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Mild traumatic brain injury (MTBI): assessment and treatment procedures used by speech-language pathologists (SLPs).

The purposes of this study were to identify how individuals with MTBI are assessed, to determine the referral process to and from speech-language pathologists (SLPs), to describe the frequency, structure, and nature of treatment, to identify how individuals with MTBI and their families are educated about the injury and counselled, and to assess current follow-up procedures. One-hundred and forty-three hospital and rehabilitation centre based SLPs from North Carolina and Illinois responded to a survey developed to address these areas of interest. Findings indicated current diagnostic tools used by SLPs lack the sensitivity to detect the subtle cognitive communication deficits associated with MTBI, referral and follow-up procedures are not sufficiently implemented in facilities to meet the growing needs of individuals with MTBI, and SLPs would benefit from increased training regarding the management of individuals with MTBI including educating and counselling patients and their families.

Brain Injuries↗

[A critical vision about nursing diagnoses].

This article is an adaptation of a conference by the author in which she planted critical perspectives and questions about nursing diagnoses in order to see these from another viewpoint. The author introduces some new considerations related to the nursing paradigm which recognize the human nature in the treatment process centered on a relationship. This discourse is important from nursing language and practice viewpoints since they make evident basic human process in professional, ethical and practical treatment.

Nursing↗

Processing of basic speech acts following localized brain damage: a new light on the neuroanatomy of language.

We examined the effect of localized brain lesions on processing of the basic speech acts (BSAs) of question, assertion, request, and command. Both left and right cerebral damage produced significant deficits relative to normal controls, and left brain damaged patients performed worse than patients with right-sided lesions. This finding argues against the common conjecture that the right hemisphere of most right-handers plays a dominant role in natural language pragmatics. In right-hemisphere damaged patients, there was no correlation between location and extent of lesion in perisylvian cortex and performance on BSAs. By contrast, processing of the different BSAs by left hemisphere-damaged patients was strongly affected by perisylvian lesion location, with each BSA showing a distinct pattern of localization. This finding raises the possibility that the classical left perisylvian localization of language functions, as measured by clinical aphasia batteries, partly reflects the localization of the BSAs required to perform these functions.

Adult↗

Language and perceptual categorisation.

In a pioneering set of experiments, Rosch investigated the colour processing of a remote traditional culture. It was concluded that colours form universally natural and salient categories. However, our own cross-cultural research, backed up by neuropsychological data and interference studies, indicates that perceptual categories are derived from the words in the speaker's language. The new data support a rather strong version of the Whorfian view that perceptual categories are organized by the linguistic systems of our mind.

Journal Article↗

Prevalence and natural history of primary speech and language delay: findings from a systematic review of the literature.

The prevalence and the natural history of primary speech and language delays were two of four domains covered in a systematic review of the literature related to screening for speech and language delay carried out for the NHS in the UK. The structure and process of the full literature review is introduced and criteria for inclusion in the two domains are specified. The resulting data set gave 16 prevalence estimates generated from 21 publications and 12 natural history studies generated from 18 publications. Results are summarized for six subdivisions of primary speech and language delays: (1) speech and/or language, (2) language only, (3) speech only, (4) expression with comprehension, (5) expression only and (6) comprehension only. Combination of the data suggests that both concurrent and predictive case definition can be problematic. Prediction improves if language is taken independently of speech and if expressive and receptive language are taken together. The results are discussed in terms of the need to develop a model of prevalence based on risk of subsequent difficulties.

Child↗

Effects of grammatical categories on children's visual language processing: Evidence from event-related brain potentials.

This study examined how school-aged children process different grammatical categories. Event-related brain potentials elicited by words in visually presented sentences were analyzed according to seven grammatical categories with naturally varying characteristics of linguistic functions, semantic features, and quantitative attributes of length and frequency. The categories included nouns, adjectives, verbs, pronouns, conjunctions, prepositions, and articles. The findings indicate that by the age of 9-10 years, children exhibit robust neural indicators differentiating grammatical categories; however, it is also evident that development of language processing is not yet adult-like at this age. The current findings are consistent with the hypothesis that for beginning readers a variety of cues and characteristics interact to affect processing of different grammatical categories and indicate the need to take into account linguistic functions, prosodic salience, and grammatical complexity as they relate to the development of language abilities.

Brain↗

Reading fluent speech from talking faces: typical brain networks and individual differences.

