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PubMed1983

Prevalence of speech and hearing disorders in a state penitentiary population.

Speech and hearing screening was conducted with 136 inmates incarcerated at the Mississippi State Penitentiary. The prevalences found for articulation and for fluency disorders were comparable to prevalence figures reported for the general population, whereas the prevalence figures for voice and hearing disorders among the sample group were appreciably higher. The demographics of the subject group as to age, sex, offender status, educational background, and receipt of previous speech/hearing evaluation are reported and discussed relative to screening failure.

Adolescent↗
PubMed1983

A quantitative analysis of special needs with emphasis on speech and hearing in the Boston Public Schools.

The purpose of the study was to develop a demographic profile and to analyze the patterns formed by the primary prototypes and educational goals used to educate public-school children with special needs. The emphasis was on communicative disorders. The study was initiated in order to supplement the limited research which examines the impact and effectiveness of service delivery for special needs (mainstreamed) children. The results indicated that (a) the special needs of the school children were not in close proportion to their racial distribution; (b) the speech and hearing needs were in alignment and in proportion to the racial distribution; (c) the number of children in the school population receiving services was higher than the number found in related studies; and (d) the analyses for goodness-of-fit revealed statistical significance for race and educational goals and prototypes and educational goals. It was also found that the need for special services decreased with age. The findings were discussed in terms of the limitations of the study and implications of the nonlabeling requirements of Massachusetts' Special Education Law.

Black or African American↗
PubMed1994

Word skills of children normal and impaired in communication skills and measures of language and speech development.

Results from two related investigations are reported, one using 60 normal language learners, ages 3-5 and one using 34 children with communication disorders, ages 5.4-8.5. Tasks involving the sequential recall of words from five categories (nouns, verbs, adjectives, adverbs, and prepositions) were given to the subjects in each investigation, thus providing an opportunity to compare group performances. A hierarchy of recall strengths of words from different categories and the organizational pattern of scores was determined for each group. Each group's word category scores were used as independent variables in regression analyses to predict scores from a battery of language tests and a test of phonology. The results were anticipated to be capable of contributing to descriptions of children's mental dictionaries, have implications for word category differences in normal and impaired language learners, and clinical relevance. Comparisons of the word recall accuracy of skills of children from each group revealed that the younger normal Ss had word scores equal to the older language and speech impaired children. However, the hierarchy of word category strengths and the patterns of organization within each group's mental dictionary were essentially the same in both groups. Word category scores predicted language and speech scores in both investigations, but the prediction was stronger in the children having impaired language or speech.

Child↗
PubMed1994

Effects of vocal loudness on nasalance measures.

The effects of vocal loudness on measures of nasalance was evaluated. Subjects were 30 young adult females with no history of communication disorder who spoke two stimulus passages at three levels of vocal loudness. One passage contained no nasal consonants (Zoo Passage) and the other contained about 35% nasal consonants (Nasal Sentences). The results indicate that there was no significant difference in nasalance measures across the three levels of vocal loudness for either passage. However, when the nasalance measures for the three conditions of vocal loudness were ranked from low to high for each subject, there was an interesting tendency for a subject's lowest nasalance score to occur in the loudest vocal condition on the Nasal Sentences but not for the non-nasal speech material of the Zoo Passage. The implications of these findings with regard to velopharyngeal function are discussed.

Adult↗
PubMed1989

The cone electrode: a long-term electrode that records from neurites grown onto its recording surface.

A novel long-term recording electrode combines neural regeneration with a standard wire recording technique. The electrode consists of an insulated gold wire fixed inside a hollow glass cone. A piece of sciatic nerve is placed in the glass cone before implantation in cortex of rat. Cortical neurites grow into the sciatic nerve in the cone from surrounding neurons and their electrical activity is recorded via the wire (or wires) in the cone. This activity increases in amplitude over the first few weeks after implantation and remains stable until termination of the experiment many months later. Activity of both single and multi units has been recorded. The cone electrode opens unique opportunities for studies of neurite growth in vivo, for plasticity studies on a captive set of neurites, for studying the neural correlates of behavior and motor learning, and for accessing the central nervous systems of patients with severe paralysing and communicative disorders.

Animals↗
PubMed1979

The effects of chronic middle ear effusion on speech and language development -- a descriptive study.

