The "beggar's" hand and the "unshakable" hand in children with total obstetric brachial plexus palsy

A total 12 consecutive children with secondary deformities following total obstetric brachial plexus palsy were included in this retrospective study. In all patients, the main complaints were two socially disabling hand postures: the "beggar's" hand and/or the "unshakable" hand. All children had a supinated forearm with no active pronation and were teased by their friends, who called them "beggars." When the impairment was severe and involved the right hand and wrist, children also complained that they were not able to shake hands. The management approach to these children was described, with the main aim of surgery being the correction of the abnormal posture. Other simultaneous tendon transfers were also performed to improve hand function if there were suitable musculotendinous units. Successful reconstruction was accomplished in all patients. Preoperatively, some children refused to go to school because of teasing, and most did not want to interact socially. After surgery, all children attended school regularly, and parents reported much better social interaction. However, the functional gain was never enough to dramatically improve the daily use of the limb. The contralateral normal limb remained the dominant one for all daily activities, including writing and eating.     

The Integration of Prosodic Speech in High Functioning Autism: A Preliminary fMRI Study

Background

Autism is a neurodevelopmental disorder characterized by a specific triad of symptoms such as abnormalities in social interaction, abnormalities in communication and restricted activities and interests. While verbal autistic subjects may present a correct mastery of the formal aspects of speech, they have difficulties in prosody (music of speech), leading to communication disorders. Few behavioural studies have revealed a prosodic impairment in children with autism, and among the few fMRI studies aiming at assessing the neural network involved in language, none has specifically studied prosodic speech. The aim of the present study was to characterize specific prosodic components such as linguistic prosody (intonation, rhythm and emphasis) and emotional prosody and to correlate them with the neural network underlying them.

Methodology/Principal Findings

We used a behavioural test (Profiling Elements of the Prosodic System, PEPS) and fMRI to characterize prosodic deficits and investigate the neural network underlying prosodic processing. Results revealed the existence of a link between perceptive and productive prosodic deficits for some prosodic components (rhythm, emphasis and affect) in HFA and also revealed that the neural network involved in prosodic speech perception exhibits abnormal activation in the left SMG as compared to controls (activation positively correlated with intonation and emphasis) and an absence of deactivation patterns in regions involved in the default mode.

Conclusions/Significance

These prosodic impairments could not only result from activation patterns abnormalities but also from an inability to adequately use the strategy of the default network inhibition, both mechanisms that have to be considered for decreasing task performance in High Functioning Autism.     

A history of noma,the "Face of Poverty"

Noma (necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs mainly among children. The disease has a global yearly incidence of 140,000 cases and a mortality rate of approximately 90 percent. Patients who survive noma generally suffer from its sequelae, including serious facial disfigurement, trismus, oral incontinence, and speech problems. The medical history of noma indicates that the disease was already known in classical and medieval civilizations in Europe. In the sixteenth and seventeenth centuries, Dutch chirurgeons clearly described noma as a clinical entity and realized that the popular name "water canker" was not sufficient, because this quickly spreading ulceration in the faces of children was different from "cancer." In the eighteenth century, awareness that noma is related to poverty, malnutrition, and preceding diseases such as measles increased in northwestern Europe. In the first half of the nineteenth century, extensive surgical procedures were described for the treatment of the sequelae of noma. At the end of that century, noma gradually disappeared in the Western world because of economic progress, which gave the poorest in society the opportunity to feed their children sufficiently. Only in the twentieth century were effective drugs (sulfonamides and penicillin) against noma developed, as well as adequate surgical treatment for the sequelae of noma. These modes of treatment remain inaccessible for the many present-day victims of noma because of their extreme poverty. The only truly effective approach to the problem of noma throughout the world is prevention, namely, combating the extreme poverty with measures that lead to economic progress. In the meantime, medical doctors in the Western world should not forget their own history and ignore this global health problem; rather, they should face "the face of poverty" with the eyes of mercy and concern suited to their profession.     

