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PubMed1993

Linguistic characteristics of neurotic, borderline and psychotic personality organization.

Thirty patients were subjected to a Structural Interview by means of which 10 of them received the diagnosis NPO (Neurotic Personality Organization), 10 BPO (Borderline Personality Organization) and 10 PPO (Psychotic Personality Organization). About 2500 words and groups of words were extracted from the patients' utterances for analysis. The word-frequencies thus found were analyzed by a PLS discriminant analysis which yielded two significant principal components (main dimensions) explaining 57% of the variance. This analysis showed that the three groups of patients are well separated from one another and that there is a definite correlation between personality organization and linguistic variables. The main features of the BPO-patients in this study seem to be that they refer to positions outside themselves and their language is impersonal; we see this as an example of a vacillating identity. The NPO-group is characterized by an intense and rich language, signs of a more advanced symbolizing ability, deixis and high level defenses. The language of the PPO-patients is poor and its predominant feature is a lack of words; in our interpretation this indicates foreclosure and a lack of identity.

Adult↗
PubMed1989

Adult follow-up of the acquired aphasia-epilepsy syndrome in childhood. Report of 7 cases.

The authors report at adult age 7 patients (6 men, one woman) with the syndrome of "acquired aphasia-epilepsy", 6 of which had been previously studied as children. The results of the language, neuropsychological and socio-educational evaluation detailed many years after the onset of the aphasia are the subject of this report. One man has recovered completely, one has a normal oral language but is severely dyslexic, one has recovered normal comprehension but has severe expressive language problems. Four have absent language comprehension and lack of expressive speech, and only one of them has learned and is using sign language with some efficiency. None has developed functional written language. Attempts to offer a substitutive language to children with prolonged inability to understand and use oral language appears important but is fraught with problems. Although there are no conclusive data about the role of the continuous paroxysmal EEG discharges and the effect of their suppression with drug treatment on the prognosis of the aphasia, the definite fluctuations of the aphasia in some cases, the isolated recent case reports of definitive improvement with drug treatment justify further trials in this potentially severe and chronic condition.

Adolescent↗
PubMed2001

PET evaluation of bilingual language compensation following early childhood brain damage.

We report a positron emission tomography (PET) study in a 37-year-old, right handed, bilingual (English and American Sign Language) male with left frontal lobe damage, without evidence of language or general intellectual dysfunction. A brain MRI scan demonstrated an atrophic lesion of the left dorsolateral prefrontal, orbital, and opercular cortices extending from the frontal pole to precentral gyrus and including parts of anterior cingulate cortex, due to an probable infantile encephalitis. H(2) (15)O PET scans found evidence of increased right hemisphere activity compared to normal controls during spontaneous generation of narrative in both English and ASL. Neuropsychological data were within normal limits with the exception of visuospatial function. The results suggest the possibility that plasticity, unmasking of neural pathways, and or other adaptations of language function in the right hemisphere may have occurred, and are discussed with regard to the crowding hypothesis.

Adult↗
PubMed1983

Late language development in a child unable to recognize or produce speech sounds.

A boy with severe quadriplegia who neither recognized nor uttered speech sounds acquired language. Until the age of 6 years he was considered to be of severely subnormal intelligence. At age 6 years 9 months he was introduced to a manual sign system. Subsequently he was able to read, write, converse, and produce imaginative stories. Attention and memory were unimpaired and affective and social responsiveness developed appropriately. The case history demonstrates the selective effects of brain lesions that, despite extensive damage, may spare functional systems necessary for cognitive and linguistic development. It highlights the difficulty in diagnosing and evaluating the intellectual and affective potential of a multihandicapped child without functional hearing or speech and emphasizes the importance of sign language as a communication channel and prerequisite for the acquisition of reading and writing skills.

Aphasia↗
PubMedDate not supplied

Late diagnosis of congenital hearing impairment in children: the parents' experiences and opinions.

