the speaker's overall quality of life. LEARNING OUTCOMES: As a result of reading this manuscript, participants, willgain an understanding of the updates to the World Health Organization's original International Classification of Impairments, Disabilities, and Handicaps that are seen in the International Classification of Functioning, Disability, and Health understand how the ICF can be applied to the study of stuttering recognize that health conditions such as stuttering are affected by both internal and external factors, and can involve more than just observable behaviors that are seen on the surface.

Disability Evaluation↗

PubMed1996

Orientation to higher education: the challenges and rewards.

A new 'starter' course for qualified nurses entering higher education is discussed in this article. The background and aims of this course, which enables traditionally trained nurses to enter a pathway of professional and academic development, are presented. Learning outcomes of the course, identified through a formal evaluation procedure, were categorized into product and process components. Course teachers anticipated that the product outcomes would be evaluated most highly but the participants reported that the process outcomes were more important to them. They believed these process outcomes would empower them not only to undertake further academic studies but also to take a greater part in clinical decision-making. The results of this evaluation demonstrate that for many nurses, who seek to launch themselves into higher education, a 'bridging' programme is necessary to support this transition.

Career Mobility↗