Listeners are able to extract important linguistic information by viewing the talker's face-a process known as ''speechreading.'' Previous studies of speechreading present small closed sets of simple words and their results indicate that visual speech processing engages a wide network of brain regions in the temporal, frontal, and parietal lobes that are likely to underlie multiple stages of the receptive language system. The present study further explored this network in a large group of subjects by presenting naturally spoken sentences which tap the richer complexities of visual speech processing. Four different baselines (blank screen, static face, nonlinguistic facial gurning, and auditory speech) enabled us to determine the hierarchy of neural processing involved in speechreading and to test the claim that visual input reliably accesses sound-based representations in the auditory cortex. In contrast to passively viewing a blank screen, the static-face condition evoked activation bilaterally across the border of the fusiform gyrus and cerebellum, and in the medial superior frontal gyrus and left precentral gyrus (p < .05, whole brain corrected). With the static face as baseline, the gurning face evoked bilateral activation in the motion-sensitive region of the occipital cortex, whereas visual speech additionally engaged the middle temporal gyrus, inferior and middle frontal gyri, and the inferior parietal lobe, particularly in the left hemisphere. These latter regions are implicated in lexical stages of spoken language processing. Although auditory speech generated extensive bilateral activation across both superior and middle temporal gyri, the group-averaged pattern of speechreading activation failed to include any auditory regions along the superior temporal gyrus, suggesting that f luent visual speech does not always involve sound-based coding of the visual input. An important finding from the individual subject analyses was that activation in the superior temporal gyrus did reach significance (p < .001, small-volume corrected) for a subset of the group. Moreover, the extent of the left-sided superior temporal gyrus activity was strongly correlated with speechreading performance. Skilled speechreading was also associated with activations and deactivations in other brain regions, suggesting that individual differences ref lect the efficiency of a circuit linking sensory, perceptual, memory, cognitive, and linguistic processes rather than the operation of a single component process.

Acoustic Stimulation↗

Computational approaches to cognition: top-down approaches.

Computational models are useful tools for exploring the nature of human cognitive processes. In particular, connectionist models are providing researchers with new ways of thinking about the basic nature of cognition and its implementation in the brain. They support novel explanations of important aspects of perception, memory, language, thought and cognitive development, and allow cognitive processes to be linked with the underlying physiological mechanisms. The models also aid our understanding of how disorders of brain function lead to disorders of cognition.

Aging↗

Unsupervised learning of natural languages.

We address the problem, fundamental to linguistics, bioinformatics, and certain other disciplines, of using corpora of raw symbolic sequential data to infer underlying rules that govern their production. Given a corpus of strings (such as text, transcribed speech, chromosome or protein sequence data, sheet music, etc.), our unsupervised algorithm recursively distills from it hierarchically structured patterns. The adios (automatic distillation of structure) algorithm relies on a statistical method for pattern extraction and on structured generalization, two processes that have been implicated in language acquisition. It has been evaluated on artificial context-free grammars with thousands of rules, on natural languages as diverse as English and Chinese, and on protein data correlating sequence with function. This unsupervised algorithm is capable of learning complex syntax, generating grammatical novel sentences, and proving useful in other fields that call for structure discovery from raw data, such as bioinformatics.

Algorithms↗

Lexical constraints in phonological acquisition.

Lexical diffusion, as characterized by interword variation in production, was examined in phonological acquisition. The lexical variables of word frequency and neighbourhood density were hypothesized to facilitate sound change to varying degrees. Twelve children with functional phonological delays, aged 3;0 to 7;4, participated in an alternating treatments experiment to promote sound change. Independent variables were crossed to yield all logically possible combinations of high/low frequency and high/low density in treatment; the dependent measure was generalization accuracy in production. Results indicated word frequency was most facilitative in sound change, whereas, dense neighbourhood structure was least facilitative. The salience of frequency and avoidance of high density are discussed relative to the type of phonological change being induced in children's grammars, either phonetic or phonemic, and to the nature of children's representations. Results are further interpreted with reference to interactive models of language processing and optimality theoretic accounts of linguistic structure.

Child↗

Brain responses to nouns, verbs and class-ambiguous words in context.

