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Sentence processing strategies in children with expressive and expressive-receptive specific language impairments.

The purpose of this study was to investigate the sentence comprehension strategies used by children with expressive and expressive-receptive specific language impairments (SLI) within a language processing framework. Fourteen children with SLI (ages 6;10-7;11) meeting strict selection criteria were compared to seven age-matched and seven younger normal controls. Children were asked to determine the agent in sentences composed of two nouns and a verb (NVN, NNV, VNN) with animacy of the noun as a second factor. Results of group comparisons revealed that children with E-SLI and ER-SLI differed from each other in the comprehension strategies they employed as well as differing from both age-matched and younger normal language control groups. Children with E-SLI relied exclusively on a first noun as agent strategy across all conditions, whereas children with ER-SLI used animacy cues when available. Additionally, maximum likelihood estimates were calculated to investigate individual patterns of performance under different cue conditions. Results revealed a significant correlation between severity of receptive language abilities and the type of strategy used, with better receptive language skills being highly correlated with children's use of word order cues.

Age Factors↗

Linguistic skills in relation to neurological findings at 8 years of age in children born preterm.

The linguistic skills of 8-year-old children born preterm (n = 42) with birthweight < 1750 grams from a 1-year birth cohort for 1985-86 in northern Finland were studied with three different language tests, namely the Illinois Test of Psycholinguistic Abilities (ITPA), the Token Test for Children (TTC) and the Morphological Test (MT) for Finnish children. Full-term control children (n = 42) with birthweight > or = 2500 grams from the same birth cohort were matched individually with their preterm pairs for age, sex, twinship, mother's education, place of residence, birth order and family type. The preterm children's language abilities were studied in relation to their neurological status and to the periventricular leukomalacia (PVL) findings of magnetic resonance imaging (MRI). The preterm children with minor neurodevelopmental dysfunctions (MND) scored worst and differed significantly from their matched controls in TTC. They also differed significantly from other preterm subgroups, namely healthy preterm and preterm children with cerebral palsy (CP), in verbal comprehension measured by TTC. PVL findings were not associated with performance in the language ability tests. A closer and regular follow-up of language development in the MND-disabled group among the low-birthweight preterm children is recommended.

Child↗

Assessment of specific language impairment in Swedish.

The results from pre-testings of 42 children selected for a cross-linguistic study are discussed to establish the usefulness of the assessment instruments used and whether the children selected are similar to children with specific language impairment (SLI) from other countries. The results from assessments of grammatical production, language comprehension and phonology clearly distinguished children with SLI from age-matched controls, while they differed from language matched controls only on phonological measures. As a group the children with SLI were about 2 years delayed on grammatical production measures and about 1 year on language comprehension. The assessment instruments used thus seem capable of distinguishing children with SLI. The Swedish children selected exhibit the same range of problems as children with SLI selected in other countries.

Child, Preschool↗

Towards assessment of prosodic abilities in Swedish children with language impairment.

Swedish children with language impairment (LI) have prosodic problems at word and phrase level, possibly also at discourse level. The aim of this study was to investigate the reliability and validity of a newly developed comprehensive procedure to capture prosody at word level (e.g., tonal word accent), phrase level (e.g., copula) and discourse level (e.g., conversation) in Swedish children with LI. Twenty-nine children with LI participated in the study. The reliability of the total score of the procedure was found to be sufficiently high, as was inter-examiner agreement. The total score significantly correlated with language comprehension and grammatical abilities. Prosodic problems were found by perceptual assessment in one third of the children. t test for equality of variances for presence versus absence of prosodic problems showed that these two groups significantly differed in total score of the procedure. This indicates that the procedure is a valid measure of prosodic problems.

Child↗

Comparison of rehabilitation outcome in patients with aphasic and non-aphasic traumatic brain injury.

OBJECTIVE: To compare the functional, cognitive and disability status of aphasic and non-aphasic traumatic brain injury patients. DESIGN: A prospective comparative study in which 103 patients with traumatic brain injury participated. SUBJECTS: Fifty-one aphasic and 52 non-aphasic patients with traumatic brain injury. METHODS: Functional Independence Measure and Disability Rating Scale were used to determine functional status and disability. Cognitive status was evaluated by the Mini-Mental Status Examination. Aphasic patients were evaluated using the Gülhane Aphasia Test for language disorders. RESULTS: The most frequent type of aphasia was Broca aphasia at 26.49% followed by anomic at 19.6% and trans-cortical motor at 15.6%. Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination scores at admission and at discharge showed significant differences in aphasic patients (p<0.001). There were no significant differences in the Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination gains between the aphasic and non-aphasic patients (p>0.01). CONCLUSION: Although aphasia could be accepted as a negative prognostic indicator in patients with traumatic brain injury, we could not detect any difference in functional and cognitive gains between the aphasic and non-aphasic patients.

