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PubMed2000

Effect of language barriers on follow-up appointments after an emergency department visit.

OBJECTIVE: To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment. DESIGN: Cohort study. SETTING: Public hospital emergency department. PARTICIPANTS: English- and Spanish-speaking patients (N = 714) presenting with nonemergent medical problems. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P =. 05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P =.78). CONCLUSIONS: Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments.

Adolescent↗

PubMed2004

Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients.

OBJECTIVE: We studied physician-patient dyads to determine how physician self-rated Spanish-language ability and cultural competence affect Spanish-speaking patients' reports of interpersonal processes of care. SETTING/PARTICIPANTS: Questionnaire study of 116 Spanish-speaking patients with diabetes and 48 primary care physicians (PCPs) at a public hospital with interpreter services. MEASURES: Primary care physicians rated their Spanish ability on a 5-point scale and cultural competence by rating: 1) their understanding of the health-related cultural beliefs of their Spanish-speaking patients; and 2) their effectiveness with Latino patients, each on a 4-point scale. We assessed patients' experiences using the interpersonal processes of care (IPC) in diverse populations instrument. Primary care physician responses were dichotomized, as were IPC scale scores (optimal vs nonoptimal). We analyzed the relationship between language and two cultural competence items and IPC, and a summary scale and IPC, using multivariate models to adjust for known confounders of communication. RESULTS: Greater language fluency was strongly associated with optimal IPC scores in the domain of elicitation of and responsiveness to patients, problems and concerns [Adjusted Odds Ratio [AOR], 5.25; 95% confidence interval [CI], 1.59 to 17.27]. Higher score on a language-culture summary scale was associated with three IPC domains - elicitation/responsiveness (AOR, 6.34; 95% CI, 2.1 to 19.3), explanation of condition (AOR, 2.7; 95% CI, 1.0 to 7.34), and patient empowerment (AOR, 3.13; 95% CI, 1.2 to 8.19)-and not associated with two more-technical communication domains. CONCLUSION: Physician self-rated language ability and cultural competence are independently associated with patients' reports of interpersonal process of care in patient-centered domains. Our study provides empiric support for the importance of language and cultural competence in the primary care of Spanish-speaking patients.

Clinical Competence↗

PubMedDate not supplied

Intracarotid amobarbital (Wada) test for language dominance: correlation with results of cortical stimulation.

Eighty-eight patients had bilateral intracarotid amobarbital (Wada) testing to determine hemispheric dominance for language in preparation for epilepsy surgery, as well as unilateral extraoperative cortical electrical stimulation using subdural electrode arrays. In none of the patients with left dominance by Wada testing were language areas found with right-sided stimulation, but two patients with right dominance by Wada testing had language areas mapped on the left side. These findings suggest that left dominance by Wada testing is strong evidence for exclusive lateralization of language function in the left hemisphere, but there is concern about the ability of the Wada test to exclude the possibility of some left-sided language function despite apparent right-sided dominance. Patients with left dominance on Wada testing do not need cortical stimulation before extensive right temporal lobectomy, but we believe that patients with right or bilateral dominance on Wada testing should have cortical stimulation for localization of language areas if extensive left or right temporal or frontal resection is planned.

Amobarbital↗

PubMed2006

Is language lateralization in temporal lobe epilepsy patients related to the nature of the epileptogenic lesion?