Cognitive auditory evoked potentials in children with special language impairment

Perception and discrimination of auditory and speech stimuli in children aged 7-9 years with either receptive (n=6) or expressive (n=5) type of special language impairment and 7 healthy age-matched controls was investigated using evoked potential technique. The measurements were performed with a 32-channel Neuroscan electroencephalographic system. Two types of stimuli were applied, pure tones (1 kHz and 2 kHz) and double syllabi consisting of one consonant and one vocal characteristic of Croatian language. The stimuli were presented in an oddball paradigm, requiring a conscious reaction for the subjects. Latencies and amplitudes of P1, N1, P2, N2, P3, N4, and SW waves were analized, as well as the reaction time and number of responses. There were found no statistically significant difference between children with special language impairment and the control group in average response time and number of responses to tone burst or double syllable. Analysis of variance of all used variables showed a statistically significant difference in P3 and Sw wave latencies after double syllable stimulation, P3 and N4 waves latencies after target stimulation, P2 and Sw wave amplitude; and in N1 wave amplitude after pure tone stimulation. Our study showed that children with speech and language disorder take longer time to perceive and discriminate between either tonal or speech auditory stimuli than children with typical speech and language development.     

Association of specific language impairment (SLI) to the region of 7q31

FOXP2 (forkhead box P2) was the first gene characterized in which a mutation affects human speech and language abilities. A common developmental language disorder, specific language impairment (SLI), affects 6%-7% of children with normal nonverbal intelligence and has evidence of a genetic basis in familial and twin studies. FOXP2 is located on chromosome 7q31, and studies of other disorders with speech and language impairment, including autism, have found linkage to this region. In the present study, samples from children with SLI and their family members were used to study linkage and association of SLI to markers within and around FOXP2, and samples from 96 probands with SLI were directly sequenced for the mutation in exon 14 of FOXP2. No mutations were found in exon 14 of FOXP2, but strong association was found to a marker within the CFTR gene and another marker on 7q31, D7S3052, both adjacent to FOXP2, suggesting that genetic factors for regulation of common language impairment reside in the vicinity of FOXP2.     

Auditory-motor learning during speech production in 9-11-year-old children

Background

Hearing ability is essential for normal speech development, however the precise mechanisms linking auditory input and the improvement of speaking ability remain poorly understood. Auditory feedback during speech production is believed to play a critical role by providing the nervous system with information about speech outcomes that is used to learn and subsequently fine-tune speech motor output. Surprisingly, few studies have directly investigated such auditory-motor learning in the speech production of typically developing children.

Methodology/Principal Findings

In the present study, we manipulated auditory feedback during speech production in a group of 9–11-year old children, as well as in adults. Following a period of speech practice under conditions of altered auditory feedback, compensatory changes in speech production and perception were examined. Consistent with prior studies, the adults exhibited compensatory changes in both their speech motor output and their perceptual representations of speech sound categories. The children exhibited compensatory changes in the motor domain, with a change in speech output that was similar in magnitude to that of the adults, however the children showed no reliable compensatory effect on their perceptual representations.

Conclusions

The results indicate that 9–11-year-old children, whose speech motor and perceptual abilities are still not fully developed, are nonetheless capable of auditory-feedback-based sensorimotor adaptation, supporting a role for such learning processes in speech motor development. Auditory feedback may play a more limited role, however, in the fine-tuning of children''s perceptual representations of speech sound categories.     

Severity-Based Adaptation with Limited Data for ASR to Aid Dysarthric Speakers

Automatic speech recognition (ASR) is currently used in many assistive technologies, such as helping individuals with speech impairment in their communication ability. One challenge in ASR for speech-impaired individuals is the difficulty in obtaining a good speech database of impaired speakers for building an effective speech acoustic model. Because there are very few existing databases of impaired speech, which are also limited in size, the obvious solution to build a speech acoustic model of impaired speech is by employing adaptation techniques. However, issues that have not been addressed in existing studies in the area of adaptation for speech impairment are as follows: (1) identifying the most effective adaptation technique for impaired speech; and (2) the use of suitable source models to build an effective impaired-speech acoustic model. This research investigates the above-mentioned two issues on dysarthria, a type of speech impairment affecting millions of people. We applied both unimpaired and impaired speech as the source model with well-known adaptation techniques like the maximum likelihood linear regression (MLLR) and the constrained-MLLR(C-MLLR). The recognition accuracy of each impaired speech acoustic model is measured in terms of word error rate (WER), with further assessments, including phoneme insertion, substitution and deletion rates. Unimpaired speech when combined with limited high-quality speech-impaired data improves performance of ASR systems in recognising severely impaired dysarthric speech. The C-MLLR adaptation technique was also found to be better than MLLR in recognising mildly and moderately impaired speech based on the statistical analysis of the WER. It was found that phoneme substitution was the biggest contributing factor in WER in dysarthric speech for all levels of severity. The results show that the speech acoustic models derived from suitable adaptation techniques improve the performance of ASR systems in recognising impaired speech with limited adaptation data.     

