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PubMed2006

Surgical resection of tumors located in subcortex of language area.

OBJECT: Although functional mapping facilitates the planning of surgery in and around eloquent areas, the resection of tumors adjacent to language areas remains challenging. In this report, we took notice that the language areas (Broca's and Wernicke's) present at the perisylvian fissure. We posit that if there is non-essential language area on the inner surface of the Sylvian fissure, safe tumor resection may be possible even if the tumor is located under the language cortex. METHODS: The study population consisted of 5 patients with intrinsic brain tumors (frontal glioma, n = 3; temporal cavernous angioma, n = 1; primary malignant central nervous system lymphoma, n = 1) located in the perisylvian subcortex, in the language-dominant hemisphere. All patients underwent awake surgery and we performed intra-operative bipolar cortical functional language mapping. When the tumor was located under the language area, the Sylvian fissure was opened and the inner surface of the opercular cortex was exposed with the patient asleep, and additional functional mapping of that cortex was performed. This enabled us to remove the tumor from the non-functioning cortex. In our series, 4 of 5 patients had not language function on the inner surface of the operculum. Only one patient, a 52-year-old man with frontal glioblastoma (Case 3) had language function on the inner surface of the frontal operculum. CONCLUSION: We suggest that even perisylvian tumors located in the subcortex of the language area may be resectable via the nonfunctioning intrasylvian cortex by a transopercular approach without resultant language dysfunction.

Adult↗

PubMed2005

Assessment of stuttering in a familiar versus an unfamiliar language.

UNLABELLED: The present study investigated how well individuals knowledgeable about stuttering are able to make disfluency judgments in clients who speak another language than their own. Fourteen native speakers of Brazilian Portuguese identified and judged stuttering in Dutch speakers and in Portuguese speakers. Fourteen native speakers of Dutch identified and judged stuttering in Brazilian Portuguese speakers and in Dutch speakers. It was found that judges can make similar level of judgment in a native and a foreign language, and that native and foreign judges can make similar level of judgment irrespective of native/foreign differences. It was also found, however, that the Dutch judges performed significantly better in identifying native stutterers than foreign stutterers. And for the identification of nonstutterers, both panels performed better in their native language than in the foreign language, and in their native language they both performed better than the other panel. Both the Brazilian Portuguese and the Dutch speaking panel were generally also less confident, and found identification of stuttering more difficult in the foreign language than in the native language. In addition, when asked for the characteristics that helped them identify stutterers, they provided more detail in the native language than in the foreign language. Also a number of differences were found between the two panels which may be due to differences in training or cultural background. The implications of the findings for clinical practice and for future research in this area are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how language influences the identification of a speech disorder such as stuttering, and (2) list, and (3) define behaviors that help to identify stuttering in a foreign language.

Adolescent↗

PubMed2006

Bilingual and multilingual language processing.

This chapter addresses the interesting question on the neurolinguistics of bilingualism and the representation of language in the brain in bilingual and multilingual subjects. A fundamental issue is whether the cerebral representation of language in bi- and multilinguals differs from that of monolinguals, and if so, in which specific way. This is an interdisciplinary question which needs to identify and differentiate different levels involved in the neural representation of languages, such as neuroanatomical, neurofunctional, biochemical, psychological and linguistic levels. Furthermore, specific factors such as age, manner of acquisition and environmental factors seem to affect the neural representation. We examined the question whether verbal memory processing in two unrelated languages is mediated by a common neural system or by distinct cortical areas. Subjects were Finnish-English adult multilinguals who had acquired the second language after the age of ten. They were PET-scanned whilst either encoding or retrieving word pairs in their mother tongue (Finnish) or in a foreign language (English). Within each language, subjects had to encode and retrieve four sets of 12 visually presented paired word associates which were not semantically related. Two sets consisted of highly imaginable words and the other two sets of abstract words. Presentation of pseudo-words served as a reference condition. An emission scan was recorded after each intravenous administration of O-15 water. Encoding was associated with prefrontal and hippocampal activation. During memory retrieval, precuneus showed a consistent activation in both languages and for both highly imaginable and abstract words. Differential activations were found in Broca's area and in the cerebellum as well as in the angular/supramarginal gyri according to the language used. The findings advance our understanding of the neural representation that underlies multiple language functions. Further studies are needed to elucidate the neuronal mechanisms of bi/multilingual language processing. A promising perspective for future bi/multilingual research is an integrative approach using brain imaging studies with a high spatial resolution such as fMRI, combined with techniques with a high temporal resolution, such as magnetoencephalography (MEG).