PURPOSE: Early acquired lesions are considered to be a risk factor for atypical language lateralization in epilepsy, whereas developmental lesions are not. Hippocampal sclerosis (HS) can be understood as an early, acquired lesion, whereas developmental tumors (DT) are thought to originate in utero. We assessed whether language lateralization differs between these groups of temporal lobe epilepsy patients. METHODS: We used 3-Tesla functional MRI (fMRI) to assess 41 patients (16 DT, 25 HS) and 50 controls, performing a noun-verb-generation task. fMRI data were processed by using SPM2. A laterality index (LI) was calculated based on the number of activated voxels in left- and right-sided frontal lobe language areas. Atypical lateralization was considered if the index was < or = 0.2. RESULTS: Patients had a lower LI (0.42 +/- 0.5) than controls (0.6 +/- 0.3; p < or = 0.05), but the LI was not different between DT (0.44 +/- 0.5) and HS patients (0.43 +/- 0.4; p = 0.9). The frequency of atypical lateralization was increased in patients (27%) compared with controls (8%) but was similar in both patient groups (DT, 31%; HS, 24%). HS patients had an earlier onset and longer duration of epilepsy and a higher frequency of significant antecedent events (p < or = 0.05). CONCLUSIONS: Patients with TLE demonstrate a deviation toward atypical language lateralization. However, language lateralization was not different between patients with presumably acquired lesions compared with patients with developmental pathology. This suggests that the nature of the temporal lobe lesion does not influence overall language lateralization.

Adult↗

PubMed1995

Personal computers and process writing: a written language intervention for deaf children.

This study was concerned with the effectiveness of word processing as a written language intervention for primary-age deaf children. Subjects were 14 children in two primary school deaf-unit classes matched in terms of age, gender, and degree of hearing loss. A quasi-experimental design incorporating multiple-group baselines with pre- and post-tests enable all subjects to receive the intervention while maintaining experimental control. Samples of children's written language were collected at the end of each phase in the study. Experienced teachers of deaf children rated five dimensions of the quality of the written language samples, while a speech and language therapist judged other linguistic qualities of the writing. Significant improvements in quality ratings over the course of the study indicated that the word processing intervention had led to improvements in the children's written language skills. These results confirm the effectiveness of word processing as an adjunct to the process writing approach to written language instruction for deaf children.

Child↗

PubMed1997

Dramatic play: a format for 'literate' language?

BACKGROUND: Research literature discussing the possibility of a relationship between dramatic play and literacy development in school beginners has evoked interest in the context of the formalisation of early years curriculum, particularly relationships between oral syntactic competence in preschool children and later reading ability. AIMS: The aim of the present study was to investigate possible differences in syntax between sociodramatic play and other play activities in small play groups. It was predicted that the language in sociodramatic play would be more 'literate', i.e., more decontextualised, explicit and linguistically elaborated. The hypothesis tested was that sociodramatic play elicits more advanced syntactic language in children. SAMPLES: Six children (six-year-olds) in groups of three girls and three boys were observed in 11 free play episodes (five sociodramatic play episodes and six other group play episodes). Approximately 100 utterances from each child in each play category were analysed. The children had normal intelligence and language ability, and had a middle class background. METHODS: The play groups were observed during indoor free play in a playroom equipped for family play and with different toys. No instructions were given. The observations were video- and audiotaped and the children's utterances transcribed and analysed syntactically, i.e., utterance types (complexity and completeness), sentence adverbials and expansions. Chi-square was used to test for statistically significant differences in children's use of syntax. RESULTS: The children's language turned out to be significantly more advanced and 'literate' with more syntactically complete and complicated utterances, use of explicit references and elaborated nominal groups in sociodramatic play than in any other play activity. CONCLUSIONS: The demands of conveying meaning to peers in dramatic play contexts seem to provide children with opportunities to practise 'literate' language, language that is similar to what is demanded when writing for an absent audience.

Chi-Square Distribution↗

PubMed1996

A cross-language comparison of vowel perception in English-learning and German-learning infants.