Recent neuropsychological and imaging data have implicated different brain networks in the processing of different word classes, nouns being linked primarily to posterior, visual object-processing regions and verbs to frontal, motor-processing areas. However, as most of these studies have examined words in isolation, the consequences of such anatomically based representational differences, if any, for the processing of these items in sentences remains unclear. Additionally, in some languages many words (e.g. 'drink') are class-ambiguous, i.e. they can play either role depending on context, and it is not yet known how the brain stores and uses information associated with such lexical items in context. We examined these issues by recording event-related potentials (ERPs) in response to unambiguous nouns (e.g. 'beer'), unambiguous verbs (e. g. 'eat'), class-ambiguous words and pseudowords used as nouns or verbs within two types of minimally contrastive sentence contexts: noun-predicting (e.g. 'John wanted THE [target] but.') and verb-predicting ('John wanted TO [target] but.'). Our results indicate that the nature of neural processing for nouns and verbs is a function of both the type of stimulus and the role it is playing. Even when the context completely specifies their role, word class-ambiguous items differ from unambiguous ones over frontal regions by approximately 150 ms. Moreover, whereas pseudowords elicit larger N400s when used as verbs than when used as nouns, unambiguous nouns and ambiguous words used as nouns elicit more frontocentral negativity than unambiguous verbs and ambiguous words used as verbs, respectively. Additionally, unambiguous verbs elicit a left-lateralized, anterior positivity (approximately 200 ms) not observed for any other stimulus type, though only when these items are used appropriately as verbs (i.e. in verb-predicting contexts). In summary, the pattern of neural activity observed in response to lexical items depends on their general probability of being a verb or a noun and on the particular role they are playing in any given sentence. This implicates more than a simple two-way distinction of the brain networks involved in their storage and processing. Experience, as well as context during on-line language processing, clearly shapes the neural representations of nouns and verbs, such that there is no single neural marker of word class. Our results further suggest that the presence and nature of the word class-based dissociations observed after brain damage are similarly likely to be a function of both the type of stimulus and the context in which it occurs, and thus must be assessed accordingly.

Adult↗

The contribution of EEG coherence to the investigation of language.

The contribution of EEG coherence analysis to the investigation of cognition and, in particular, language processing is demonstrated with examples of recent EEG studies. The concept of EEG coherence analysis is explained, and its importance emphasized in the light of recent neurobiological findings on frequency-dependent synchrony as a code of information processing between nerve cell assemblies. Furthermore, EEG coherence studies on naturally spoken and written word and sentence processing are reviewed and experimental results are presented giving new insights into the occurrence of "transient functional language centers" within the brain.

Adult↗

Subcortical mechanisms in language: lexical-semantic mechanisms and the thalamus.

Four previously published cases of dominant thalamic lesion in which the author has participated are reviewed to gain a better understanding of thalamic participation in lexical-semantic functions. Naming deficits in two cases support Nadeau and Crosson's (1997) hypothesis of a selective engagement mechanism involving the frontal lobes, inferior thalamic peduncle, nucleus reticularis, and other thalamic nuclei, possibly the centromedian nucleus. This mechanism selectively engages those cortical areas required to perform a cognitive task, while maintaining other areas in a state of relative disengagement. Deficits in selective engagement disproportionately affect lexical retrieval based on semantic input, as opposed to lexical and sublexical processes, because the former is more dependent upon this attentional system. The concept of selective engagement is also useful in understanding thalamic participation in working memory, as supported by data from one recent functional neuroimaging study. Other processes also may be compromised in more posterior thalamic lesions which damage the pulvinar but not other components of this selective engagement system. A third case with aphasia after a more superior and posterior thalamic lesion also had oral reading errors similar to those in neglect dyslexia. The pattern of deficits suggested a visual processing problem in the early stages of reading. The fourth case had a category-specific naming deficit after posterior thalamic lesion. Taken together, the latter two cases indicate that the nature of language functions in more posterior regions of the dominant thalamus depends upon the cortical connectivity of the thalamic region. Together, findings from the four cases suggest that thalamic nuclei and systems are involved in multiple processes which directly or indirectly support cortical language functions.

Aphasia↗

Gender differences in descriptions of angina symptoms and health problems immediately prior to angiography: the ACRE study. Appropriateness of Coronary Revascularisation study.