Visual Cross-Modal Re-Organization in Children with Cochlear Implants

Background

Visual cross-modal re-organization is a neurophysiological process that occurs in deafness. The intact sensory modality of vision recruits cortical areas from the deprived sensory modality of audition. Such compensatory plasticity is documented in deaf adults and animals, and is related to deficits in speech perception performance in cochlear-implanted adults. However, it is unclear whether visual cross-modal re-organization takes place in cochlear-implanted children and whether it may be a source of variability contributing to speech and language outcomes. Thus, the aim of this study was to determine if visual cross-modal re-organization occurs in cochlear-implanted children, and whether it is related to deficits in speech perception performance.

Methods

Visual evoked potentials (VEPs) were recorded via high-density EEG in 41 normal hearing children and 14 cochlear-implanted children, aged 5–15 years, in response to apparent motion and form change. Comparisons of VEP amplitude and latency, as well as source localization results, were conducted between the groups in order to view evidence of visual cross-modal re-organization. Finally, speech perception in background noise performance was correlated to the visual response in the implanted children.

Results

Distinct VEP morphological patterns were observed in both the normal hearing and cochlear-implanted children. However, the cochlear-implanted children demonstrated larger VEP amplitudes and earlier latency, concurrent with activation of right temporal cortex including auditory regions, suggestive of visual cross-modal re-organization. The VEP N1 latency was negatively related to speech perception in background noise for children with cochlear implants.

Conclusion

Our results are among the first to describe cross modal re-organization of auditory cortex by the visual modality in deaf children fitted with cochlear implants. Our findings suggest that, as a group, children with cochlear implants show evidence of visual cross-modal recruitment, which may be a contributing source of variability in speech perception outcomes with their implant.     

Speech Defects in Children Aged 7 Years: A National Study

A series of screening procedures applied on a national scale by doctors, teachers, and health visitors showed that between 10% and 13% of British 7-year-old children born in one week in 1958 were reported as having an appreciable degree of speech impairment. Between 1% and 2% had a marked speech defect though hearing normally. This latter group of speech-defective children were more often male and of poor family background, and more were born towards the end of a long family. They were often at a disadvantage educationally and had more clumsiness and defects of vision and visuomotor co-ordination than the rest of the sample. The methods used for screening provided a reliable guide in the selection of children who require further investigation.     

W.H.R. Rivers Graduate Prize Essay (1996). "Imperfect angels" : narrative "emplotment" in the medical management of children with craniofacial anomalies

This article uses the paradigm of "therapeutic emplotment" to investigate the medical management of children with facial disfigurements at a craniofacial anomalies center in Northern California. Data are observations of, and semistructured interviews with, plastic surgeons, nurses, geneticists, orthodontists, and other medical professionals who composed the craniofacial anomalies team. Team members perceived that children feel socially stigmatized by their disfigurements. These medical professionals adjusted their own behavior according to these perceptions. They "emplotted" their actions, using the theme that disfigured children are attractive and worthy of attention and affection. Medical professionals attempted to depersonalize and neutralize the symbolically loaded disfigurements through the use of clinical language in an attempt to "separate" the child from his or her facial anomaly. The range of styles and approaches to interaction was diverse and varied in effectiveness, suggesting that some medical professionals were more skilled at emplotment than others.     