Activities of Daily Living↗

Language in dementia of recent referral.

Twenty-four recently referred patients with dementia were assessed on a range of language tests and a mental status test. The tasks which appeared to present the most difficulties for the patients were written spelling, pragmatic processing tasks like sentence disambiguation and proverb interpretation. 'Straight' linguistic processing tasks sensitive to aphasia, like oral reading, serial identification of objects, naming and correction of semantically incorrect sentences, appeared to present fewer problems. It is concluded that certain language tasks may be useful and sensitive detectors of developing dementia, and that in early dementia those aspects of language which depend on straight linguistic processing can be relatively preserved.

Aged↗

Brain lesions associated with nonfluent aphasia fifteen years following penetrating head injury.

Men who sustained penetrating head injuries resulting in nonfluent aphasia within six months following injury, were examined fifteen years later and classified into two groups, 13 with persistent nonfluent aphasia, and 26 without symptoms of aphasia. Relative to a normal control group on a comprehensive battery of speech and language tests, the chronic nonfluent aphasics demonstrated syntactic processing deficits in all language modalities, with only mild or no impairment in other language faculties. The recovered group demonstrated deficits only in written expressive syntax. The CT lesions of the two groups differed in the extent of left hemisphere lesion volume and the degree of posterior and deep lesion extension within the left hemisphere. The nonrecovered group did not have greater right hemisphere damage. Broca's area was equally involved in 77 per cent of patients in both groups. All patients in the nonrecovered group had posterior extension of their lesions in Wernicke's area with some involvement of the underlying white matter and basal ganglia in the left hemisphere.

Adolescent↗

Impaired grammar with normal fluency and phonology. Implications for Broca's aphasia.

Extensive testing of grammatical function, including assessment of spontaneous language, inflectional morphology, ability to produce grammatical structures, syntactic comprehension and grammatical judgement, was carried out in 2 patients with large dominant frontal lobe lesions, including but not confined to, the third frontal convolution. Both patients were fluent and had normal articulation and phonological production and neither was agrammatic, suggesting that even very large frontal lesions do not produce Broca's aphasia and that language cortex proper is confined to the postcentral perisylvian region. Both patients were impaired in the use of more complex syntactic structures and one, who in addition had severe generalized impairment in frontal lobe function, also had impaired judgement regarding the use and placement of functors. These data provide further support for the dissociability of syntactic and morphological aspects of grammar in aphasic patients and, together with other studies, link these functions with the frontal lobe and the postcentral perisylvian cortex, respectively. The sparing of grammatical judgement in 1 patient, despite a very extensive lesion, suggests that very large portions of the frontal lobe are involved in grammatical function. The nature of frontal lobe function in syntax appears to be congruent with the role of the frontal lobes in other aspects of behaviour.

Adult↗

Phonolexical agraphia. Superimposition of acquired lexical agraphia on developmental phonological dysgraphia.

Study of neuropsychological sequelae of a focal acquired brain lesion may bring out and help delineate the features of a compensated developmental language disorder and its anatomical substrate. A left-handed man with a history of phonological developmental dyslexia and dysgraphia learned in early adulthood to read and write using a lexical system. Following a small posterior right parietal infarct when aged 56 yrs he developed a severe agraphia displaying features of phonological dysgraphia with impaired segmentation and features of lexical agraphia. Writing was severely impaired for all classes of word and nonword stimuli but his errors did not resemble those attributable to a deficit in the system responsible for the short-term storage of the graphemic representation of a word (graphemic output buffer). These observations imply that an acquired lexical agraphia has been superimposed on his developmental phonological dysgraphia, resulting in a combined or 'phonolexical' agraphia.

Agraphia↗

Category-specific naming and comprehension impairment: a double dissociation.

We describe 2 neurologically impaired patients with lesions involving primarily the left temporal lobe, whose production and comprehension of words in the semantic category of animals were disproportionately spared in 1 case and disproportionately impaired in the other, in comparison to performance with other common categories. This double dissociation provides neurally based evidence for the view that lexical-semantic information is organized categorically.

Aged↗

Effects of cholinergic blockade on language in healthy young women. Implications for the cholinergic hypothesis in dementia of the Alzheimer type.