Aging↗

PubMed2004

The neurology of sign language.

Forms of sign language have developed in a number of countries. American Sign Language, which originated from French signing, has been most extensively researched. As sign language is based on gestures executed in space and perceived visually it might be thought that it would mainly be a function of the right cerebral hemisphere when this is the non-dominant one. A number of studies are reviewed showing that sign language is a language in its own right and therefore, as with spoken language, its primary site of organization is in the dominant hemisphere. This does not mean that there is not a significant contribution from the other hemisphere with an interplay between the two. Each research project usually contributes some facet of knowledge apart from the main conclusions. These included the importance of distinguishing signs from gestures, the localization of different types of signing within the left dominant cerebral hemisphere, the fact that lesions of the right non-dominant hemisphere, although not causing a loss of signing will result in dyspraxia, and that aphasic symptoms of signing and speech are not modality dependant but reflected a disruption of language processes common to all languages. Examples are given of discoveries made by the use of the newer neuroradiological techniques such as functional magnetic resonance imaging and positron emission tomography, and no doubt these will lead to further advances in knowledge. The use of sign language in the treatment of patients with verbal aphasia is considered, especially of children with the Landau-Kleffner syndrome, but therapy of this kind can be used in children with delayed language development, and in other types of acquired aphasia at any age. Other methods of treatment than signing, such as cochlear implants may be increasingly used in the future, but it seems likely that sign language will continue to be a dominant feature in the deaf culture.

Aphasia↗

PubMedDate not supplied

The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice.

Although Spanish was the primary language of an estimated 11 % of adults in the year 2000, the U.S. health care system is largely geared toward serving English speakers. A systematic review was conducted of studies published in biomedical journals from 1990 to 2000 examining language barriers in health care for Latino populations. Aspects of the problem examined were access to health care, quality of care, and health status/health outcomes. Five (55%) of the nine studies examining access to care found a significant adverse effect of language; three (33%) found mixed or weak evidence that language affected access. Six (86%) of the seven studies evaluating quality of care found a significant detrimental effect of language barriers. Two of the three studies examining health status or outcomes found language to be a risk factor for adverse outcomes. Evidence was mixed as to the level of importance attributable to language when access to care is considered; however, non-English-speaking status was a marker of a population at risk for decreased access. Solid evidence showed that language barriers can adversely affect quality of care. Health care practitioners are recommended to devise an effective strategy to bridge language barriers in their setting. National laws and policies are discussed; practical guidelines and resources for providing language access in health care are provided. This article is intended to supply basic knowledge for providers and institutions in devising effective strategies for bridging the language barrier.

Adult↗

PubMed2005

The language abilities of bilingual children with Down syndrome.

Children with Down syndrome (DS) have cognitive disabilities resulting from trisomy 21. Language-learning difficulties, especially expressive language problems, are an important component of the phenotype of this population. Many individuals with DS are born into bilingual environments. To date, however, there is almost no information available regarding the capacity of these individuals to acquire more than 1 language. The present study compared the language abilities of 8 children with DS being raised bilingually with those of 3 control groups matched on developmental level: monolingual children with DS (n = 14), monolingual typically developing (TD) children (n = 18), and bilingual TD children (n = 11). All children had at least 100 words in their productive vocabularies but a mean length of utterance of less than 3.5. The bilingual children spoke English and 1 other language and were either balanced bilinguals or English-dominant. English testing was completed for all children using the following: the Preschool Language Scale, Third Edition; language sampling; and the MacArthur Communicative Development Inventories (CDI). Bilingual children were also tested in the second language using a vocabulary comprehension test, the CDI, and language sampling. Results provided evidence of a similar profile of language abilities in bilingual children as has been documented for monolingual children with DS. There was no evidence of a detrimental effect of bilingualism. That is, the bilingual children with DS scored at least as well on all English tests as their monolingual DS counterparts. Nonetheless, there was considerable diversity in the second-language abilities demonstrated by these individuals with DS. Clinical implications are addressed.