In this study, the speech and language skills of children with histories of chronic middle ear effusion were analyzed. Forty-seven children between the ages of one year eleven months and five years five months were given a battery of speech and language tests in the course of a diagnostic evaluation. All the children had been referred to speech pathology by a physician because of a suspected communication disorder. All subjects had histories of three or more episodes of middle era effusion, with the first episode occurring prior to 18 months of age. All medical records were checked and in-depth case histories were obtained in order to rule out other possible complicating factors that might have contributed to a speech and language delay. The results of this study revealed essentially age-appropriate receptive language skills in this group of children. Expressive language and articulatory skills were significantly below chronological age level expectation, indicating the possible serious effects of chronic middle ear effusion on speech and language development.

Child, Preschool↗
PubMed1993

Hearing loss in very preterm and very low birthweight infants at the age of 5 years in a nationwide cohort.

In a geographically defined population of very preterm and very low birthweight infants (gestational age < 32 weeks and/or birthweight < 1500 g) hearing was evaluated in 890 children by pure-tone audiometry at the age of 5 years. Hearing loss was conductive/unspecified in 123 (13.8%) and sensorineural in 13 (1.5%) children. The prevalence of sensorineural hearing loss was 15 times as high as in 5-7 year old children in the Dutch population at large. The sensorineural hearing loss prevalence in very low birthweight and extremely low birthweight infants was similar. On account of communication disorders 10 (1.1%) children were classified as disabled and 6 (0.7%) as handicapped, following the definitions of the International Classification of Impairments, Disabilities, and Handicaps of the World Health Organisation. Children with conductive hearing loss had a higher risk of impairments, disabilities and handicaps of language and speech development, than children with normal hearing, the difference being statistically significant. The same holds for children with sensorineural hearing loss; moreover they had a significantly higher risk of impairments, disabilities and handicaps of mental development. Overall comparison of children with and without sensorineural hearing loss proved that the children with sensorineural hearing loss had a significantly less favourable outcome, based on 15 perinatal factors simultaneously. The age at which sensorineural hearing loss in very preterm and/or very low birthweight infants is detected has to be improved.

Audiometry, Pure-Tone↗
PubMed1985

Auditory middle latency responses in children: effects of age and diagnostic category.

The nature of auditory middle latency responses (MLRs) in children has been the subject of considerable debate. In order to study MLRs as a function of age, MLRs were obtained in 217 subjects ranging in age from 6 days to 20 years, all with normal auditory brain-stem responses (ABRs). Subjects were classified into several diagnostic categories: normal; communicative disorders (language delay, learning disability); mentally retarded, multiply handicapped; and post-meningitic. Age effects, the effects of diagnostic category, and possible differences in MLRs of males vs. females and right vs. left ears were examined. The detectability of both Na and Pa was found to increase significantly as a function of age. Detection of these MLR components became similar to adult values (approaching 100% detectability) at approximately 10 years of age. No significant differences were found among diagnostic categories. There were also no significant differences in the detectability of MLRs in males as compared to females, and there were no right vs. left ear differences. The strong age effect which appears to exist in the MLR influences their clinical use. When responses are present, they may be useful indicators of hearing sensitivity, but the absence of MLRs in children cannot be taken as an indication of hearing loss. Similarly, absent or abnormal MLRs cannot be interpreted as a manifestation of auditory pathway dysfunction, since there appears to be little difference in MLRs in normal subjects and MLRs in patients with a wide range of neurologic, cognitive, and speech and language disorders.

Adolescent↗
PubMed1991

The identification of nasal obstruction through clinical judgments of hyponasality and nasometric assessment of speech acoustics.

This study examined the records of a consecutive series of 79 patients referred for evaluation at the Oral-Facial and Communicative Disorders Program during a 3-month period in 1989. The purpose was to determine whether clinical judgments of hyponasality, based on a six-point equal-appearing interval scale or an acoustic assessment with a Kay Elemetrics nasometer could provide information concerning nasal airway patency comparable to that obtained by means of aerodynamic measurement techniques. Among the 40 adults in the series, the sensitivity of hyponasality ratings was 0.55 when nasal airway impairment was defined as a condition in which the airway was less than 0.40 and 0.71 when the definition was limited to airways of less than 0.30 cm2. Specificities for the two groups were 0.89 and 0.85, respectively. Similarly, the sensitivity of nasometer ratings was 0.30 for the first group and 0.38 for the second group, while the specificity for the two groups was 0.83 and 0.92, respectively. Comparable analyses for children were not possible because of the extent to which nasal airway size varies in children younger than 15 years of age. Possible reasons for the findings and their clinical significance are discussed.

Adolescent↗
PubMed1988

Effects of prenatal exposure to neuroleptic drugs on children's growth.