Although the prevalence of angina in women is increasing, women are less likely than men to undergo invasive management of coronary disease. Gender differences in language use may contribute to disparities in management, since the diagnosis of angina relies on a patient's description of their symptoms. This study set out to investigate whether gender differences exist in the language used when describing angina symptoms and perceived health problems at the time of angiography, which might influence the rate of subsequent revascularisation. Content analysis was used to analyse written accounts of 'symptoms and health problems' in 200 (96 female) patients randomly selected within age strata who were undergoing coronary angiography for chronic stable angina in the Appropriateness of Coronary Revascularisation (ACRE) study. Written free text was coded into seven categories: pain location (chest or arm and throat, neck or jaw); pain character; breathlessness; other symptoms; effects on lifestyle; symptom attributions; and patient discourses ('story' or 'factual'). Women described more throat, neck or jaw pain than men among those with low physical functioning ( p=0.06), in the presence of coronary artery disease (p = 0.04) and in those who were not subsequently revascularised (p =0.05). Women also gave more accounts than men of breathlessness and other symptoms, but there was little evidence for gender differences in the use of 'factual' discourses. We conclude that from the time of angiography, gender differences in language use do exist and description of angina pain may influence subsequent revascularisation. Further research is necessary to investigate the nature and consequences of gender differences in language use at this and earlier stages in the referral process.

Activities of Daily Living↗

Evidence for cognition without grammar from causal reasoning and 'theory of mind' in an agrammatic aphasic patient.

Understanding the inter-relationship between language and thought is fundamental to the study of human cognition [1] [2] [3]. Some investigators have proposed that propositions in natural language serve to scaffold thinking, by providing, for example, a sequential structure to a massively parallel process [4]. Others have maintained that certain thoughts, such as inferring the mental states of others, termed 'theory of mind' (ToM) reasoning, and identifying causal relationships, necessarily involve language propositions [5]. It has been proposed that ToM reasoning depends upon the possession of syntactic structures such as those that permit the embedding of false propositions within true statements ('Mary knows that John (falsely) thinks chocolates are in the cupboard') [6]. The performance on reasoning tasks of individuals with severe agrammatic aphasia (an impairment of language following a lesion of the perisylvian areas of the language-dominant hemisphere) offers novel insights into the relation between grammar and cognition. We report the unusual case of a patient with agrammatic aphasia of such severity that language propositions were not apparently available at an explicit processing level in any modality of language use. Despite this profound impairment in grammar, he displayed simple causal reasoning and ToM understanding. Thus, reasoning about causes and beliefs involve processes that are independent of propositional language.

Aphasia↗

The role of the gross spectral shape as a perceptual cue to place articulation in initial stop consonants.

This series of studies explored the extent to which the gross shape of the onset spectrum is used by the listener for the identification of place of articulation in initial stop consonants. Synthetic stimuli were generated with onset frequencies appropriate to the syllables [ba bi du da di du] and with the gross shape of the onset spectrum manipulated to be appropriate for either alveolar consonants or labial consonants. Stimuli were presented for identification and discrimination. In addition, adaptation effects of stimuli containing appropriate frequency and shape and incompatible frequency and shape were explored on a place-of-articulation onset continuum. Although identification performance was determined by onset frequency rather than gross shape of the spectrum, presentation of stimuli in which shape was inconsistent with frequency reduced identification performance. Further, subjects could discriminate stimuli which varied only in spectral shape. Finally, significantly less adaptation was found for a [da] onset with a labial spectrum shape than [da] onset with an alveolar spectrum shape. These results suggest that although the invariant properties residing in the gross shape of the onset spectrum may serve as a classificatory framework for the phonetic dimensions of natural language, they may not provide the primary perceptual attributes for place of articulation in ongoing speech processing.

Humans↗

Natural language storage and retrieval of medical diagnostic information. Experience at the UCLA hospital and clinics over a 10-year period.

A natural language storage and retrieval system initially designed for pathology reports has been in operation for ten years at UCLA Hospital and Clinics. The original system has been improved to provide a thesaurus processor with added capabilities for expanding search request terms and a newly developed set of search programs with user options that make complex and more accurate retrievals possible. Summarized diagnostic statements or impressions from five specialities (Surgical Pathology, Bone Marrow, Autopsy, Nuclear Medicine, and Neuroradiology), are automatically encoded by referencing a master computer dictionary containing a unique numeric code for each English word. Input and retrievals are batch, off-line operations in free text, and are currently processed on the IBM 370/145. User acceptance is high, quality of retrievals improved, and cost is nominal. This paper describes an expanded natural language system which in now providing a viable form of information storage and retrieval for research, medical education, patient care, quality control, statistics and administrative purposes.

California↗