Aptitude↗

PubMedDate not supplied

[Verbal and nonverbal intelligence in children with language development disorders].

Difficulties in language acquisition seem to be serious, if there are additional problems like intellectual and/or emotional/social impairment, which are often reported [10]. These additional problems and the definition of specific language impairment as a developmental disorder, restricted to language acquisition seem to be contradictory [17]. Aim of that study is to look for specific language impaired children with similar cognitive abilities and though to investigate, if there are children without additional cognitive problems considering the definition of specific language impairment. 93 children, between 4;0 and 6;6 years old, were diagnostized as specific language impaired (ICD-10) and were assessed by the "Hannover Wechsler Intelligenztest für das Vorschulalter (HAWIVA)" [6] (german version of WPPSI). Cluster analysis showed, that 1/3 of the specific language impaired children presented no additional cognitive problems and 2/3 of them showed cognitive problems regarding nonverbal and verbal intelligence indeed. These additional cognitive problems indicate that there may be a more basic cognitive defect underlying specific language impairment [15]--at least for a group of specific language impaired children. Furthermore the nonverbal and verbal intellectual difficulties emphasize to general developmental support of specific language impaired children for optimal improvement in language acquisition.

Child↗

PubMedDate not supplied

Working memory and novel word learning in children with hearing impairment and children with specific language impairment.

BACKGROUND: Working memory is considered to influence a range of linguistic skills, i.e. vocabulary acquisition, sentence comprehension and reading. Several studies have pointed to limitations of working memory in children with specific language impairment. Few studies, however, have explored the role of working memory for language deficits in children with hearing impairment. AIMS: The first aim was to compare children with mild-to-moderate bilateral sensorineural hearing impairment, children with a preschool diagnosis of specific language impairment and children with normal language development, aged 9-12 years, for language and working memory. The special focus was on the role of working memory in learning new words for primary school age children. METHODS & PROCEDURES: The assessment of working memory included tests of phonological short-term memory and complex working memory. Novel word learning was assessed according to the methods of. In addition, a range of language tests was used to assess language comprehension, output phonology and reading. OUTCOMES & RESULTS: Children with hearing impairment performed significantly better than children with a preschool diagnosis of specific language impairment on tasks assessing novel word learning, complex working memory, sentence comprehension and reading accuracy. No significant correlation was found between phonological short-term memory and novel word learning in any group. The best predictor of novel word learning in children with specific language impairment and in children with hearing impairment was complex working memory. Furthermore, there was a close relationship between complex working memory and language in children with a preschool diagnosis of specific language impairment but not in children with hearing impairment. CONCLUSIONS: Complex working memory seems to play a significant role in vocabulary acquisition in primary school age children. The interpretation is that the results support theories suggesting a weakened influence of phonological short-term memory on novel word learning in school age children.

Adolescent↗

PubMed2004

Language reorganization in children with early-onset lesions of the left hemisphere: an fMRI study.