Canine-assisted Speech Therapy for Children with Communication Impairments: A Randomized Controlled Trial

Developmental dysphasia (DD) is a disorder resulting in a communication impairment. Children diagnosed with this condition are usually referred to a speech therapist. Further to conventional speech therapy it is possible to adopt a complementary animal-assisted approach. For the present study, we assembled a cohort comprising 69 children diagnosed with DD. The children in the experimental group (n = 31; 21 male, 10 female) ranged from 4 to 7 years (M = 5.53 years, SD = 0.81 years). The control group was comprised of children (n = 38; 31 male, 7 female) aged from 4 to 6 years (M = 4.85 years, SD = 0.51 years). While the latter received traditional speech therapy, the experimental group experienced sessions enhanced by animal-assistance therapy (AAT) with a dog present for co-therapy purposes. As primary outcome measures, the Kwint-Stambak (KS) test was adopted (for assessing facial motricity), together with the Bruininks-Oseretsky (BO) test (for evaluating motor proficiency). Both of these revealed statistically significant improvement in some primary outcome measures for the experimental group over the control group. Regarding narrowing and shutting of the eyes, as well as filling up the cheeks with air and smiling (as measured by the KS test), the experimental group did significantly better than the control group. The inclusion of dogs in such therapy increased the chances of success in certain abilities, when assessed by the KS and BO tests (odds ratios for success: 1.6 and 2.0, respectively), compared with the control group. Canine-assisted speech therapy may be a valuable tool for enhancing the effect of speech therapy on children with DD, and we speculate that the reason for this relates to the nature of communication between children and companion animals.     

"Slight" of hand: the processing of visually degraded gestures with speech

Co-speech hand gestures influence language comprehension. The present experiment explored what part of the visual processing system is optimized for processing these gestures. Participants viewed short video clips of speech and gestures (e.g., a person saying "chop" or "twist" while making a chopping gesture) and had to determine whether the two modalities were congruent or incongruent. Gesture videos were designed to stimulate the parvocellular or magnocellular visual pathways by filtering out low or high spatial frequencies (HSF versus LSF) at two levels of degradation severity (moderate and severe). Participants were less accurate and slower at processing gesture and speech at severe versus moderate levels of degradation. In addition, they were slower for LSF versus HSF stimuli, and this difference was most pronounced in the severely degraded condition. However, exploratory item analyses showed that the HSF advantage was modulated by the range of motion and amount of motion energy in each video. The results suggest that hand gestures exploit a wide range of spatial frequencies, and depending on what frequencies carry the most motion energy, parvocellular or magnocellular visual pathways are maximized to quickly and optimally extract meaning.     

Word production errors in children with developmental language impairments

This review focuses on the errors that children with developmental language impairments make on three types of word production tasks: lexical retrieval, the elicitation of derivationally complex forms and the repetition of non-sense forms. The studies discussed in this review come principally from children with specific language impairment, and from children who are English-speakers or deaf users of British sign language. It is argued that models of word production need to be able to account for the data presented here, and need to have explanatory power across both modalities (i.e. speech and sign).     

"The Vulgar Spirit of Blogging": On Language, Culture, and Power in Persian Weblogestan

This article is an ethnographic study of Persian-language weblogs (blogs), focusing on a divisive argument among Iranian bloggers that came to be known as the "vulgarity debate." Sparked by a controversial blogger who ridiculed assertions that Islam was compatible with human rights, the debate revolved around the claim that blogging had a "vulgar spirit" that made it easy for everything from standards of writing to principles of logical reasoning to be undermined. My study focuses primarily on the linguistic side of the controversy: I analyze blogging as an emergent speech genre and identify the structural features and social interactions that make this genre seem "vulgar." I also examine the controversy as a confrontation between bloggers with unequal access to cultural capital and a struggle over "intellectualist" hegemony. In the conclusion, I use the construct of "deep play" to weave together multiple layers of structure, explanation, and meaning in the debate.     

A technical comparison of digital frequency-lowering algorithms available in two current hearing aids

Background

Recently two major manufacturers of hearing aids introduced two distinct frequency-lowering techniques that were designed to compensate in part for the perceptual effects of high-frequency hearing impairments. The Widex “Audibility Extender” is a linear frequency transposition scheme, whereas the Phonak “SoundRecover” scheme employs nonlinear frequency compression. Although these schemes process sound signals in very different ways, studies investigating their use by both adults and children with hearing impairment have reported significant perceptual benefits. However, the modifications that these innovative schemes apply to sound signals have not previously been described or compared in detail.