Studies of cross-language consonant discrimination have shown a shift from a language-general to a language-specific pattern during the first year of life. Recently, the same pattern of change was observed for English-speaking infants' discrimination of two non-native vowel contrasts (Polka and Werker, 1994). The present study was designed to provide a more direct assessment of language-specific influences on infant vowel contrast perception. In experiment 1 adults were tested on a German (non-English) contrast, /dut/ versus /dyt/, and an English (non-German) contrast, /d epsilon t/ versus /daet/. English and German adults discriminated both contrasts with high levels of accuracy in a categorial AXB task. However, results of an identification and rating task showed that, within each non-native vowel contrast, one vowel perceptually matched a native vowel category better than the other. In experiment 2 discrimination of /dut/ versus /dyt/ and /d epsilon t/ versus /daet/ was examined in English- and German-learning infants in two age groups (6-8 months and 10-12 months) using the conditioned headturn procedure. English and German infants did not differ in their discrimination of either contrast and there were no age differences in discrimination of either contrast for the German or for the English infants. However, in both language groups at both ages, there were clear differences in performance related to the direction in which the vowel change was presented to the infants. For the German contrast, discrimination was significantly poorer when the contrast changed from /dut/ to /dyt/. For the English contrast, discrimination was significantly poorer when the contrast changed from /daet/ to /d epsilon t/. The directional asymmetries observed here and in other infant vowel studies point to a language-universal perceptual pattern which suggests that vowels produced with extreme articulatory postures serve as perceptual attractors in infant vowel perception.

Adult↗

PubMed2000

An investigation of current models of second language speech perception: the case of Japanese adults' perception of English consonants.

This study reports the results of two experiments with native speakers of Japanese. In experiment 1, near-monolingual Japanese listeners participated in a cross-language mapping experiment in which they identified English and Japanese consonants in terms of a Japanese category, then rated the identifications for goodness-of-fit to that Japanese category. Experiment 2 used the same set of stimuli in a categorial discrimination test. Three groups of Japanese speakers varying in English-language experience, and one group of native English speakers participated. Contrast pairs composed of two English consonants, two Japanese consonants, and one English and one Japanese consonant were tested. The results indicated that the perceived phonetic distance of second language (L2) consonants from the closest first language (L1) consonant predicted the discrimination of L2 sounds. In addition, this study investigated the role of experience in learning sounds in a second language. Some of the consonant contrasts tested showed evidence of learning (i.e., significantly higher scores for the experienced than the relatively inexperienced Japanese groups). The perceived phonetic distance of L1 and L2 sounds was found to predict learning effects in discrimination of L1 and L2 sounds in some cases. The results are discussed in terms of models of cross-language speech perception and L2 phonetic learning.

Adult↗

PubMed2004

Language and the origin of numerical concepts.

Reports of research with the Pirahã and Mundurukú Amazonian Indians of Brazil lend themselves to discussions of the role of language in the origin of numerical concepts. The research findings indicate that, whether or not humans have an extensive counting list, they share with nonverbal animals a language-independent representation of number, with limited, scale-invariant precision. What causal role, then, does knowledge of the language of counting serve? We consider the strong Whorfian proposal, that of linguistic determinism; the weak Whorfian hypothesis, that language influences how we think; and that the "language of thought" maps to spoken language or symbol systems.

Animals↗

PubMed2006

New standardised texts for assessing reading performance in four European languages.

AIMS: To develop standardised texts for assessing reading speed during repeated measurements and across languages for normal subjects and low vision patients. METHODS: 10 texts were designed by linguistic experts in English, Finnish, French, and German. The texts were at the level of a sixth grade reading material (reading ages 10-12 years) and were matched for length (830 (plus or minus 2) characters) and syntactic complexity, according to the syntactic prediction locality theory of Gibson. 100 normally sighted native speaking volunteers aged 18-35 years (25 per language) read each text aloud in randomised order. The newly designed text battery was then applied to test the reading performance of 100 normally sighted native speaking volunteers aged 60-85 years (25 per language). RESULTS: Reading speed was not significantly different with at least seven texts in all four languages. The maximum reading speed difference between texts, in the same language was 6.8% (Finnish). Average reading speeds (SD) in characters per minute are, for the young observer group: English 1234 (147), Finnish 1263 (142), French 1214 (152), German 1126 (105). The group of older readers showed statistically significant lower average reading speeds: English 951 (97), Finnish 1014 (179), French 1131 (160), German 934 (117). CONCLUSION: The authors have developed a set of standardised, homogeneous, and comparable texts in four European languages (English, Finnish, French, German). These texts will be a valuable tool for measuring reading speed in international studies in the field of reading and low vision research.

Adolescent↗

PubMed1999

Global aphasia without hemiparesis: language profiles and lesion distribution.