It is widely assumed that following extensive damage to the left hemisphere sustained in early childhood, language functions are likely to reorganize and develop in the right hemisphere, especially if the lesion affects the classical Broca's or Wernicke's language areas. In the present study, functional MRI (fMRI) was used to examine language lateralization in 10 children and adolescents with intractable epilepsy who sustained an early lesion in the left hemisphere. Lesions were adjacent to or within anterior language cortex in five patients, while they were remote from both Broca's and Wernicke's areas in the remainder. A lateralization index was calculated on the basis of the number of voxels activated in the left and right inferior frontal gyri when performing a covert verb generation task. Only two patients were right-handed, suggesting a high incidence of functional reorganization for motor control in the remaining patients. Five out of 10 showed bilateral or right language lateralization, but lateralization could not be inferred from the proximity of lesions to classical language areas on an individual basis. Lesions in or near Broca's area were not associated with inter-hemispheric language reorganization in four out of five cases, but with perilesional activation within the damaged left hemisphere. Paradoxically, lesions remote from the classical language areas were associated with non-left language lateralization in four out of five cases. Finally, handedness, age at onset of chronic seizures, and site of EEG abnormality also showed no obvious association with language lateralization. In conclusion, it is difficult to infer intra- versus inter-hemispheric language reorganization on the basis of clinical observations in the presence of early pathology to the left hemisphere.

Adolescent↗

PubMed2003

Language abilities of siblings of children with autism.

BACKGROUND: Language abilities of siblings of children with autism were examined to explore the possibility that language abilities are behavioral markers specific to the genetic liability for autism, as part of the broader phenotype. METHOD: Language abilities were compared among 27 siblings of children with autism, 23 siblings of children with mental retardation of unknown etiology (MR), and 22 siblings of children with developmental language disorders (DLD). Groups were matched by siblings' age, gender, birth order, family size, ethnicity, family income and by probands' gender and mental age. RESULTS: Siblings of children with autism achieved higher scores than siblings of children with DLD on receptive, expressive, and total language scales of the Children's Evaluation of Language Fundamentals and on verbal IQ. Moreover, within the DLD group, school problems in the domains of reading and arithmetic were more prevalent than within the other two groups. Only 2 siblings of children with autism received clinical diagnoses based on DSM-IV criteria compared to 3 siblings of children with MR and 7 siblings of children with DLD. CONCLUSIONS: After excluding data of the diagnosed siblings, no differences in language abilities could be discerned among the groups, except that more siblings in the DLD group were identified as having language difficulties. In summary, although language deficits characterize autism, siblings of children with autism were not found to demonstrate deficits in language skills assessed by formal language tests, IQ, or academic skills.

Adolescent↗

PubMed1997

Relationships, individual differences, and children's use of literate language.

BACKGROUND: Research in children's oral language and early literacy learning currently stresses the facilitative role of social context. Social context in this literature is typically treated on a macro-level, e.g., mother-child interaction or peer interaction. We present a more differentiated model of peer influences on children's learning one oral language register, 'literate language'. Literate language, which predicts school-based literacy, is defined as talk about language and literacy. AIMS: We suggest that children's temperament and their close relationships, in the form of friendships, play important roles in literate language learning. We present separate models for friends and nonfriends and posit that literate language is learned more effectively between friends because of the emotional tenor of this relationship. When they are with friends children, even those that might be considered 'difficult', disagree, resolve disagreements, then express emotions indicative of social understanding. Reflection upon emotion states, in turn, leads to literate language. SAMPLE: The sample comprised 33 males and 23 females attending American kindergarten classes, with a mean age of 65 months. METHODS: Dyads of same gender and race were observed 12 times across the school year during which time samples of oral language were taken. Measures of children reading and writing were also collected. RESULTS: The data support our model, and the friendship model accounting for more of the variance in literate language (R2 = .69) than did the nonfriend model (R2 = .43). CONCLUSIONS: Children with friends engage in the sort of conceptual conflict and resolutions which maximise use of literate language. This context seems particularly important for 'difficult' children. Future research should continue to examine the interface between individual and group levels variables.

Child, Preschool↗

PubMed1999

Effects of anomalous language representation on neuropsychological performance in temporal lobe epilepsy.