To investigate the effect of cholinergic blockade on language, 22 healthy young women performed tests of reading, spelling and oral language after a subcutaneous injection of 0.4 or 0.6 mg scopolamine. The results were compared with the performance after 0.6 mg methylscopolamine, which produce no central cholinergic effects. The reading and spelling tests were constructed to evaluate the lexical and phonological strategies for reading and spelling of single words. After scopolamine there were dose-dependent impairments in reading, spelling, verbal fluency and object naming. In 25-60% of the subjects receiving 0.6 mg scopolamine there were clinically significant impairments on tests assessing the lexical and phonological strategies. This pattern is similar to the deficits in reading and spelling observed in patients with dementia of the Alzheimer type. Cholinergic loss may be associated with the language impairments found in dementia of the Alzheimer type.

Acetylcholine↗

Comprehension of metaphors and idioms in patients with Alzheimer's disease: a longitudinal study.

Language in patients with Alzheimer's disease has been extensively studied, with the exception of non-literal language comprehension. However, in our speech, we often make use of expressions, which are not necessarily interpreted on a literal ground. Comprehension of metaphors and idioms was examined in 39 patients with probable early Alzheimer's disease. The results showed that the decline of figurative language is not an early symptom of dementia and can occur independently from the impairment of propositional language. It was also found that metaphors and idioms differ as far as the predominant kind of error is concerned.

Aged↗

Late plasticity for language in a child's non-dominant hemisphere: a pre- and post-surgery fMRI study.

The ability of the right hemisphere to sustain the acquisition or the recovery of language after extensive damage to the left hemisphere has been essentially related to the age at the time of injury. Better language abilities are acquired when the insult occurs in early childhood (perinatal insults) compared with later occurrence. However, while previous studies have described the neuropsychological pattern of language development in typical cases, the neural bases of such plasticity remain unexplored. Non-invasive functional MRI (fMRI) is a unique tool to assess the neural correlates of brain plasticity through repeated studies, but the technique has not been widely used in children because of methodological limitations. Plasticity of language was studied in a boy who developed intractable epilepsy related to Rasmussen's syndrome of the left hemisphere at age 5 years 6 months, after normal language acquisition. The first fMRI study at age 6 years 10 months showed left lateralization of language networks during a word fluency task. After left hemispherotomy at age 9 years, the child experienced profound aphasia and alexia, with rapid recovery of receptive language but slower and incomplete recovery of expressive language and reading. Postoperative fMRI at age 10 years 6 months showed a shift of language-related networks to the right during expressive and receptive tasks. Right activation was seen mainly in regions that could not be detected preoperatively, but mirrored those previously found in the left hemisphere (inferior frontal, temporal and parietal cortex), suggesting reorganization in a pre-existing bilateral network. In addition, neuropsychological data of this case support the hypothesis of innately more bilateral distribution of receptive than expressive language. This first serial fMRI study illustrates the great plasticity of the child's brain and the ability of the right hemisphere to take over some expressive language functions, even at a relatively late age. It also suggests a limit for removal of the dominant hemisphere beyond the age of 6 years, a classical limit for the critical period of language acquisition.

Brain↗

Specialization of left auditory cortex for speech perception in man depends on temporal coding.

Speech perception requires cortical mechanisms capable of analysing and encoding successive spectral (frequency) changes in the acoustic signal. To study temporal speech processing in the human auditory cortex, we recorded intracerebral evoked potentials to syllables in right and left human auditory cortices including Heschl's gyrus (HG), planum temporale (PT) and the posterior part of superior temporal gyrus (area 22). Natural voiced /ba/, /da/, /ga/) and voiceless (/pa/, /ta/, /ka/) syllables, spoken by a native French speaker, were used to study the processing of a specific temporally based acoustico-phonetic feature, the voice onset time (VOT). This acoustic feature is present in nearly all languages, and it is the VOT that provides the basis for the perceptual distinction between voiced and voiceless consonants. The present results show a lateralized processing of acoustic elements of syllables. First, processing of voiced and voiceless syllables is distinct in the left, but not in the right HG and PT. Second, only the evoked potentials in the left HG, and to a lesser extent in PT, reflect a sequential processing of the different components of the syllables. Third, we show that this acoustic temporal processing is not limited to speech sounds but applies also to non-verbal sounds mimicking the temporal structure of the syllable. Fourth, there was no difference between responses to voiced and voiceless syllables in either left or right areas 22. Our data suggest that a single mechanism in the auditory cortex, involved in general (not only speech-specific) temporal processing, may underlie the further processing of verbal (and non-verbal) stimuli. This coding, bilaterally localized in auditory cortex in animals, takes place specifically in the left HG in man. A defect of this mechanism could account for hearing discrimination impairments associated with language disorders.