OBJECTIVES: Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically manifested by patients with global aphasia after large left perisylvian lesions. A few cases of GAWH have been reported with conflicting conclusions regarding pathogenesis, lesion localisation, and recovery. The current study was conducted to attempt to clarify these issues. METHODS: Ten cases of GAWH were prospectively studied with language profiles and lesion analysis; five patients had multiple lesions, four patients had a single lesion, and one had a subarachnoid haemorrhage. Eight patients met criteria for cardioembolic ischaemic stroke. RESULTS: Cluster analysis based on acute language profiles disclosed three subtypes of patients with GAWH; these clusters persisted on follow up language assessment. Each cluster evolved into a different aphasia subtype: persistent GAWH, Wernicke's aphasia, or transcortical motor aphasia (TCM). Composite lesion analysis showed that persistent GAWH was related to lesioning of the left superior temporal gyrus. Patients with acute GAWH who evolved into TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolved into Wernicke's type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but one patient. CONCLUSIONS: Although patients with acute GAWH are similar on neurological examination, they are heterogeneous with respect to early aphasia profile, language recovery, and lesion profile.

Adult↗

PubMed2000

Pathological switching between languages after frontal lesions in a bilingual patient.

Cerebral lesions may alter the capability of bilingual subjects to separate their languages and use each language in appropriate contexts. Patients who show pathological mixing intermingle different languages within a single utterance. By contrast, patients affected by pathological switching alternate their languages across different utterances (a self contained segment of speech that stands on its own and conveys its own independent meaning). Cases of pathological mixing have been reported after lesions to the left temporoparietal lobe. By contrast, information on the neural loci involved in pathological switching is scarce. In this paper a description is given for the first time of a patient with a lesion to the left anterior cingulate and to the frontal lobe-also marginally involving the right anterior cingulate area-who presented with pathological switching between languages in the absence of any other linguistic impairment. Thus, unlike pathological mixing that typically occurs in bilingual aphasia, pathological switching may be independent of language mechanisms.

Aphasia↗

PubMed2003

Deciphering the genetic basis of speech and language disorders.

A significant number of individuals have unexplained difficulties with acquiring normal speech and language, despite adequate intelligence and environmental stimulation. Although developmental disorders of speech and language are heritable, the genetic basis is likely to involve several, possibly many, different risk factors. Investigations of a unique three-generation family showing monogenic inheritance of speech and language deficits led to the isolation of the first such gene on chromosome 7, which encodes a transcription factor known as FOXP2. Disruption of this gene causes a rare severe speech and language disorder but does not appear to be involved in more common forms of language impairment. Recent genome-wide scans have identified at least four chromosomal regions that may harbor genes influencing the latter, on chromosomes 2, 13, 16, and 19. The molecular genetic approach has potential for dissecting neurological pathways underlying speech and language disorders, but such investigations are only just beginning.

Family Health↗

PubMed2001

Psycholinguistics: a cross-language perspective.

Cross-linguistic studies are essential to the identification of universal processes in language development, language use, and language breakdown. Comparative studies in all three areas are reviewed, demonstrating powerful differences across languages in the order in which specific structures are acquired by children, the sparing and impairment of those structures in aphasic patients, and the structures that normal adults rely upon most heavily in real-time word and sentence processing. It is proposed that these differences reflect a cost-benefit trade-off among universal mechanisms for learning and processing (perception, attention, motor planning, memory) that are critical for language, but are not unique to language.

Aphasia↗

PubMedDate not supplied

Cognitive and linguistic profiles of specific language impairment and semantic-pragmatic disorder in bilinguals.