OBJECTIVE: To examine the effects of anomalous language representation (i.e., mixed- and right-cerebral dominant) on neuropsychological performance. BACKGROUND: Right cerebral language dominance resulting from early cerebral injury is associated with relatively preserved language function with decreased visuospatial ability. However, previous reports of this phenomenon have examined patients with relatively large cerebral injuries (e.g., infantile hemiplegia) or limited sample sizes. METHODS: A total of 561 patients with complex partial seizures of left temporal lobe origin were studied. Patients were classified into left (n = 455), bilateral (n = 58), and right (n = 48) language dominant groups based on Wada testing. RESULTS: Right language dominant patients performed more poorly on multiple tests of visuospatial function, including Performance IQ (PIQ), than did left language patients. No significant group differences were detected for measures of language or general verbal function. The effects of bilateral language on PIQ differed according to handedness. Lowered PIQ was present in the bilateral nondextral group but not for bilateral dextral patients, and this pattern was observed with other visuospatial measures. CONCLUSIONS: In patients with relatively small lesions restricted to the left mesial temporal lobe, a shift in language dominance to the right hemisphere is associated with decreased visuospatial functions but preserved verbal abilities. Nondextral patients with bilateral language representation also displayed decreased visuospatial performance, although dextral patients with bilateral language did not.

Adult↗

PubMed2003

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial.

OBJECTIVE: To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP). DESIGN: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests. PATIENTS: The participants had complete UCLP without soft tissue bands or other malformations. RESULTS: IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant. CONCLUSIONS: Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Analysis of Variance↗

PubMed2003

Localization of language function in children: results of electrical stimulation mapping.

OBJECT: The authors examined the localization of language sites and the frequency of naming errors at these sites in a population of children undergoing electrical stimulation mapping during surgeries in which epileptic foci and dominant hemisphere neoplasms were resected. The frequency with which essential language sites were found (that is, "the frequency of language sites") in children was compared with that of a population of adults who had undergone this procedure, to assess the relationship of age to the distribution of essential areas for language. METHODS: The results of electrical stimulation mapping to determine sites of naming and speech arrest in 26 children ranging in ages from 4 to 16 years are presented in this report. Mapping was performed in the intraoperative setting in eight patients and in the extraoperative setting, by stimulation across a subdural grid, in 18 patients. The frequency and distribution of essential language areas were analyzed in populations of different ages and according to the method used to obtain the map. Considerable variability was found in the localization of language sites. When the language site distribution in pediatric patients was compared with the language site distribution found previously in a population of patients older than 16 years of age, a relative paucity of language sites was found in all perisylvian cortices in the younger age group. This relationship was also found within the group of patients 16 years of age and younger, when segregated into two groups: those patients 8 years of age or younger, and those patients between 9 and 16 years of age. These findings are relevant to theories of the intrahemispheric organization of the cortex devoted to language function. CONCLUSIONS: The differences found between groups of younger and older patients in the frequencies of sites where stimulation produces naming errors was identified suggests the possibility that, with advancing age, maturational processes contribute new foci of cortex essential for language.

Adolescent↗

PubMed2003

Timed picture naming in seven languages.

Timed picture naming was compared in seven languages that vary along dimensions known to affect lexical access. Analyses over items focused on factors that determine cross-language universals and cross-language disparities. With regard to universals, number of alternative names had large effects on reaction time within and across languages after target-name agreement was controlled, suggesting inhibitory effects from lexical competitors. For all the languages, word frequency and goodness of depiction had large effects, but objective picture complexity did not. Effects of word structure variables (length, syllable structure, compounding, and initial frication) varied markedly over languages. Strong cross-language correlations were found in naming latencies, frequency, and length. Other-language frequency effects were observed (e.g., Chinese frequencies predicting Spanish reaction times) even after within-language effects were controlled (e.g., Spanish frequencies predicting Spanish reaction times). These surprising cross-language correlations challenge widely held assumptions about the lexical locus of length and frequency effects, suggesting instead that they may (at least in part) reflect familiarity and accessibility at a conceptual level that is shared over languages.