The purpose of the present investigation is to describe how parents experience a delayed identification of their child's hearing impairment. Ten parents of 8 children were interviewed. The impairment was confirmed when the children were between 2 years, and 5 years and 8 months. The results show that the parents and their child pass through a series of distinct phases: Unawareness, Suspicion, Confirmation and Habilitation. After the birth of the child there was first a calm period, which lasted until the possibility of a hearing impairment was suspected. Once the suspicion was raised, a time of much anxiety and frustration ensued. The parents described how defective communication and misunderstanding lead to frequent conflicts with their child. The differing behaviour of the child, in combination with poor language development, initiated referral to audiological assessment and confirmation of the hearing impairment. After confirmation, the parents felt relief but at the same time a sorrow. When hearing aids had been fitted and education in sign language was under way, the child's language and social behaviour improved. Supposedly, the late detection is explained by the combination of an insufficient test method that cannot detect all children with a hearing impairment and, in cases of uncertainty, a tendency to let the child pass rather than "bringing bad news". All parents in the present study would have wished to participate in a hearing screening program for new-borns, had the opportunity been present.

Adult↗
PubMed2000

Teachers' ratings of functional communication in students with cochlear implants.

The study examined factors associated with teachers' ratings of functional communication skills of students with cochlear implants. Deaf students living in and around a metropolitan area were surveyed to locate 51 with cochlear implants. Teachers rated each student's functional use of the implant, given three defined ratings. Additional information regarding sex, communication option, placement, home language, rural or nonrural address, etiology, and presence or absence of an additional disability was gathered. Chi-square analyses of the data were performed. The data indicated that students with a known etiology and a rural address, and who used sign language at home or school, were less likely than others to use the implant as a primary channel for receptive communication. The authors suggest that the teacher's role in implant use warrants more attention. Speech-language pathologists, otologists, audiologists, and parents of deaf children should consider all factors related to successful implant use before advocating or choosing this financially, emotionally, and therapeutically challenging option.

Adolescent↗
PubMed1981

Hearing loss.

Defective hearing is the most prevalent chronic health problem in the United States, making it a primary concern of the physician. Failure to diagnose, misdiagnose, and delay of diagnosis of hearing loss are common errors that have serious implications. However, they can be avoided. If children exhibiting the symptoms of delayed language, articulation defects, and academic problems (especially with reading or a medical history of certain diseases) are referred for audiological testing, most cases of hearing impairment will be promptly detected. With adults the implications of hearing loss are different, both medically and psychosocially. After 30 years of age the prevalence of hearing defects increases rapidly. Some major causes are noise, otosclerosis, otitis media, and presbycusis. Surgery and amplification are the principle treatments. Management of nonmedical aspects should involve programs such as the Division of Vocational Rehabilitation, state schools for the deaf, and sign language classes.

Adult↗
PubMed1997

Manifestations in institutionalised adults with Angelman syndrome due to deletion.

Undiagnosed institutionalised patients were reviewed in an attempt to identify those with Angelman syndrome (AS). The aim was to test these patients for deletion of chromosome 15(q11-13) and to describe the adult phenotype. The selection criteria included severe intellectual disability, ataxic or hypermotoric limb movements, lack of speech, a "happy" demeanour, epilepsy, and facial appearance consistent with the diagnosis. Patients were examined, medical records perused, and patients' doctors contacted as required. Genetic tests performed included routine cytogenetics, DNA methylation analysis (with probe PW71B), and fluorescence in situ hybridisation (with probes D15S10, GABRbeta3, or SNRPN). A deletion in the AS region was detected in 11 patients (9 males and 2 females) of 22 tested. The mean age at last review (March 1996) was 31.5 years (range 24 to 36 years). Clinical assessment documented findings of large mouth and jaw with deep set eyes, and microcephaly in nine patients (two having a large head size for height). No patient was hypopigmented; 1/11 patients was fair. Outbursts of laughter occurred in all patients but infrequently in 7/11 (64%) and a constant happy demeanour was present in 5/11 (46%). All had epilepsy, with improvement in 5/11 (46%), no change in 4 (36%), and deterioration in 2 (18%). The EEG was abnormal in 10/10 patients. Ocular abnormalities were reported in 3/8 patients (37.5%) and 4/11 (36%) had developed kyphosis. Two had never walked. All nine who walked were ataxic with an awkward, clumsy, heavy, and/or lilting gait. No patient had a single word of speech but one patient could use sign language for two needs (food and drink). Our data support the concept that AS resulting from deletion is a severe neurological syndrome in adulthood. The diagnosis in adults may not be straightforward as some manifestations change with age. Kyphosis and keratoconus are two problems of older patients.