This study explored the notion that the extent to which language-impaired children can become bilingual depends on the type of language impairment. Single-case studies were conducted on two 7-year-old bilingual children, who had both been exposed to English and Afrikaans consistently and regularly from an early age. The subjects presented with specific language impairment (SLI) and semantic-pragmatic disorder (SPD), respectively. They were assessed on a battery of cognitive and linguistic tests in both their languages. Results indicate that the SLI subject, who presented with a deficit in successive processing on the Cognitive Assessment System, had difficulty in acquiring the surface features of both languages. She developed much better proficiency in English than in Afrikaans, despite substantial exposure to the latter. The SPD subject, whose cognitive profile was characterised by planning and attention deficits, but a strength in successive processing, presented with equal proficiency in both languages. The theoretical and clinical implications of this research are discussed.

Child↗

PubMedDate not supplied

Language development in very low birth weight preterm children: a follow-up study.

The language development of 17 very low birth weight (VLBW) preterm children was compared with that of matched controls at the ages of 2 and 4 years. At the age of 2 years, the VLBW preterm children achieved significantly lower scores in the language comprehension test than their matched controls. In addition, they used shorter and more immature sentences. At the age of 4 years, difficulties in the VLBW preterm children manifested as deficiencies in language comprehension, naming and auditory discrimination. The language test results at the age of 2 years significantly correlated with those at the age of 4 years, but mainly in the preterm group. The highest and most frequent correlations were found between the language test scores at 2 years and the auditory discrimination test scores at 4 years. The only significant correlation to be found in the control group was between the vocabulary test score at 2 years and the consonant discrimination test score at 4 years. Therefore, language development of the VLBW preterm children should be measured and monitored from toddler age onwards. Special attention should be paid to measurements of auditory processing. While the results of the present study, however, represent mainly the outcome in a group of VLBW preterm children with changes in the neonatal MRI, the results should not be generalized to all VLBW preterm children.

Brain↗

PubMedDate not supplied

Language acquisition in relation to cumulative posttraumatic stress disorder symptom load over time in a sample of re-settled refugees.

OBJECTIVE: To study the effects of symptoms of posttraumatic stress disorder (PTSD), depression and dissociation as well as cumulative symptom load on language learning during the introduction phase in re-settled refugees. METHOD: Participants were re-settled refugees of Iraqi origin. They were assessed by means of a structured interview for PTSD at baseline as well as self-rating questionnaires. Language acquisition was studied by means of register data from the school system. Five levels of language proficiency were recorded. Self-reported symptom scores for PTSD, depression and dissociation (Impact of Events Scale-22, Hopkins Symptom Checklist-25, Dissociative Experiences Scale) were measured at four time points during 9 months immediately after resettlement. In 49 participants in a longitudinal study, data regarding progress in language studies were accessible. RESULTS: The results of the study indicate that the speed of language acquisition - the number of levels taken during the study, adjusted to hours of school presence - is related to the cumulative PTSD symptom load over time (Events Scale-22), but is not related neither to the symptom load of depression and dissociation, nor to the number of previous school years. CONCLUSION: The study shows that the symptom load of PTSD during the follow-up period is significantly inversely related to the speed of language acquisition in refugees. This implies that treatment as well as preventive measures against worsening of PTSD symptoms are important in order to minimise harmful post-migration stress for the facilitation of integration.

Adult↗

PubMed1994

Cross-language differences in phonological acquisition: Swedish and American /t/.

Our understanding of phonological acquisition has benefited immensely from cross-linguistic investigations which allow researchers to separate biological and learned factors. To date, most cross-linguistic studies have focused either on differences in phonetic inventories or on differences in frequency of occurrence of particular phonetic and phonological properties in the adult language. This paper describes a third type of study: comparisons of segments that occur in two (or more) languages but differ in their phonetic properties. We present perceptual and acoustic analyses of adult and child productions of word-initial alveolar /t/ in American English and dental /t/ in Swedish. Results showed that listeners' perception of place of articulation was strongly associated with language (alveolar: American English, dental: Swedish) for both adult and child tokens, and was effective in assigning individual speakers to language groups. Three acoustic measures, voice onset time, burst intensity and burst spectral diffuseness correlated with language for both child and adult tokens; the latter two measures correlated with perception as well. The findings suggest that American and Swedish children at 30 months of age have acquired some language-specific phonetic aspects of /t/ phonemes.

Cross-Cultural Comparison↗