The effect of prenatal exposure to neuroleptic drugs on height and weight from birth to 7 years was examined in children of psychiatrically normal parents and of parents with a history of psychiatric treatment, using data from the Collaborative Perinatal Project of the National Institute of Neurological Diseases, Communicative Disorders, and Stroke. Analysis of covariance was used to control for potential confounding factors. We found that prenatal exposure to dopamine receptor-blocking neuroleptic drugs was associated with increased height in one or more of our groups at 4 months, 1 year, and 7 years and less consistently with increased weight. Seven-year-old children who had been exposed to these drugs for more than 2 months during gestation were approximately 3 cm taller than unexposed controls (p less than 0.05). Prenatal exposure to dopamine-depleting agents was associated with decreased height at 4 months but not later. Possible mechanisms for these effects, including a permanent decrease in the number of brain dopamine receptors and effects on various hormones, are discussed.

Antipsychotic Agents↗
PubMed2005

Characterization of hearing loss in aged type II diabetics.

Presbycusis - age-related hearing loss - is the number one communicative disorder and a significant chronic medical condition of the aged. Little is known about how type II diabetes, another prevalent age-related medical condition, and presbycusis interact. The present investigation aimed to comprehensively characterize the nature of hearing impairment in aged type II diabetics. Hearing tests measuring both peripheral (cochlea) and central (brainstem and cortex) auditory processing were utilized. The majority of differences between the hearing abilities of the aged diabetics and their age-matched controls were found in measures of inner ear function. For example, large differences were found in pure-tone audiograms, wideband noise and speech reception thresholds, and otoacoustic emissions. The greatest deficits tended to be at low frequencies. In addition, there was a strong tendency for diabetes to affect the right ear more than the left. One possible interpretation is that as one develops presbycusis, the right ear advantage is lost, and this decline is accelerated by diabetes. In contrast, auditory processing tests that measure both peripheral and central processing showed fewer declines between the elderly diabetics and the control group. Consequences of elevated blood sugar levels as possible underlying physiological mechanisms for the hearing loss are discussed.

Aged↗
PubMed2006

Age-related structural and functional changes in the cochlear nucleus.

Presbycusis - age-related hearing loss - is a key communication disorder and chronic medical condition of our aged population. The cochlear nucleus is the major site of projections from the auditory portion of the inner ear. Relative to other levels of the peripheral and central auditory systems, relatively few studies have been conducted examining age-related changes in the cochlear nucleus. The neurophysiological investigations suggest declines in glycine-mediated inhibition, reflected in increased firing rates in cochlear nucleus neurons from old animals relative to young adults. Biochemical investigations of glycine inhibition in the cochlear nucleus are consistent with the functional aging declines of this inhibitory neurotransmitter system that affect complex sound processing. Anatomical reductions in neurons of the cochlear nucleus and their output pathways can occur due to aging changes in the brain, as well as due to age-dependent plasticity of the cochlear nucleus in response to the age-related loss of inputs from the cochlea, particularly from the basal, high-frequency regions. Novel preventative and curative biomedical interventions in the future aimed at alleviating the hearing loss that comes with age, will likely emanate from increasing our knowledge and understanding of its neural and molecular bases. To the extent that this sensory deficit resides in the central auditory system, including the cochlear nucleus, future neural therapies will be able to improve hearing in the elderly.

Age Factors↗
PubMed2003

The auditory basis of language impairments: temporal processing versus processing efficiency hypotheses.

Claims have been made that language-impaired children have deficits processing rapidly presented or brief sensory information. These claims, known as the 'temporal processing hypothesis', are supported by demonstrations that language-impaired children have excess backward masking (BM). One explanation for these results is that BM is developmentally delayed in these children. However, little was known about how BM normally develops. Recently, we assessed BM in normally developing 6- and 8-year-old children and adults. Results showed that BM thresholds continue to improve over a comparatively protracted period (>10 years old). We also analysed reported deficits in BM in language-impaired and younger children, in terms of a model of temporal resolution. This analysis suggests that poor processing efficiency, rather than deficits in temporal resolution, can account for these results. This 'processing efficiency hypothesis' was recently tested in our laboratory. This experiment measured BM as a function of delays between the tone and the noise in children and adults. Results supported the processing efficiency hypothesis, and suggested that reduced processing efficiency alone could account for differences between adults and children. These findings provide a new perspective on the mechanisms underlying communication disorders, and imply that remediation strategies should be directed towards improving processing efficiency, not temporal resolution.

Auditory Threshold↗
PubMed2006

Cortical interactions underlying the production of speech sounds.