Abnormalities, Multiple↗
PubMed1981

Community mental health center readiness to comply with Section 504 of the Rehabilitation Act.

The purpose of this study was to assess the state of CMHC readiness for compliance with the provisions of Section 504 of the rehabilitation Act of 1973, and as amended. Data reported are responses to a mailed survey to 80% of the CMHCs nationally; 26% of the CMHCs in the sample responded. The survey was done six months prior to the time in which full compliance was required by regulation. The findings were (a) only 14% of all respondent CMHCs completed the compliance steps required by Section 504; (b) site accessibility and program accessibility generally were better for mobility impaired than for hearing or vision impaired consumers; (c) 87% of respondent CMHCs had no equipment for telephone access by deaf persons, but 35.4% reported clinical personnel with sign language ability; and (d) for those few (N = 24) CMHCs who reported being threatened by DHEW with sanctions for non-compliance, positive steps towards compliance were in most instances twice as likely as for the majority of CMHCs that were not so threatened.

Architectural Accessibility↗
PubMed1995

Improvements in preventive care and communication for deaf patients: results of a novel primary health care program.

OBJECTIVE: To test the hypothesis that profoundly deaf persons would have better preventive care compliance and improved physician communication if enrolled in a primary care program providing American Sign Language (ASL) interpreters. DESIGN: A case-cohort community-based study. The authors had ASL-fluent research assistants interview 90 randomly selected patients (the cases) enrolled in a unique primary care program for the deaf (Deaf Services Program), which provided full-time ASL interpreters and subsidized health care costs for some patients. Eighty-five deaf controls were friends of the cases drawn from the community. RESULTS: The cases were poorer and less often married than were the controls, but other baseline characteristics were similar. The cases were more likely (p < 0.05) to report receiving within the preceding three years Pap tests (90% vs 72%), mammography (86% vs 53%), and rectal examinations (72% vs 25%), but not breast examinations (76% vs 71%, p = 0.7). The cases were more likely than the controls to report receiving counseling in ASL for psychiatric and substance abuse problems (49% vs 5%, p < 0.001). Although only 18% of the controls were fluent in written English, 67% of them used written notes to communicate with their physicians. Twenty percent of the controls used ASL interpreters compared with 84% of the cases (p < 0.001). More cases than controls were moderately or extremely satisfied with communication with their physicians (92% vs 42%, p < 0.001). CONCLUSION: Deaf persons enrolled in a primary care program that included full-time interpreters were more likely to use ASL, were more satisfied with physician communications, and had improved preventive care outcomes.

Adult↗
PubMedDate not supplied

A new concept in blepharoplasty.

Apart from what may be considered complications, the intervention of any aesthetic surgery can have undesired effects (scar sequelae, normal regional dynamic disorders, edema, iatrogenic acceleration of the aging process in the area). The orbital region is particularly sensitive to these undesirable effects due to its situation and the importance of the eyelids in facial sign language. The sum of these undesirable effects and not infrequent complications often place the plastic surgeon in a compromising situation. It is for this reason that in recent years we have made a special effort to analyze causes, to design new techniques, and to evaluate the combination of different techniques in an attempt to minimize these undesirable effects, so as to be able to offer patients more natural and safer results. It is with this intention that this paper records some anatomical and functional details of the eyelids, analyzes the physiology of the aging process, and examines some classic and modern techniques.

Eyelids↗
PubMedDate not supplied

Sentence intonation and syllable stress in speech produced during simultaneous communication.

This study investigated prosodic variables of syllable stress and intonation contours in contextual speech produced during simultaneous communication (SC). Ten normal-hearing, experienced sign language users were recorded under SC and speech only (SO) conditions speaking a set of sentences containing stressed versus unstressed versions of the same syllables and a set of sentences containing interrogative versus declarative versions of the same words. Results indicated longer sentence durations for SC than SO for all speech materials. Vowel duration and fundamental frequency differences between stressed and unstressed syllables as well as intonation contour differences between declarative and interrogative sentences were essentially the same in both SC and SO conditions. The conclusion that prosodic rules were not violated in SC is consistent with previous research indicating that temporal alterations produced by simultaneous communication do not involve violations of other temporal rules of English speech.