Cross-Cultural Comparison↗

PubMed2005

[Specific language disorders: their diagnosis, classification and study using magnetoencephalography].

INTRODUCTION: Specific language disorder (SLD) is defined as a disorder in which language is slow and retarded with respect to the patient's chronological age, and which is not related to a sensory-auditory or motor deficit or to a pervasive development disorder; in other words, structural and functional neurological developmental disorders must be excluded. After many studies and attempts to reach an agreement, specific language disorders have been broadly classified into two groups: specific expressive language disorder and specific receptive-expressive language disorder. AIMS: Our objective was to study SLD using magnetoencephalography (MEG) in order to look for epileptiform manifestations in precise language areas. PATIENTS AND METHODS: We studied a sample made up of 11 patients with SLD, one of whom had Landau-Kleffner syndrome and one with cryptogenic-type SLD. The criteria used were age-dependent autism exclusion tests and specific language tests for SLD. The MSI technique was carried out on all the patients, by magnetic resonance and MEG. RESULTS: A characteristic pattern is obtained for SLD in the form of irregular spike and polyspike-wave discharges in bilateral frontal channels. The dipoles were situated mainly in the left perisylvian areas. CONCLUSIONS: The study of specific language disorders using MEG enables us to identify the SLD included in a proposed classification as primary-type specific language disorder, cryptogenic-type specific language disorder and secondary-type type specific language disorder, like Landau-Kleffner syndrome.

Language Disorders↗

PubMed1996

Use of functional MR to map language in multilingual volunteers.

PURPOSE: To use functional MR imaging to compare brain activation during processing of languages in which multilingual volunteers are fluent with brain activation during processing of languages in which they are not fluent. METHODS: Echoplanar images were obtained for five right-handed male multilingual subjects who performed a language task in three languages, one of which was a language in which the subject was not fluent. The functional MR technique included echoplanar images obtained at 1 per second during cycles of rest and performance of the task, from which functional images were processed by means of cross-correlation analysis. The numbers of active pixels in each volunteer and for each language were compared. RESULTS: Activation was noted in the left frontal lobe in all subjects performing language tasks. In each subject, the number of activated pixels was greatest for the language in which the subject was least fluent. CONCLUSION: Functional MR imaging shows differences in the processing of different languages in multilingual volunteer subjects, depending on the level of fluency in the language, and it is an effective functional imaging method for studying the processing of different languages.

Brain↗

PubMed1997

[Language and aphasias].

INTRODUCTION AND OBJECTIVE: Approximately 400,000 years ago men started to use language. Initially it was probably poor with few phonemes. With social evolution it became more complex, with the appearance of new phonemes and a more complete grammatical structure. The current concept of the processing of language dates, with little change, from the nineteenth century. DEVELOPMENT: With the birth of phrenology language began to be studied. This lead to the hypothesis of Wernicke, with two main areas joined by the fasciculo arcuato, which is still held to be valid with modifications by Gerchwind and Damasio, amongst others. Important advances in the study of language are due to Chomsky and his transformational grammar. This supports the universal structure of language, since one learns it following genetically determined laws. Language has three main aspects: creativity which makes both the transmitter and the receiver active participants in communication, the form from which words are constructed and the content of the message. Aphasia is an alteration in the comprehension and understanding of language, which may be the clinical expression of many different aetiologies. They help us to localize the lesion topographically. They are divided depending on the clinical signs, into motor or Broca's aphasia, in which understanding is conserved but the patient uses a language with poor grammatical structure, although the semantic content is acceptable: sensitive or Wernicke's aphasia, with inability to understand and language which is fluid but unintelligible; conduction aphasia due to limitation in the transmission of impulses from Wernicke's area to that of Broca, with acceptable understanding and fluid language and the trans-cortical aphasias where the main characteristic is indemnity of the capacity of repetition. CONCLUSIONS: The aphasias, as the expression of an alteration of language are an important support in the topographical localization of lesions, even before these can be shown on computerized tomography.

Agraphia↗