Acoustic Stimulation↗

Auditory evoked potential patterns to voiced and voiceless speech sounds in adult developmental dyslexics with persistent deficits.

Auditory evoked potentials (AEPs) were recorded from eight developmental dyslexic adults with persistent reading, spelling and phonological deficits, and 10 non-dyslexic controls to voiced (/ba/) and voiceless (/pa/) consonant-vowel syllables. Consistent with previous data, non-dyslexics coded these stimuli differentially according to the temporal cues that form the basis of the voiced/voiceless contrast: AEPs had time-locked components with latencies that were determined by the temporal structure of the stimuli. Dyslexics were characterized by one of two electrophysiological patterns: AEP pattern I dyslexics demonstrated a differential coding of stimuli on the basis of some temporal cues, but with an atypically large number of components and a considerable delay in AEP termination time; AEP pattern II dyslexics demonstrated no clear differential coding of stimuli on the basis of temporal cues. These data reveal the presence of anomalies in cortical auditory processing which could underlie persistent perceptual and linguistic impairments in some developmental dyslexics. Furthermore, scalp AEP distribution maps showing the difference observed between /ba/ and /pa/ activity over time suggest that the regions implicated in the processing of crucial time-related acoustic cues were not systematically lateralized to the left hemisphere like they were for non-dyslexics. These findings may be conducive to a better understanding and treatment of perceptual dysfunctions in developmental language disorders.

Acoustic Stimulation↗

Group intervention changes brain activity in bilingual language-impaired children.

This investigation assessed the effectiveness of a phonological intervention program on the brain functioning of bilingual Finnish 6- to 7-year-old preschool children diagnosed with specific language impairment (SLI). The intervention program was implemented by preschool teachers to small groups of children including children with SLI. A matched group of other bilingual children with SLI received a physical exercise program and served as a control group. Auditory evoked magnetic fields were measured before and after the intervention with an oddball paradigm. The brain activity recordings were followed by a behavioral discrimination test. Our results show that, in children with SLI, the positive intervention effect is reflected in plastic changes in the brain activity of the left and right auditory cortices.

Adaptation, Physiological↗

Long-term sequelae of Rocky Mountain spotted fever.

Twenty-five patients with definite or probable Rocky Mountain spotted fever (RMSF) who were hospitalized for > or = 2 weeks were identified from our database of 105 patients. Follow-up information was collected for 20 patients, per telephone and/or medical records. The remaining five patients were lost to follow-up or died. Nine patients had > or = 1 long-term sequelae (defined as complications related to an original acute infection with Rickettsia rickettsii that persisted for > or = 1 year following hospital discharge). The ages of patients with sequelae ranged from 2 to 74 years (mean and median, 38 years); duration of follow-up ranged from 1 to 18 years (mean, 11 years). The mean lengths of hospitalization for patients with and without long-term sequelae were 47 days and 20 days, respectively (P < .05). Long-term neurological sequelae included paraparesis; hearing loss; peripheral neuropathy; bladder and bowel incontinence; cerebellar, vestibular, and motor dysfunction; and language disorders. Nonneurological sequelae consisted of disability from limb amputation and scrotal pain following cutaneous necrosis. These data suggest that significant long-term morbidity is common in patients with severe illness due to RMSF.

Adolescent↗

Decline of language among women and men with Alzheimer's disease.

Previous research raises the possibility that gender differences occur in language function in Alzheimer's disease, but this hypothesis has not been evaluated systematically in longitudinal studies. The authors examined the association of gender with rate of decline in language and other cognitive functions among 410 persons with Alzheimer's disease. Participants were recruited from a dementia clinic and followed for up to 5 annual evaluations. Follow-up participation among survivors exceeded 90%. Decline in a composite score based on 8 language tests was evaluated in random effects models with age, education, and race controlled. Annual decline was 0.71 standard units (95% confidence interval [CI] = 0.62-0.79) for women and 0.74 units (95% CI = 0.61-0.86) for men, not a significant difference. Decline on the individual language tests and on composite measures of memory, perception, and global cognition also indicated no significant association with gender. These results suggest that Alzheimer's disease affects language and other cognitive functions similarly in women and men.

Aged↗