UNLABELLED: Speech production involves the integration of auditory, somatosensory, and motor information in the brain. This article describes a model of speech motor control in which a feedforward control system, involving premotor and primary motor cortex and the cerebellum, works in concert with auditory and somatosensory feedback control systems that involve both sensory and motor cortical areas. New speech sounds are learned by first storing an auditory target for the sound, then using the auditory feedback control system to control production of the sound in early repetitions. Repeated production of the sound leads to tuning of feedforward commands which eventually supplant the feedback-based control signals. Although parts of the model remain speculative, it accounts for a wide range of kinematic, acoustic, and neuroimaging data collected during speech production and provides a framework for investigating communication disorders that involve malfunction of the cerebral cortex and interconnected subcortical structures. LEARNING OUTCOMES: Readers will be able to: (1) describe several types of learning that occur in the sensory-motor system during babbling and early speech, (2) identify three neural control subsystems involved in speech production, (3) identify regions of the brain involved in monitoring auditory and somatosensory feedback during speech production, and (4) identify regions of the brain involved in feedforward control of speech.

Brain Mapping↗
PubMed2004

Preparing the singing voice specialist revisited.

In review of singing voice specialist preparation, discussion can be chronicled prior to the establishment of Arts Medicine in 1987. Although discussion began in 1984 (and earlier), no formal academic program currently exists to train the singing voice specialist. The need now is greater than ever for a formal program of study to prepare a person who seeks to be a singing voice specialist. The question of adequate preparation continues to be in need of an appropriate answer because no formal training programs or fellowships are available. It is essential to first define the role of singing voice specialists and the populations that they will encounter. To meet the needs of a diverse population, care of the professional voice demands cross-disciplinary training. Knowledge from the fields of music, science, medicine and communication disorders and experience/observation, clinical preparation, and research would provide for optimal preparation. To meet this need, development of a Masters degree program seems highly desirable. The structure of such a program is proposed, along with specific requirements outlined from the music and singing voice pathology components for a Masters Degree in Arts Medicine with a concentration in voice.

Curriculum↗
PubMed2006

Care of the vocalist: an uncommon perspective in rehabilitative medicine.

Neurogenic communication disorders are a routine component of clinical practice in physiatry. The organicity of motor speech impairments and of forms of dysphagia is a basic, recurring element of clinical practice in physical and rehabilitative medicine. The purpose of this article is to provide an overview of some forms of and causes for predictable dysphonias associated with professional voice use. Intended as a synopsis of hyperfunctional voice disorders associated with professional voice use, only certain laryngeal pathologies with functional etiology and their effects on phonation are acknowledged.

Disability Evaluation↗
PubMed1996

The future.

Within the next 20 years, nuclear medicine could become a major focus of medical practice and biomedical research as medicine enters a new age of certainty, in which surgery, radiation, and chemotherapy will only be used when a benefit is certain to result from the treatment. Not only in neuropsychiatric disease, but also in other diseases, such as cancer, disease will be viewed as molecular dissonance, or, a communication disorder. Cells become cancerous and people become anxious, neurotic, or even psychotic because specific tissue cells or neurons either do not get the right messages because of a deficiency in DNA transcription and wrong messages are produced, or because of a failure in reception of the correct messages carried to cells. Nuclear medicine makes it possible to characterize these transmitters and receptors as they are distributed throughout various parts of the living human body. No field of clinical medicine is better equipped to transfer the advances in molecular biology and genetics to the care of the sick. Nuclear medicine takes a physiological and biochemical, rather than an anatomical or ontological, view of disease. Disease is characterized as a statistically defined deviation of one or more functions or regional biochemical processes from those of healthy people under circumstances as close as possible to those of a person of the same sex and age as the patient. The emission of photons from radioactive tracers that can penetrate from the inside of the body to external radiation detectors is what makes it possible to examine molecular interactions involving picomolar concentrations of molecules involved in biochemical interactions between macromolecular recognition sites, enzymes, and substrates within different parts of the living body. Perturbations (stress tests) will be increasingly used to detect abnormal responsiveness to external forces early in the course of a disease. Movement of the diagnostic process from an orientation toward anatomy to a more fundamental level, the molecular level, will be the hallmark of medicine in the next millennium. Gross or histopathologic changes will no longer suffice. Radiotracers will be able to characterize plasma membrane and intracellular recognition sites and will also provide in vivo probes, making it possible to identify changes in specific genes, as well as their molecular expression, even before the disease or disorder has manifest itself by symptoms and physical signs. Such molecular characterization of disease in situ will make it possible to treat the patient as an individual and not just as a representative member of a group of patients who have similar problems and have been labeled as having a particular disease. Diagnosis will become increasingly specific despite the heterogeneity of the present diagnostic labels.

Biochemistry↗