Communication↗
PubMedDate not supplied

Effect of vowel environment on fricative consonant duration in speech produced during simultaneous communication.

This study investigated the effect of vowel environment on fricative consonant duration in contextual speech produced during simultaneous communication (SC). Previous studies (Schwartz, 1969) of vowel influences on consonant duration supported the notion of anticipatory scanning, in which final vowel targets influence the duration of preceding fricative consonants. Ten normal-hearing, experienced sign language users recorded palatal and alveolar fricatives produced in four vowel environments in contextual sentences under SC and speech-only (SO) conditions. Results indicated longer sentence durations for SC than for SO, and significant effects of vowel context on fricative consonant duration in contextual speech in both SC and SO conditions that revealed similar anticipatory scanning effects as seen in previous studies. These data confirm previous research indicating that the temporal alterations produced by simultaneous communication do not involve violations of the temporal rules of English speech.

Adult↗
PubMed1980

Psychomotor development in 65 home-reared children with cri-du-chat syndrome.

The psychomotor development of 65 noninstitutionalized individuals with cri-du-chat syndrome was examined through parental questionnaire responses and supporting medical records. Social quotients determined by a Vineland Maturity Scale ranged from 6 to 85, the ages at which developmental milestones were attained varied from the upper limits of normal to six years delayed. Achievement levels were influenced favorably by the early introduction of special education, and were affected adversely by the presence of an unbalanced translocation. This study suggests that many children with cri-du-chat syndrome can attain developmental and social skills normally seen in 5- to 6-year-old children, although their linguistic abilities are seldom as advanced. Contrary to the commonly portrayed clinical picture of severe mental retardation and bedridden debilitation, the older home-reared cri-du-chat child was usually ambulatory, had a moderate degree of independence in self-care skills, and was able to communicate either verbally or through gestural sign language. Physicians and parents should be aware of the full range of psychomotor potential of the child with cri-du-chat syndrome in order to make informed decisions concerning institutional placement.

Achievement↗
PubMed1999

A survey of the accessibility of chiropractic clinics to the disabled.

OBJECTIVE: To determine to what degree chiropractic clinics are complying with the Americans with Disabilities Act (ADA), which mandates that health care clinics be accessible to the disabled. METHODS: A survey was developed and mailed to 200 chiropractic clinics in Orange and Los Angeles counties. The survey asked about the essential necessities for health care clinics to be accessible to the wheelchair-bound, the blind, and the deaf. It also sought to discover how many disabled patients these clinics were treating and the attitudes of practitioners and staff toward this population. RESULTS: The response rate was 50.5%. Accessibility for the wheelchair-bound was high. Accessibility for the blind was limited by a lack of Braille signs. Accessibility to the deaf was limited by lack of telecommunications device for the deaf or use of sign language interpreters. Most clinics were treating few or no disabled patients and did not perceive a need to become more accessible. CONCLUSION: There appears to be poor compliance with the ADA in chiropractic clinics in Los Angeles and Orange counties. Although data are lacking, it appears likely that the disabled population is being underserved by the chiropractic profession. Education for chiropractors on the rights and needs of the disabled population is necessary to give this group equal access to chiropractic health care.

Attitude of Health Personnel↗
PubMed1983

A method to break the cognitive barrier between a deaf child and a hearing parent.

A deaf child actively uses about 1000 concepts in common with the hearing world. The rest of his up to 10,000 concepts belong to sign language and cannot be accurately translated into written language. This makes it difficult for the deaf to understand a normal written text, especially its abstractions. We have developed a new communication system in order to break the barrier between the hearing and the deaf. In this system a deaf child speaks with a writing hand-piece terminal through an FM route to a small unlimited text-to-speech synthesizer carried by the parent. The parent answers similarly to a 48-grapheme alphanumerical display carried by the child on a rack in front of him. The parent's unit with a speech synthesizer weighs about 2 kg and its size is about 7 X 20 X 25 cm; the size of the child's unit is one half of that and it weighs, with the display, 2 kg. Even a 4-year-old child carries the apparatus easily; nevertheless a still lighter unit is under construction. The system takes the learning process to everyday situations and makes it possible for a deaf child to converse in the normal written and spoken language. Thus, his concept capacity in the spoken language can be increased.

Adult↗