Methods

The main aim of the present study was to analyze these schemes''technical performance by measuring outputs from each type of hearing aid with the frequency-lowering functions enabled and disabled. The input signals included sinusoids, flute sounds, and speech material. Spectral analyses were carried out on the output signals produced by the hearing aids in each condition.

Conclusions

The results of the analyses confirmed that each scheme was effective at lowering certain high-frequency acoustic signals, although both techniques also distorted some signals. Most importantly, the application of either frequency-lowering scheme would be expected to improve the audibility of many sounds having salient high-frequency components. Nevertheless, considerably different perceptual effects would be expected from these schemes, even when each hearing aid is fitted in accordance with the same audiometric configuration of hearing impairment. In general, these findings reinforce the need for appropriate selection and fitting of sound-processing schemes in modern hearing aids to suit the characteristics and preferences of individual listeners.     

Metaphorical and Associative Thinking in Healthy Children and in Children with Asperger's Syndrome at Different Ages

The study of healthy children and patients with childhood autism (Asperger's syndrome) showed that metaphorical thinking is normally efficient at the age of 7–8 years and that autistic children have an impaired ability to understand metaphors and idioms widely used in verbal communication. The deficit of metaphorical thinking in autism is thought to be due to a decreased activity of the right hemisphere. In a study of associative thinking, healthy schoolchildren displayed a high degree of association between words describing sensual objects and autistic patients displayed an impairment of objective associations and a predominance of proper names, which is indicative of the left-hemispheric type of association. The impairment of the speech and mental activity (metaphorical and associative thinking) testified to changes in the interhemispheric interaction in autistic children, which is likely to show up in a decreased functional activity of the right hemisphere and an increased activity of the left hemisphere.     

Duration and variability of speech segments in fluent speech of children with and without stuttering

The purpose of this study was to compare the duration and variability of speech segments of children who stutter with those of children who do not stutter and to identify changes in duration and variability of speech segments due to the effect of utterance length. Eighteen children participated (ranging from 6.3 to 7.9 years of age). The experimental task required the children to repeat a single word in isolation and the same word embedded in a sentence. Durations of speech segments and Coefficients of variation (Cv) were defined to assess temporal parameters of speech. Significant differences were found in the variability of speech segments on the sentence level, but not in duration. The findings supported the assumption that linguistic factors pose direct demands on the speech motor system and that the extra duration of speech segments observed in the speech of stuttering adults may be a kind of compensation strategy.     

Developmental Changes in Mismatch Responses to Mandarin Consonants and Lexical Tones from Early to Middle Childhood

The purpose of this study was to use mismatch responses (MMRs) to explore the dynamic changes of Mandarin speech perception abilities from early to middle childhood. Twenty preschoolers, 18 school-aged children, and 26 adults participated in this study. Two sets of synthesized speech stimuli varying in Mandarin consonant (alveolo-palatal affricate vs. fricative) and lexical tone features (rising vs. contour tone) were used to examine the developmental course of speech perception abilities. The results indicated that only the adult group demonstrated typical early mismatch negativity (MMN) responses, suggesting that the ability to discriminate specific speech cues in Mandarin consonant and lexical tone is a continuing process in preschool- and school-aged children. Additionally, distinct MMR patterns provided evidence indicating diverse developmental courses to different speech characteristics. By incorporating data from the two speech conditions, we propose using MMR profiles consisting of mismatch negativity (MMN), positive mismatch response (p-MMR), and late discriminative negativity (LDN) as possible brain indices to investigate speech perception development.     

Angelman syndrome and hypothyroidism - coincidence or unique correlation?

Angelman Syndrome (AS, MIM 105830), classified among neurogenetic disorders, occurs with estimated frequency of 1:10 000 to 1:40 000. The characteristics features apart from neurodevelopmental impairment and seizures include peculiar face traits, absent speech, outburst of laughter, ataxia, stereotyped jerky (puppet-like) movements. The authors report three children with Angelman syndrome who were also diagnosed with hypothyroidism.